The Immigrant and Refugee Mental Health Project facilitates a virtual Community of Practice (CoP) comprised of health, settlement and social services providers across Canada who support the mental health of immigrants and refugees. The CoP online discussion board allows providers to pose questions to the Project's panel of subject matter experts (SMEs). We will be bringing you some of the questions posed by providers and answers provided by the SMEs.

Dr. Debra Stein, staff psychiatrist (children and adolescents), SickKids Centre for Community Mental Health, writes:

Some of the biggest challenges to mental health for immigrants and refugees relate to variables that are mostly out of the individual's control, for example, poor access to safe, affordable housing, food insecurity, uncertain status in Canada, lack of recognition of foreign credentials, racism/discrimination/islamophobia etc. Among these variables, poverty in particular can have an enormous impact on resilience and mental health. The question here, however, asks about self-care, i.e. what can newcomers do to cope personally with these burdens?

The concept of "self-care" may be culturally constrained, and a less familiar concept outside the highly individualistic West. Self-sacrifice and not attending to personal needs may be held as ideals, a tendency which is especially common for parents. The "oxygen mask" metaphor can be useful here; we can remind our clients of the instruction, on airplanes, that in the event of a crisis the caregiver must put their oxygen mask on first before attending to their child.

I think it is always important to start with the client's own self-care practices. We can empathize with structural and systemic difficulties the client is facing, and then ask, "how are you taking care of yourself during this difficult time?" The answer may be very instructive, and provide a springboard for discussion. A second question, if it feels like self-care is minimal, might be, "How do people (men, women, parents, youth) in your home country cope and take care of themselves when times are tough?"

We can ask about what gives our clients peace and pleasure. We can ask about friendships and social outlets. We can teach basic relaxation skills such as abdominal breathing, progressive muscle relaxation and visualizing a peaceful scene. We can support our clients in asserting their needs and setting limits. But, as the question suggests, the first step is connecting with our clients over the value of self-care. Only then can we help our clients discover what self-care might look like for them, personally.