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CAMH Stories Centre for Addiction
and Mental Health

Building a Refugee Mental Health Framework

no one leaves home unless
home is the mouth of a shark
you only run for the border
when you see the whole city running as well
you have to understand
that no one puts their children in a boat
unless the water is safer than the land
… “home” by Warsan Shire (2015)


May 27, 2016 - With refugees fleeing war in many parts of the world, and Canada accepting a “surge” of 25,000-plus refugees from Syria, the complex issue of refugee mental health has become a priority.

To keep this issue in front of decision-makers, CAMH Education, Sherbourne Health Centre and Thorncliffe Neighborhood Office (TNO) hosted a forum this spring for service providers, researchers and program planners working with refugee communities.

The forum was spearheaded by leaders working with Canada’s Tamil mental health community: Dr. Pushpa Kanagaratnam, Dr. Nalini Pandalangat, and Mr. Ravi Subramaniam.

“The goal is to build on a refugee mental health approach developed by the Tamil community so that it can be used broadly across refugee communities,” said Asha Maharaj, CAMH Director of Community and Continuing Education.

The Canadian Tamil Medical Association and the Psychological Recovery Clinic sponsored the forum.

Participants shared challenges and opportunitiesParticipants shared challenges and opportunities at a series of break-out sessions.

Tamil community uniquely positioned

“The Tamil community is uniquely positioned to take on this pilot role,” said Dr. Pandalangat, Director of Newcomer Health and Specialty Services at Sherbourne Health Centre.  Despite ongoing challenges for resettlement, the Sri Lankan Tamil community is entrenched in the Canadian mosaic, she said. It has a strong group of service providers, and has benefited from focused research, program development and community organization.

“Different refugee communities are at different points in their journey in Canada,” she noted. A refugee mental health framework can inform work in all refugee communities and foster advocacy at the federal and provincial levels.

She and her colleagues Dr. Kanagaratnam, Assistant Professor at the University of Toronto and CAMH Research Scientist and Psychologist, and Mr. Subramaniam, TNO Partnership and Organizational Development Lead, covered key themes including resettlement, the conceptualization of health, help-seeking, social dimensions of support and challenges with the current system, such as siloed services.

John Trainor of the Open Society Foundation addressed challenges and opportunities of a refugee mental health framework, and two community members, Arularasy Singam and Ajith Ravichandran, shared their lived experiences.

John Trainor 
John Trainor

Understanding refugee community values, experience

Concrete lessons from the Sri Lankan Tamil community generated a rich dialogue on the implications for other refugee communities. Participants validated the need for a refugee mental health framework that:

  • starts from a fundamental understanding of the community values and characteristics, its experience through migration and settlement
  • considers these different aspects at all levels of service provision, research, program, policy and system design
  • incorporates factors such as context, time, resources and continuous learning.

“What I see foremost among refugee communities is the struggle to be accepted, and to find adequate resources and services,” said participant Parvathy Kanthasamy, Director of the Vasantham-Tamil Wellness Centre in Scarborough, who came to Canada in the late 1980s from Sri Lanka. The biggest challenge is to influence policymakers for services that support refugees, she added.

A post-conference advisory committee, led by Dr. Kanagaratnam, Dr. Pandalangat, and Mr. Subramaniam, will identify next steps to refine and share the framework.

Dr. Nalini Pandalangat and Dr. Pushpa KanagaratnamDr. Nalini Pandalangat, and Dr. Pushpa Kanagaratnam

Dr. Ivan Silver, CAMH Vice President of Education, said: “It made so much sense to work together today to refine a mental health framework designed by the Tamil community and then apply our learning to enable and benefit other communities.”

 “We plan to offer the CAMH Portico webportal ( to help disseminate the conference findings -- and as a place for refugee communities to host their mental health websites,” said Dr. Silver. “Clinicians, clients, patients and their families from these communities will gather online to share experiences, teach, learn and foster best mental health practices.” 

Participants discuss the road aheadHope and opportunity: participants discuss the road ahead for a refugee mental health framework. The May forum was facilitated by Aman Melles (second from right, above), a consultant and President of InterChange, the International Peacebuilding Institute.
Forum participantsForum participants from left: Dr. Pushpa Kanagaratnam, Parvathy Kanthasamy, Cyrus Sundar Singh, Asha Maharaj, Aman Melles
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