Migrants experiences with depression and anxiety
Transcript
Miriam Taylor, Constituency Assistant
People are coming here seeking asylum, looking for a place where they can feel safe, and they’re viewed with suspicion.
Richard Goldman, Lawyer
We talk about people who are asking for refugee status or have been refused and are trying to exercise their resources and avoid deportation. We’re talking about a very vulnerable population.
Caroline Petitpierre, Psychologist
Usually a patient comes in, with a request for psychotherapy. We work in depth, we work on issues, we go back in the past and we work on deeper issues. With an immigrant, I noticed that the psychotherapy is much shorter. So they come, we work on the most urgent problems: it can be anxiety, difficult moments they are going through such as the long waiting period to be reunited with their family. Once the family’s reunited, the individual doesn’t come back anymore.
Key reflections from the study
How anxious and depressed do non-status migrants feel?
People have been victims of torture, of trauma such as sexual assault, people with very serious mental or physical health problems.
I know if they’re under the threat of deportation, it’s the uncertainty. They’re stuck in a limbo, they can’t even get on with their life in the way that the rest of us can.
My own opinion, not based on statistics, is that the majority have some sign of depression, anxiety, post-traumatic stress disorder.
Some would come with clear symptoms of depression; they would come in a very depressed state. In those cases, we would work according to the level of depression, often in combination with medication. Others would come for another reason but noticed depression symptoms in tandem. Anxiety is present for almost everyone, lots of sleeping disorders, tiredness and somatization. All kinds of problems: they go see a doctor in a clinic – a volunteer physician – they come with small (somatic) issues that often have a psychological origin.
How do non-status migrants communicate their depression and anxiety?
They rarely come in saying: I have this and that, what can you do for me? It rarely happens and even in depression cases it isn’t named as such. They don’t come in asking, am I suffering from depression?
I think that we feel their distress more in the way they tell the story, or you can just feel it in their energy.
Rather, they talk about discomfort: I am not well,
They express despair, because they’re in a process that’s out of their control and they don’t know how long it’ll be. They have a lot of uncertainty in some cases. It’s not unusual to have people cry.
I don’t feel well, I am very tired, I don’t have an appetite anymore, I have heart palpitations, or I am in the metro and suddenly I feel I am going to pass out.
Even in just recounting the facts, you can feel the intensity of their emotion. I had one woman here who came from an African country, and one of her daughters had been kidnapped and another one was raped. Just the weight of the world on that woman’s shoulders. But she wasn’t just spilling it out, she was telling me the facts so that I could help her with her immigration process, bringing her kids here.
Solitude: a reluctant choice
Solitude is a very important element among all the migrants I have met. It leads to depression, it leads to a lot of anxiety, especially when they come from cultures where they live together in a community with extended family, lots of friends. It is a loneliness due in part to the language barrier; they don’t speak French or English. They are often here alone and even if there are people from their country here, it is not the same, the relationship is not the same. Often their families have remained behind. They don’t say that they live isolated but they describe a lifestyle where they barely go out, where they seldom meet people. Sometimes there may be a church, a temple, or someplace where they can go according to their religion. I also forgot to mention – and I saw this among many immigrants – there is also the shame of being without legal status, of having to work under the table, of not being a citizen. It is another obstacle for building relationships.
Fear & separation
Many immigrants I’ve met live in a state of fear that creates anxiety, which generates lots of anxiety and stress. They fear being caught by the police – and this is something I have seen a lot. They are very careful where they go, whom they meet, what they can or cannot say. They are also careful when they meet new people because they are afraid of being caught by the police and sent back to their country.
To undergo separations of years, it just takes an unbelievable toll on people’s morale, on mental health, happiness.
I remember someone who came and left behind his wife and children hoping that reunification would happen quickly. Once here, he realized that no, it wouldn’t work like that, it would take years. Just for him alone, it would take years to obtain legal status and then, sponsoring his family would take even longer. He was caught here, obviously he couldn’t take a vacation to travel and see his relatives, he couldn’t leave the country. So then what? He was asking himself: what do I do? What do I do? He had to wait for at least 8 to 10 years before seeing his family and children again. He was in a very serious state of depression. And his condition worsened very quickly.
Despair: suicide as sacrifice & liberation
One of my clients thought of killing himself as a way out, first of all, he couldn’t bare the thought of being deported, and second of all, he thought that maybe if he committed suicide, it would allow his family members to stay. In this particular instance, we were able to get him some psychological help, but it involved a psychologist being willing to give their time without remuneration, which is rare.
Do non-status migrants have access to adequate mental health care?
So, I’ll give you an example, somebody who’s being followed by the HIV unit at the hospital, they may be able to set something up with a psychiatrist working in the hospital. For someone who is not being followed very closely for a serious physical problem, it’s not obvious to me that they will have access to care. I really am not sure what the attitude of the local [health services organization] are. My experience which, I’ve never done a systematic study, is that it’s a little hit and miss. I think sometimes their attitude is: you’re a refugee claimant, you don’t have legal status, go to [a health services organization]. Whereas, in fact, my understanding is they do have access to the same services at this [health services organization]. Other times, they seem to get a more open reception and they do have access to services.
If someone has been refused refugee status here, and they’re still in the process of trying to fight the deportation, they no longer have access to healthcare.
Are delays in immigration procedures contributing to anxiety and depression?
The delays, especially under the previous government, have become so long – two years, three years – that even the most fortunate in terms of the procedures, wait for years. If you have bad luck, a lot unfortunately is who you fall on, what decision maker, whether you’re able to overturn a bad decision, but if you have bad luck somewhere along the way, even if you have a very good case, the three years of separation can become six, seven, ten. When there’s family members with health problems, with serious health problems, this can severely slow down everything.
It seems to me that the whole system of seeking asylum and obtaining asylum has major flaws in it. I think in general, the whole sponsorship system, the delays are just much too long, much too long. And every stage there’s stressors built into the system. So, right now for instance, even renewing a work permit or study permit takes four or five months. And, any slipup on the part of the immigrant and they’re under threat of having to leave the country.
Is government policy contributing to anxiety and depression?
The network of psychologists that is assisting victims of torture, it was very very active until a few years ago, with many therapists able to take on patients as therapists, typically psychotherapists, but they even have other things: massotherapists and other types of therapy that are helpful. Unfortunately they suffered a very big financial blow with the cuts to the interim federal health program of June 2012, which the new government has pledged to reverse but it hasn’t happened yet. So, we don’t have them, and in the same numbers of therapists that are able to take on cases. And, separation, especially artificial separation, due to deliberate choices of the government to reduce resources from certain parts of the immigration system, is a very cruel choice: very antisocial, very anti-family. That generates an enormous amount of human misery.
Why do non-status migrants refuse or stop attending the few mental health services available?
Unfortunately, I have noticed that many give up rather quickly. I believe there are many reasons for this. First of all, there is the fact of coming to talk to someone they don’t know, for instance. For migrants from certain countries where things are different, it is very disturbing to sit with someone they have never met and share personal matters. And I’ve noticed that after a while – or rather, fairly quickly – a reticence sets in where they become very reluctant to talk, and the conversation goes around in circles, they don’t want to face certain realities, and then I don’t see them again. As to whether – I think – they would gain a lot if working on these issues here, it would help them a great deal but there is hesitancy. We’ve noticed this from the very beginning at the clinic: people suffering, who were anxious, or alone, and experiencing a very difficult migration period. We would suggest help in many ways without using the words psychologist, psychotherapy. Using only words like ‘listening’, ‘talking to someone’… No, there is something not quite getting through.
Don’t take for granted that there is not even a huge stigma, a huge reluctance to seek out care, misconceptions about what a healthcare provider does, I mean it’s very sad, but again, I have people who come from countries where if someone is schizophrenic or bipolar, they tie them to a bed in a hospital. I mean, they chain them to a bed, that’s just how they deal with it. So, there may be an enormous amount of fear and apprehension.
Is treating mental health symptoms appropriate, effective or sufficient?
I followed a case where one of my clients had psychotic symptoms as a result of the stress of being deported to a country where things are very dangerous. And, when they finally got the news that they could stay in Canada, he was a transformed, completely different person. Completely different. He wasn’t eating, he was withdrawn [inaudible], there was no hope. And today, he’s joyful, he’s open, he’s got a great appetite, and I was told by someone with a lot of experience in the field that’s typical, that transformation. It shows that his issue was directly related to the threats in his life, not to some innate problem.
In some ways, I think we’re all limited to dealing with symptoms because if, for example, a person can’t sleep because they know their 15 year old daughter is in a country where they’re exposed to sexual violence, to being recruited or forcibly recruited for human trafficking and prostitution, where they could be getting HIV from a sexual assault. How much can you do to help this person as a mental health professional, I’m sure you can be beneficial to their mental health, but the root cause is so profound, if they can’t eat, they can’t sleep, you’re dealing with a situation which is possibly very different than you might encounter in your other cases where, Quebecers have mental health problems and they need treatment, but they are not facing a kind of existential problem that just haunts them day and night in the same way. So, you have to be very sensitive to these very profound root causes of depression and anxiety.
Are the key solutions to improving the mental health of non-status migrants in the hands of policy makers?
What should absolutely change is the access to care. Not like our clinic which has a secret address where everything occurs in a grey zone because of their legal status. Migrants should have access to resources like everyone else, like every citizen in the country: a universal access to care.
Better resources, more resources for mental health which, again, for mental health support/treatment which I think would apply probably to Quebecers as well as to refugees and new immigrants.
For many people, they’ve said that that makes a difference. There is a governmental office where they feel someone cares enough to do the maximum to help them, within the framework of the system.
There’s no question in my mind that we should be going back to the interim federal health program before the previous government severely cut it in June 2012.
I think communication is very important, because even just being able to tell them where things are in the process, I see that soothes a lot of anxiety.
It would certainly be number one for me, because I see so many problems generated by family separation, would be faster family reunification. This, to me, would alleviate I would say the majority of problems of anxiety and depression.
Mental health care: current approaches to treatment
We work a lot in trying to see how they could adapt to this new life without having too many regrets of what they left behind. How to integrate the past from the country left behind to a new lifestyle. How to not become completely torn apart between the past and what is being offered now. How to find the tools to be able to take what is best for oneself in the new country. We work with a psychiatrist when it becomes more serious and there is a need for medication.
Mental health care: natural approaches to treatment
Family is an enormous resource. The people who have their families are often much more resilient. At least, they know they’re here, they go home, okay, look, they’re struggling, they’re not sure what will happen in a year or two. They might even get deported. But, they go home, their family is there. They can sit and eat with their family, they can hold their family.
Listening. Listening to the story. I think it’s very important.
Non-status migrants living with anxiety and depression
I heard that a kid near Jean Talon had hung himself. And he wasn’t crazy, I’m sure of it. In my experience he was probably in really bad shape, he was very, very depressed. And so this is why every day I struggle against this. I don’t want to be that headline, of that lady who killed herself.
When we made the decision to sell everything – we sold everything. My sister told us that we were burning all our bridges. And we came with the belief that we were coming not just to try things out but to stay. So leaving everything at first causes a lot of anxiety. Depression begins once you arrive, when you become aware of this break with the past, the separation with your personal possessions, your family. The change in lifestyle is what causes depression.
The anxiety of not having identification papers
And when they ask you for some form of ID and you don’t have any, it causes a lot of anxiety. You have to be very strong to realize that… I know I’m not a criminal. I’m law abiding. I may be illegal but I’m a good person. But it’s those little things like not having an ID card that causes me a great deal of anxiety.
Family separation and restricted communication
My family, my daughter have been greatly affected. She would like me to return, to be there with her. She can’t come here. My siblings and my father worry a lot; they’d like me to return as soon as possible. But they also know that I have a goal that I’d like to achieve so they worry but they’re also a bit distant. Or perhaps I don’t involve them that much in my situation. I only talk about the nice things. I’m not going to tell them I’m depressed. The truth is that I never tell them.
Are qualified non-status migrants at risk of anxiety and depression?
Looking for work, at least in my field, and knowing that I can only find work where they don’t recognize your skills. First of all, they are badly paid. Secondly, most jobs we can get are those where they take advantage, abuse people. That leads to a lot of depression because one knows one’s skills, but can’t get ahead. You’re stuck in, like, a limbo. I’ve felt that I’m… Sorry. Suddenly, you feel that you are sinking, but there is no way out.
Self-doubt, dissimulation, and alienation
So having a Mom crying all the time is not good for anyone. So I have to force myself to look normal, to be calm, to be strong, to pretend a little.
I feel that I have more strength to fight as if each time I have to do more, more, more. I don’t know if after each depression I find myself with more strength, I don’t know if I’m just hiding my depression by saying, “Oh, I’m stronger now!”
It starts like, the hormone of fear, when you approach a dog, you’re afraid and your body begins to secrete a hormone and the dog can smell your fear. It’s the same thing. That’s how I feel it. It’s like a fragrance, a smell that has been released from your body… like a monster that comes… grabs you, and you always struggle to get out. I fight not to be so… how I feel right now is how I feel, again, this desolation, again I’m crying…
Living through diverse levels of anxiety and depression
Usually illnesses are physical. I mean, you get hurt, you feel pain but you know it’s physical. In my case I didn’t know that one could get mentally sick in this way. So I start feeling something pushing from inside me. But I don’t know what it is. I feel lie… there is something in my head… but I don’t know exactly what it is. So I just go about my days in this state… I’m trying to work, to go to school, and do what I need to do but… I’m not aware that I am ill. But it’s like… it’s like having the flu not knowing what to do with it.
When I’m anxious I feel like eating. When I’m depressed, I remember, but say, “On, no, I’ll do it tomorrow” until I say, “ok, today I have to get back to my plans.”
I was in bad shape already back in 2010, I no longer remember. I had persecutory delusions… it was, like… I don’t know… At work I’d feel my coworkers in more places than one.
Aggression, self-harm, and suicide
This depression makes me aggressive, in a bad mood. If my daughter asks me something I’ll answer her aggressively. But it’s released suddenly, like in an unconscious state of mind. So I’ll be aggressive, say things, throw things… it’s like an unconscious state of… a “peak”… which, when I realize it, I react, and notice that I have hurt myself and my daughter.
Yes, in fact in 2014 I thought about committing suicide. And one always thinks that committing suicide is… but one who is here, on this side… I definitely thought that to commit suicide one needed to be very brace. Not everyone is capable of doing it. But it’s not the bravery… the isolation is such that one feels so alone; I feel so vulnerable. It’s something that hurts me a lot. In 2014 I visualized it, thought about it, planned it. I was going to commit suicide. I couldn’t take it any longer. I thought that now my daughter is older and she can already be without me. I’ve been through a lot alone with my daughter. I’ve tried to make sure that her life is different. But to imagine her coming home and seeing me dead?
Finding adequate mental health care
I felt like I was in… a dead end. I mean, not having access to better jobs, access to… to be able to study, to be able to have an ID card. So when I went to [an NGO] I was feeling somewhat depressed, thinking about my separation from my family, my daughter. So I’d be suddenly up or down.
I knew I definitely had to see a psychologist. The French school offered psychological help (to everyone). Then suddenly I felt that there was something; so I began to find out discretely, I saw the social worker, and then he sent me to a psychologist. I have seen 4 or 5 psychologists in Canada.
Closing reflections
Non-status migrants’ state of mind and the path towards healing
Given the time you’ve been in Canada, from the time you arrived up until now, do you feel that your symptoms of depression and anxiety have improved or not?
Here in Canada… no. Having an answer from the government is what would help me. That emotional instability is caused by my situation with immigration. So I feel that I need to know now. Yes, no. Ok, I’m leaving or I’m staying.
So I say, today is a new day and something could happen, like suddenly, “Oh, an amnesty!” All of a sudden the Queen could come to visit… something could happen. I’m still alive! I need to hold on to the thought that it’s going to change. I need to hold on to faith.
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