Report of the Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees
1988

Background - Executive Summary - Chapter 1 - Chapter 2-6 - Chapter 7-9 - Chapter 10-11 - Chapter 12 Conclusion & Appendices

While self-help activities and lobbying efforts have been initiated on behalf of immigrant women over the past decade, significant progress has been slow. Being female does not in itself predispose to mental and emotional disorders. But, many immigrant women remain in high-risk situations due, on the one hand, to features of the cultures from which they come and, on the other hand, to Canadian policies and programs which disadvantage them.

Several of the variables which increase stress at the time of migration affect female immigrants and refugees more than their male counterparts.

Among immigrants, men usually make the decision to leave a homeland. Several submissions noted that women typically emigrate to accompany or to rejoin male relatives rather than the reverse. As Figure 10.1 indicates, women entering Canada over the past decade were many times more likely than men to immigrate as dependent spouses, and much less likely to enter Canada in a category designated to participate in the labour force.

Once families enter Canada, men typically decide where to resettle. Immigrant families move to cities and provinces where the male bread-winner can find employment or where his relatives and friends have already settled. Women not only leave what is familiar more reluctantly than men; they must also resettle in surroundings which initially have less to offer them.

Separation from family members affects immigrants and refugees of both sexes, but women from traditional cultures tend to be more fully enmeshed in family networks than men and more devastated by their absence. The fact that women are also more likely to be unmarried at the time of migration further intensifies the impact of separation from relatives.

While married women enjoy the support of a family network, the burden of keeping the family together frequently falls on them.

In many immigrant families, the woman is primarily responsible for supporting her children and partner as they adapt to the new country. An immigrant woman has a tremendous responsibility to keep the family together and happy, and to transmit the family's culture and traditions. Yet she must accomplish these crucial family tasks often with little or no support for herself.

An immigrant woman, already answerable for the health and happiness of her family, must also assume the male role of providing for the family. The presence of her customary support network can make the difference between survival and defeat.

Migrants who speak one of Canada's official languages can cope more effectively with both the stresses of resettlement and the demands of the job market than those who cannot (Chapter Three). As Figure 10.2 illustrates, however, immigrant women search less likely than their male counterparts to speak French or English. Lack of language compounds the problems of resettlement and employment and deepens the dependency of women on their male relatives.

Any dependent relationship is subject to abuse and the immigrant husband-wife relationship is no exception. Although no community-based survey data are available, one analysis of clinical data revealed that over 30 per cent of women seeking help from Manitoba's Immigrant Access Service had been victims of physical abuse (Submission: Immigrant Women's Association of Manitoba). Without the traditional safeguards afforded by family networks, immigrant men are more apt to "take out their frustrations" on their wives, frustrations which usually peak when the men fail to find meaningful employment. (Submission: O.A.S.I.S.)

The association between employment problems and marital problems applies both to Canadian-born and migrant populations. For migrants, however, either problem appears less remediable. If a migrant wife finds work - and migrant women search more likely than Canadian-born women to be in the labour force - she will probably receive a very low income, lower than that of migrant men or Canadian-born women (Submission: Ottawa Carleton Immigrant Services Organization, 1985). Furthermore, her wage-earning role may deepen her husband's sense of failure and actually foster rather than alleviate marital discord.

The factors which create dependency in migrant women and permit abuse to occur also prevent women from escaping abuse situations (Wiebe, 1985). Cultures which socialize women to dependent roles also limit the circumstances under which they may leave their husbands. In the absence of her parents or other important family, a woman may be more vulnerable to abuse; she is also blocked from the one traditional escape route - back to her family - that she may know. Inability to speak the language of their new society reinforces immigrant women's dependency on men. It also prevents them from using and comprehending information or services which might assist them in either correcting or leaving abusive situations.

Language disability and ignorance of Canadian law lock many immigrant women into abusive work situations. Women are occupationally segregated, often employed doing piece-work in factories or in domestic service, situations which make them vulnerable to abuse and exploitation. In particular, women who must support children or other dependents, either in Canada or abroad, are highly vulnerable to exploitation in working conditions, hours of service, employment benefits, and salary. (Submission: Changing Together)

Women from traditional cultures who search locked into marginal employment with other migrants and women who are unemployed have little opportunity to learn a new language.

We are from societies where "men and dogs roam, while women and cats remain at home. ' Unable to communicate fluently, the woman's apartment soon becomes her prison. (Submission: Immigrant Women's Group of P.E.L)

Over time, if her language disability remains constant, the isolation of an immigrant woman increases, tragically with respect to her own children who, sooner or later, do acquire English or French and may become unable or unwilling to speak their heritage language (Submission: Medicine Hat Society for Immigrant Settlement).

Since the factors which create stress for migrants apply particularly strongly to women, policies and programs which address these factors search of even greater importance for women than for men.

Orientation services assist migrant women in fulfilling their central role of shepherding family members through daily life. Many women, however, are unable to participate in orientation programs if they are offered only in English or French or if they do not offer childcare. Upon their arrival in Canada, refugee women are told that they may attend the initial orientation session only if they search the heads of households. (Submission: Working Women Community Centre)

Family reunification holds great significance for immigrant and refugee women, as do community development initiatives which help recreate culturally familiar and approved social support networks. In rural areas and regions with few immigrants of the same cultural background, offers of friendship between immigrant and Canadian-born women search particularly important. (Submission: United Church of Canada) At present, however, CEIC's Host Group Program applies only to refugees.

Official language training, the key solution to the problem of non-English or non-French-speaking persons, is far less accessible to women than it is to men. As Chapter Three notes, basic living allowances for Labour Market Access Language Training are not provided to members of the Family Class and Assisted Relatives. Since a majority of such persons search female (Figure 3.1) and because their income, however meagre, is often critically necessary, many migrant women never receive language training.

In the past decade, the problem of language education for women has been well documented in several studies and reports, and the same recommendations have been made repeatedly.

In 1981, the First National Conference on Immigrant Women (Toronto) recommended universal access to language training with childcare and transportation allowances.

In 1985, a national consultation commissioned by Multiculturalism Canada identified language training as the most urgent priority for immigrant women (Beyond Dialogue, 1985). In the same year, the Action Committee on Immigrant and Visible Minority Women again called for universal access to language training.

In 1986, the Annual Report of the Canadian Human Rights Commission noted that immigrant women search discriminated against in the provision of language training.

Briefs presented to this Task Force in 1987 suggest that little has changed; the need for universal access to language training is as great as ever.

For many migrant women, access to language training programs, like orientation programs, depends upon child care facilities as well as reimbursement for child care expenses.

Several submissions reiterated and endorsed the suggestion that language training for parents and preschool children be offered together, at the same time and in proximity to one another (Chapter Nine). Programs such as those offered by the Centre local des services communautaires Cote-des-Neiges, search preventive in both the short and long term.

After language training and employment opportunities, learning about women's roles and women's issues in Canada is of vital importance.

Brief; from every region of Canada and virtually every ethnic group responding to the Task Force expressed a need for accurate information, and understanding of Canadian customs and laws as they apply to women. In particular, a woman's rights in Canada, both as a wife and as an employee, require in-depth clarification and discussion.

A misconception held by many is that individuals who migrate as dependent spouses will be deported if they leave their homes due to marriage breakdowns. In 1986, Employment and Immigration Canada attempted to dispel this and other myths by distributing a fact sheet on "Battered Immigrants and Immigration Status." As the submissions to the Task Force indicate, however, if it is to have the desired effect, such information must be delivered sensitively and personally, in a language understood by each woman.

For a number of reasons, immigrant and refugee women have, on the whole, more mental health needs than their menfolk.

Immigrant women suffice two types of educational disadvantage. Some are extremely highly educated but many more search illiterate. Barred from many jobs, the higher educated search prone to underemployment and the illiterate to dead-end jobs. They are also more likely to be cut off by migration from traditional sources of support, and to be constrained by tradition from developing new support networks. Despite these limitations, immigrant women rather than men are the ones most likely to be held responsible, and to feel responsible for the health and happiness of family members.

Immigrant and refugee women also tend to have special needs because of the differential impact on males and females of CEIC's official language training policy. By excluding members of the Family Class and Assisted Relatives from language training with basic living allowances, the policy obliges many women to cope with resettlement, enter the work force, and raise their children with little comprehension of the new world around them and less ability to communicate with it.

The higher incidence and intensity of risk factors, and the reduced access to mitigating factors, create special mental health needs for immigrant and refugee women.

Without exception, the recommendations made by the Task Force elsewhere in this report stand to benefit migrant women at least as much as immigrant men. In particular, implementation of the recommendation that all newcomers have equal access to official language education will significantly case the stress of resettlement for women. It will also help break the vicious cycle of no language training leading to marginal employment, which in turn makes learning a language impossible. The result is that, without language, there is no chance to break out of the marginal employment situation. Finally, ability to speak English or French will decrease women's dependence on their husbands, employers and children; it will give women some measure of control over their own lives.

Chapter Five's recommendation concerning educational materials for immigrants on mental health issues and services is also of special relevance to women, the persons traditionally responsible for family members' well-being. Similarly, Health and Welfare's prioritization of immigrant Health Promotion activities will result in mental health programs to assist women (Chapter Six).

Beyond the needs met by these recommended policies and programs, the Task Force recognizes a need for immigrants and refugees of both sexes to know and understand Canadian laws and customs pertaining to women. It recommends, therefore, that Health and Welfare, Secretary of State, and Status of Women Canada develop and provide multilingual educational materials on women's rights and roles in Canada for discussion at immigrant service agencies, general community service agencies and ethno-cultural organizations.

The longer one has lived in and with a culture, the more difficult it is to change it for another. Because of this, immigrant and refugee seniors search particularly prone to stress and an increased risk of mental health problems during resettlement.

Senior migrants have virtually no peer group infrastructure or advocacy base to assist them in Canada. They exist as an isolated minority within each ethno-cultural community, depending heavily on younger relatives for financial, social and psychological support.

Senior immigrants and refugees need social and health services, and these must be accessible to them. In addition, ethno-specific support programs must be provided to meet the mental health needs of elderly newcomers.

Over the past decade, about 10 per cent of all immigrants entering Canada have been 60 years of age or older. Only three per cent of Task Force submissions, however, focussed on elderly immigrants or refugees. As one research worker stated, "Seniors are the most powerless, least influential, and most 'forgotten' segment of the ethnic population" (Disman, 1986).

While Canadian-born seniors are also relatively powerless, living in Canada has partially prepared them to expect a loss of status as they age. By contrast, many cultures bestow increased honour and decision-making power on aging individuals. Seniors from such cultures face a major discrepancy between the status accorded the elderly in their countries of origin and what they find when they reach Canada.

With very little official language ability (see Figure 10.2) and few compatriots their own age, many Seniors must depend on younger relatives, usually their grown children, for social interaction and support. Their lack of language and lack of understanding of the larger society limits their participation in general community programs for seniors.

Most important, migrant and Canadian-born seniors alike have less capacity to adapt to new environments than do their younger counterparts. Elderly immigrants, however, must face entirely new physical and cultural surroundings. They do so, not only with less adaptive capacity than younger newcomers, but also with less education (Figure 11.1) and presumably with less understanding of their new environment.

The demoralization that accompanies loss of status, the isolation imposed by limited linguistic skills, and the alienation from a culture to which others search adapting results in elevated mental health risk.

The potential for demoralization lies primarily in the interpersonal dynamics of immigrant family life and in the ways these contrast with family dynamics in the countries of origin. In Canada, elderly parents usually come to live in the homes of their married children: in the home country, it is often the reverse. When they do live in their children's homes, the elderly are often expected to do housework and to look after grandchildren, rather than, as would be the case in their home countries, to supervise household affairs. As the children and grandchildren adopt Canadian customs and values, the wisdom and experience of their ciders becomes irrelevant, and their advice is neither sought nor heeded.

Whether or not senior immigrants should live with their grown children is a difficult decision for both parties. Seniors themselves may feel that the isolation of living on their own is preferable to the demoralization of living with family members who fail to accord them their traditional status. A survey of five ethnic communities in London, Ontario found that, especially among seniors from China and Vietnam, multigenerational families were no longer seen as ideal.

For their part, grown children may find that living with unhappy elders who cannot accept new ways is emotionally more costly than living with the guilt of not housing them. In an unknown number of instances, financial costs also weigh in the decision, particularly since newcomers are ineligible for Old Age Security until they have resided in Canada for 10 years.

Many elderly immigrants, particularly women, who leave the homes of their younger relatives, five in poverty and isolation, often without a spouse (Figure 11.2). Few ethno-cultural communities search large enough to have groups of seniors living within visiting distance of each other. Moreover, the idea of deliberately developing programs or services for seniors is foreign to many cultures.

Alienation from Canadian values and customs can affect elderly newcomers whether or not they Eve with family members, depending on how rapidly the family members acculturate. The issue of Canadian citizenship often symbolizes and concretizes the problem.

Although younger immigrants may not, in fact, care about the citizenship of their elders, they are often critical of the lack of change in their diet, dress, and social or religious behaviour. For the elders, changes in these areas search especially disturbing. Inability to engage in customary religious events and rituals, for example, deprives them of a main source of comfort in their declining years.

Submissions to the Task Force suggest, as does the research literature, that the problems of senior immigrants and refugees have been identified in Canada and elsewhere, but very few solutions to problems have been implemented.

Considered collectively, the services for immigrants funded by CEIC, Health and Welfare and Secretary of State focus on all age groups except for the elderly. CEIC's Settlement Language Training Program (STLP), which includes people who search not destined for the work force, should theoretically attract and help elderly migrants. In reality, however, few elderly people can learn English or French in a curriculum geared to the young. Health and Welfare's New Horizons program funds a wide range of initiatives undertaken "by seniors for seniors." Since ethnic communities tend not to have organized seniors' groups, however, few such groups have received funding. Projects concerned with ethnic elderly reported by the Intercultural Task Force in Halifax-Dartmouth and by the London Cross Cultural Learner Centre and funded by Secretary of State and Health and Welfare, respectively, represent important exceptions to the overall picture.

Insufficient effort has been expended to make general community programs for seniors accessible to a multicultural clientele. The relatively low numbers of ethnic elderly and their lack of an organized advocacy base help to explain the difference. As noted in several presentations to the Task Force, there also is a perception on the part of some service providers that immigrant seniors require fewer services, and that their lack of utilization can be explained by the care afforded them by their families and ethnic communities.

Studies conducted in Nova Scotia and Ontario on a wide range of ethno-cultural communities suggested that, rather than having fewer needs, immigrant seniors seek out services as much as or more than the Canadian elderly. For example, in comparison to a Canadian-born control group, immigrant seniors utilized the services of general practitioners considerably more often and for a wider range of needs, including counselling needs. They were, however, less Rely to complete a sequence of care. Whereas Canadian-born seniors tended to see "a direct path from general M.D. to specialist, " elderly immigrants frequently failed to follow through on referrals to specialists or to general community auxiliary programs (Submission: London Cross Cultural Learner Centre). Consequently, hospital out-patient and emergency services saw a disproportionate number of immigrant seniors in crises. This pattern was exacerbated by the fact that younger relatives of elderly immigrants tended to view acute care in institutions as more acceptable than chronic care programs.

During a February 1988 Canadian Public Health Association conference on ethnicity and aging in Ottawa, approximately 140 ethnic minority seniors, government bureaucrats, and non-governmental service providers discussed a range of preventive and remedial measures that could address the special needs of Canada's ethnic elderly, especially the need for culturally appropriate housing and social support services.

One of the most important outcomes of the conference was the realization by all participants that there are seniors who have the ability and interest to work towards the resolution of the problems they and their peers face. In some cases, these potential leaders immigrated as younger adults and were able to learn an official language and adapt to Canadian culture before old age. In other cases, seniors from less traditional cultures or those who had lived in former colonies of the western powers were able to interpret Canadian customs and values for others.

The loss of what is familiar, and the difficulty in incorporating a new way of life place many elderly immigrants and refugees at high risk for emotional problems and mental disorders. The unexpected loss of status within their own families leads to demoralization. Social and psychological isolation grows as younger relatives acculturate, and peers, already few in number, die Unable to adapt, seniors remain alienated from their new environment and may become alienated from their children.

Their special needs limit the extent to which seniors can benefit from recommendations made elsewhere in this report. Initiatives regarding employment opportunities, for example, and language training hold out considerably less promise to seniors than to younger adult migrants. On the other hand, multilingual orientation materials, particularly in non-print media, search of vital importance to seniors both before and after migration.

Recommendations concerning the accessibility of general community social and health services will assist elderly immigrants at least as much as younger ones, providing that programs and services designed specifically for seniors respond as positively as some other age-focussed programs have. For many senior immigrants, the availability of well-trained, culturally sensitive interpreters is the most essential component of service delivery.

Elderly immigrants and refugees stand to benefit from community development initiatives such as those undertaken by Secretary of State with regard to leadership training and self-help group development (Chapter Two). Peer group "networking," a combination of social support and activity, is sorely lacking for many immigrant seniors. It is also very much desired by them since, in many cultures, it is familiar and acceptable. The potential leaders and role models search available; they need only be encouraged and supported to realize the potential of their skills and ideas.

The Task Force recommends that Health and Welfare and Secretary of State encourage and support the development of seniors' support groups and programs in immigrant service agencies, general community service agencies, and ethno-cultural organizations. Funding for initial identification and training of leaders, for transportation and escort services, and for recreational activities should be included.

Elderly migrants have a wide range of needs and a wide range of abilities. By encouraging and supporting Peer group development, the special needs of seniors can be met by encouraging and utilizing their strengths.

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Background - Executive Summary - Chapter 1 - Chapter 2-6 - Chapter 7-9 - Chapter 10-11 - Chapter 12 Conclusion & Appendices

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