TORONTO, February 10, 2017 - As CAMH’s New Beginnings Clinic celebrates its first anniversary in March, the treatment service is taking a big-picture approach to providing mental health care to refugees making a new home in Canada.
“This is a very resilient group – they are seeking help for mental health issues while also addressing basic necessities and getting established,” says clinic Manager Stephanie Carter. Many patients are part of the recent surge of Syrian refugees to Canada. Along with professional treatment, the clinic provides them with understanding, community connections -- and hope.
A global focus: CAMH’s new beginnings clinic has served refugees from Afghanistan, Czechoslovakia, Ethiopia, Hungary, Iran, Iraq, Jordan, Nigeria, Syria, Turkey, Albania, Eritrea, Pakistan, Somalia and Caribbean countries. Up to 30 per cent are from Syria, reflecting the recent surge of Syrian refugees to Canada. Team members, from left, include: Social Work student Ellen Tang, Social Worker Karen Fournier, Administrator Iman Hussain, and consulting Psychiatrist Dr. Lisa Andermann.
The team prepared a report on the clinic’s work based on the first 53 patients it treated last year, many of whom return regularly for continuing care.
PTSD a common challenge
Post-traumatic stress disorder (PTSD), depression and anxiety form the largest cluster of mental health challenges faced by patients to date, Stephanie says. And consistent with the experience of some refugees, “key factors may include trauma, torture, human trafficking and sexual assault.” Suicidal thoughts and attempts were not uncommon in this group of patients who had fled their homes due to civil war, violence and persecution.
New Beginnings, launched in partnership with Women’s College Hospital Crossroads Clinic, offers direct treatment services to patients as well as consultation to caregivers for their refugee clients. The service is available to any refugee who lives in the GTA and has arrived in Canada within the past two years, and who is referred by their general practitioner.
New Beginnings Clinic Manager Stephanie Carter
Understanding refugees’ life stories
Dr. Lisa Andermann, the clinic’s consulting psychiatrist, has assisted hundreds of refugees over the past several years, through her affiliation with the Canadian Centre for Victims of Torture, Mount Sinai Hospital and now CAMH.
“On paper there is a specific mental health condition to be diagnosed and treated but that is always balanced with understanding each refugee’s life story,” she says – what stage they are at in settling in Canada, stresses they’re facing, basic needs, and their hopes for the future.
One of her current patients is from Africa. “She’s dealing with insomnia and other symptoms of PTSD,” notes Lisa. “We assessed the medication she was prescribed by her family doctor but have also assisted her with community connections and language services, for example.”
“It’s helped her feel like she is on the right track and fully supported.”
Part of that process involved ensuring a translator is available who speaks the patient’s first language, as she continues to learn English through an ESL program. Patients at the clinic have immediate access to interpretation for Arabic and other languages through CAMH’s interpretation service. For treatment, Dr. Andermann and her colleagues use culturally-informed assessment approaches and the principles of narrative-focused therapy.
The clinic helps patients deal with stresses and hopes that are two sides of the same coin: reunification with loved ones, financial and career aspirations, good education for their kids, having a solid day-to-day routine, and their current status and hurdles in the refugee process. These major life stresses and aspirations are closely tied to mental health.
The road ahead – “Month 13”
Looking ahead, says Lisa, “we are now into the period that’s known as ‘Month 13’ – when many of the recent Syrian refugees are transitioning from the first year of sponsorship support, and may struggle.” This can also be a period where the initial honeymoon of resettlement ends and reality settles in around challenges with housing or job prospects, she says.
Lisa and her CAMH colleagues Dr. Branka Agic and Karen Fournier have submitted a paper on these issues and the clinic’s work to the upcoming North American Refugee Health Conference in Toronto this June. (Consulting psychiatrist Dr. Clare Pain is on sabbatical in 2017). The team’s work was also presented at the Sherpa conference – Opening the doors to refugees: Practices and Policies -- in November 2016, at the Montreal Museum of Fine Arts.
“There are some tough adjustments for refugees,” says Lisa, “but our patients have a tremendous sense of hope.”