Children as the Symptom Bearers: Supporting South Asian Families through School Interventions

This paper will focus on the interface of school, children, families and mental health support for South Asian immigrant children and adolescents in a Quebec context. South Asian students have often been considered a model minority with strong educational achievement. South Asian culture inherently has both protective factors and dissonances with mainstream culture, which often places a burden of cultural negotiation on children and youth. A few clinical vignettes will outline some of the complexities of the ethical, identity, social and mental health agendas that are vital to a discourse on the school as a factor in these negotiations of children and adolescents. While the rates of self referral by South Asian families seeking child mental health services remain low, the school as well as social services are often the social institutions promoting mental health intervention. In this context, school staff and counselors may need to build on cultural competencies to deal with increasing culturally diverse school populations. In addition, current South Asian immigrant and refugee populations in schools may have significant pre-immigrant trauma whether from circumstances of poverty, social, domestic or war related causes as demographics of migration are changing. The social realities of Quebec (Bouchard G. et Taylor, C 2008) have also changed as the priorities of language assimilation are promoted to create a cohesive society while the social space seeks to balance an equitable place for minority cultures and influences. Schools are implicated in this socio-psychological dynamic of dealing with increasing immigrant populations from origins outside Europe or North America while they promote both academics and student resilience. Cet article visera sur l’interface de l’appui scolaire, infantile, familial et santé mentale disponible pour les enfants et adolescents d’immigrants d’Asie du Sud, dans le contexte québécois. Les étudiants Sud-Asiatique sont souvent considérés comme un modèle de minorité ayant de forts résultats scolaires. La culture sud-asiatique possède et des facteurs conservateurs et des dissonances par rapport à la culture dominante, ce qui souvent pèse lourd sur les enfants et les jeunes dans leur négociation culturelle. Quelques vignettes cliniques souligneront quelques-unes des complexités des programmes d’éthique, d’identité, de société et de santé mentale, qui sont vitaux pour tout discours sur l’école comme facteur dans ces négociations d’enfants et d’adolescents. Quoique le taux de familles sud-asiatiques ayant, d’eux-mêmes, recours aux services de santé mentale pour enfant, reste bas, l’école ainsi que les services sociaux sont souvent les institutions sociales qui encouragent les interventions en santé mentale. Dans ce contexte, le personnel scolaire et les conseillers devraient développer des compétences culturelles afin de gérer la croissante d’une population scolaire culturellement diversifiée. De plus, les actuels immigrants Sud-Asiatiques et la population de réfugiés peuvent très bien souffrir de significatifs traumatismes pré-migration, quelque soit les circonstances dues à la pauvreté, aux effets sociaux, domestiques ou liés à la guerre étant donné que les démographies migratoires changent. Les réalités sociales de Québec (Bouchard, G. et Taylor, C., 2008) changent aussi, autant que les priorités accordées à l’assimilation langagière sont promues afin de créer une société unie pendant que le milieu sociale cherche à équilibrer un espace équitable pour les cultures et les influences des minorités. Les écoles sont impliquées dans cette dynamique socio-psychologique qui gère un nombre croissant d’immigrants venant de pays autres que l’Europe et l’Amérique du Nord, tout en encourageant, et le travail scolaire, et l’ajustement personnel de l’élève

Re-bordering Immigrant and Refugee Identities in Quebec’s Multicultural Society: The Case of South Asian (SA) Youth

Re-bordering is an aspect of globalization. Borders have become impervious to national, political and even cultural boundaries. All regions of the world are permeable to political, economic, cultural, social, environmental and epidemic factors. People’s identities and identifications are no longer seen as being stable and fixed, but rather- they are constantly in a state of flux. Canada is a country of immigrants and the last census (2006) put the number of visible minority people at 16.20% of a population of nearly 34 million people (Statistics Canada, 2007). Canada is known as a country with a broad immigration policy and one of the top destinations for immigrants. Canada is also seen as a leader in refugee protection and ranks first among the G8 major industrialized countries in the number of refugee status claimants per capita of its population. In 2001, the Immigration Act of 1976 was replaced by the Immigration and Refugee Protection Act (IRPA) (Bill-11), at which point Canada began to accept approximately 25,000 refugees a year. OECD figures indicate that in 2008, 34,800 people sought asylum in Canada. Since 9/11 there has been a significant change in how cultural and religious minorities, especially those from certain parts of the world, are viewed. People from South Asia 1 more if they are identifiable as Muslims – are viewed with suspicion. Globalization and international migration, as well as refugees from the wars in Afghanistan and Sri Lanka2 have been bringing people from the sub-continent of India to Western countries in larger numbers than ever before. South Asians (SAs) are the largest source of immigration in Canada, and in fact, one of the fastest growing immigrant groups in North America. This trend is not likely to change given the need for immigrants for a graying population and a below sustainable birthrate. Many SAs come to Quebec which has around 80,000 people with origins in the sub-continent, and they are mainly concentrated in Montreal. “Retracer les frontières ” est un aspect de la globalisation. A travers les frontières, les bornes nationales, politiques et même culturelles sont devenues imperméables. Toutes les régions du monde sont perméables aux facteurs politiques, économiques, culturels, sociaux, environnementaux et épidémiques. Les notions d’identités et d’identifications du genre humain ne sont, désormais, plus considérées comme étant stables et fixes, mais plutôt sont-elles constamment en état de fluctuation. Le Canada est un pays d’immigrants, et le dernier recensement (2006) a avancé le nombre des minorités visibles à 16,20% d’une population de près de 34 millions d’habitants (Statistics Canada, 2007). Le Canada est reconnu comme un pays ayant une vaste politique migratoire et est l’une des destinations préférées des immigrants. Le Canada est également perçu comme un leader dans la protection des réfugiés et occupe la première place parmi les grands pays industrialisés du G8, dans le nombre des revendicateurs du statut de réfugié et par habitant dans sa population. En 2001, la Loi sur l’Immigration de 1976 a été remplacée par la Loi sur l’Immigration et la Protection des Réfugiés (LIPR) (Projet de loi-11), à un tel point que le Canada a commencé à accepter environs 25 000 réfugiés par an. Les données de l’OECD indiquent qu’en 2008, 34 800 personnes ont cherché asile au Canada. Depuis le 11 Septembre, un changement significatif a été constaté dans la manière dont les minorités culturelles et religieuses, particulièrement celles qui proviennent de certaines parties du monde, sont perçues. Les habitants d’Asie du Sud, davantage s’ils sont Musulmans, sont regardés avec suspicion. La globalisation et la migration internationale, ainsi que les réfugiés des guerres en Afghanistan et au Sri Lanka, ont entraîné des gens en plus grand nombre que jamais, du souscontinent de l’Inde vers les pays occidentaux. Les Sud-Asiatiques (SA) représentent la source la plus importante de l’immigration canadienne, et en fait, l’un des groupes d’immigrants à la croissance rapide, en Amérique du Nord. Cette tendance n’est pas susceptible de changer, compte tenu de la nécessité des immigrants pour compenser à une population vieillissante et à un taux de naissance en dessous de la moyenne. Beaucoup de SA vont au Québec qui compte environ 80 000 habitants originaires du sous-continent, et ils sont principalement concentrés à Montréal

Children of War: Quebec’s Social Policy Response to Children and Their Families

Canada has signed the Optional Protocol of the Convention on the Rights of the Child on the involvement of children in armed conflict that obligates signatories to ensure assistance and support to war-affected children’s physical and psychological recovery as well as their social reintegration. In light of this obligation, the paper reviews the most recent policies related to immigrants and refugees of four Quebec (Canada) ministries, with particular attention to the frameworks underpinning these policies and practices in order to explore how the needs of refugee children are conceptualised and how these same conceptualisations orient the action plans. Miller and Rasmussen’s (2010) psychosocial/trauma integrative model is used as a benchmark to assess whether and how policies integrate considerations from both psychosocial and trauma focused conceptual models. The analysis suggests that all four ministries adopt a psychosocial focus but that none directly mention the impact of war, potential trauma or pre-migratory experiences on children’s reintegration or resettlement. There seems to be a divide and a lack of coherence in the goals and underlying philosophies of the action plans of the different ministries, most likely in part related to their differences in mandate. Indeed, the Ministry of Health and Social Services emphasizes individual and family wellbeing, while the Ministry of Education prioritizes citizenship and the development of Quebec. Potential implications of these policy orientations for children having been exposed to war living in the Quebec context are discussed

Um roteiro-memória-reflexão sobre os catorze anos de prática médica e teatral comunitária: do Hospício do Engenho de Dentro ao Teatro-Clínica Dyonises

En un guion de escritura autobiográfica performativa, contamos las historias que nos llevaron a desarrollar la experiencia en teatro y psiquiatría transcultural en el hospital psiquiátrico público más antiguo de Brasil. Esta experiencia tuvo la contribución de maestros de la ciencia y el arte brasileños hasta la constitución del Teatro-Clínica de DyoNises y del Hotel de la Locura, además de la colaboración metodológica de autores brasileños e internacionales.Num roteiro de escrita performativa autobiográfica, relatamos as histórias que nos levaram a desenvolver experiência de teatro e psiquiatria transcultural no mais antigo hospício público brasileiro. Essa experiência teve a contribuição de mestres da ciência e da arte brasileiras até a constituição do Teatro-Clínica DyoNises e do Hotel da Loucura, além da colaboração metodológica de autores brasileiros e internacionais.In a performative autobiographical writing script, we tell the stories that led us to develop experience in transcultural theater and psychiatry in the oldest public asylum in Brazil. This experience had the contributions of Brazilian masters of science and art until the constitution of the TheaterClinic of DyoNises and the Madness Hotel, in addition to the methodological collaboration of Brazilian and international authors

Searching for Best Practices:A Systematic Inquiry Into the Nature of Psychosocial Interventions Aimed at Reducing the Mental Health Burden in Conflict and Postconflict Settings

Despite a growing body of literature, substantial variance remains between researchers, mental health experts, clinicians, and practitioners over the nature, structure, and contents of psychosocial interventions aimed at reducing the mental health burden in war-torn and postconflict societies. We conducted a focused and systematic review of the literature published over the last two decades on the most commonly used psychotherapeutic treatment modalities in medical and humanitarian interventions as represented by expert opinion, observational and qualitative or mixed-method studies, case reports, case control, and community-based studies, excluding randomized controlled trials (RCTs) and meta-analyses of RCTs. More specifically, we aimed at searching for best practices and supporting psychosocial interventions within the domain of adult mental health in civilian populations in low- and middle-income countries affected by protracted political violence, armed conflict, and wars. We noted the need to translate existing knowledge into action (know-do gap) and the critical importance of applying qualitative evidence-based knowledge that informs and supports collective interventions and best practices in medical and humanitarian assistance programs currently being undertaken

The mothering experience of women with FGM/C raising ‘uncut’ daughters, in Ivory Coast and in Canada

Abstract Background While Female Genital Cutting (FGM/C) is a deeply entrenched cultural practice, there is now mounting evidence for a gradual decline in prevalence in a number of geographical areas in Africa and following migration to non-practicing countries. Consequently, there is now a growing number of women with FGM/C who are raising ‘uncut’ daughters. This study used a qualitative methodology to investigate the experience of women with FGM/C raising daughters who have not been subjected to the ritual. The aim of this study was to shed light on mothers’ perception of the meaning and cultural significance of the practice and to gain insight into their mothering experience of ‘uncut’ girls. Methods To this end, in-depth interviews were conducted with fifteen mothers living in Abidjan, Ivory Coast and in Montreal, Canada (8 and 7, respectively). Results Thirteen mothers intrinsically refused to perpetuate FGM/C onto their daughters and two diasporic mothers were in favour of FGM/C but forewent the practice for fear of legal repercussions. Whether the eschewing of FGM/C was deliberate or legally imposed, raising ‘uncut’ daughters had significant consequences in terms of women’s mothering experiences. Mothers faced specific challenges pertaining to community and family pressure to have daughters undergo FGM/C, and expressed concerns regarding their daughters’ sexuality. Conversely, women’s narratives were also infused with pride and hope for their daughters, and revealed an accrued dialogue between the mother-daughter dyad about cultural norms and sexuality. Interestingly, women’s mothering experience was also bolstered by the existence of informal networks of support between mothers with FGM/C whose daughters were ‘uncut’. These communities of mothers engaged in open dialogue about the consequences of FGM/C and offered reciprocal solidarity and support in their decision to forego FGM/C for their children. Conclusion Women with FGM/C who are raising ‘uncut’ daughters in their homeland and in their country of immigration vastly report a positive experience. However, they also face specific challenges related to immigration, psychosocial, and psychosexual considerations, which must be tackled from a multidisciplinary perspective

Cultural ConsultationEncountering the Other in Mental Health Care /

XIX, 355 p. 1 illus.online resource

The ethics of relationality in implementation and evaluation research in global health: reflections from the Dream-A-World program in Kingston, Jamaica

Abstract Background Despite recent developments aimed at creating international guidelines for ethical global health research, critical disconnections remain between how global health research is conducted in the field and the institutional ethics frameworks intended to guide research practice. Discussion In this paper we attempt to map out the ethical tensions likely to arise in global health fieldwork as researchers negotiate the challenges of balancing ethics committees’ rules and bureaucracies with actual fieldwork processes in local contexts. Drawing from our research experiences with an implementation and evaluation project in Jamaica, we argue that ethical research is produced through negotiated spaces and reflexivity practices that are centred on relationships between researchers and study participants and which critically examine issues of positionality and power that emerge at multiple levels. In doing so, we position ethical research practice in global health as a dialectical movement between the spoken and unspoken, or, more generally, between operationalized rules and the embodied relational understanding of persons. Summary Global health research ethics should be premised not upon passive accordance with existing guidelines on ethical conduct, but on tactile modes of knowing that rely upon being engaged with, and responsive to, research participants. Rather than focusing on the operationalization of ethical practice through forms and procedures, it is crucial that researchers recognize that each ethical dilemma encountered during fieldwork is unique and rooted in social contexts, interpersonal relationships, and personal narratives