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by Dr. Nancy Clark: Twenty percent of British Columbians are racialized immigrants or refugees and suicide is ten times more likely amongst racialized immigrants and refugees. (Hansson,et al 2012) The Canadian Institutes for Health Research (CIHR) and Social Sciences and Humanities Research Council of Canada (SSHRC) have favored that more research needs to meaningfully involve diverse patient and population groups to affect meaningful change toward improving health outcomes. Dr. Nancy Clark at the University of Victoria School of Nursing has recently been awarded funding for community-based research with people who have experienced discrimination to study culturally safe mental health support and services. Four projects are currently underway.

Race-Based data for patients with mental health conditions in the context of Covid-19

The University of Victoria Internal Research/Creative Project Grant explores the practice and policy implications of race-based data for patients with mental health conditions in the context of COVID-19. The pandemic has brought heightened awareness about disproportionate impacts of COVID-19 among racialized groups, including those with mental health conditions. Little is known about how ‘race-based’, i.e., how ethnicity data is collected and used to support pathways for culturally safe care for patients with pre-existing mental health conditions in the context of the COVID-19 pandemic.

Racialized mental health patients are disproportionately impacted by COVID-19 and are particularly vulnerable to worsening mental health due to increased isolation, discrimination, and stigma. Studies on COVID-19 and mental health care have found that Chinese and South Asian groups delay seeking help and experience increased social isolation, and Black and racialized patients experience multiple hospitalizations (Holmes et al., 2020; Cénat et al.,2020;Sheridan Rains et al.,2020 ).

These studies suggest that mental health may be worse for ethnically diverse patients. Recent media reports  point to a highly racialized health care system, where stereotypes of Indigenous peoples in Canada influence patient care with fatal consequences— the legacy of systemic racism and colonization contributes to significant patient inequities across health care systems. These issues are significant in ethnically diverse British Columbia (BC). According to the 2016 census, 1,312,445 individuals identified as having Asian heritage (28.78% of the BC population), including 18.76% who identified as East or South East Asian and 11.84% who identified as having a Chinese heritage. Further, 43,500 identified as Black (almost 1% of the population) and 270,585 reported Aboriginal identity (5.93%) (Statistics Canada, 2017).The legacy of systemic racism and colonization contributes to significant patient inequities across health care systems.

A Call for Action: All jurisdictions in Canada are called on to start collecting ‘race-based’ data to address the disproportionate impacts of COVID-19 on racialized groups. The BC Office of the Human Rights Commissioner (BCOHRC) (2020) has advocated for inclusion of racialized groups with lived experience to operationalize how ‘race-based’ data shapes health equity and pathways to care. This means that data collection must shift control toward equitable inclusion of data governance. That is, research that collects ‘race based’ data must meaningfully include people directly impacted by this policy. In addition, ethnicity data should include an analysis of the intersecting dimensions which structure racism so that services can address the socially constructed categories, which shape inequality and advance social justice. We are exploring patient and provider perspectives within the Vancouver Coastal Health (VCH) region as a case study that will support funding for a larger operating grant. This study will also conduct a systematic review of policy literature based on best practices for collecting race-based data and how collecting such data has the potential to advance mental health equity and culturally safe care.

Patient Oriented Research Planning grant 

With funding provided by the British Columbia Academic Health Science Network (Vancouver Island Centre) this project will develop a culturally safe framework for engaging immigrant, refugee, ethnocultural patients in mental health research. Patient Oriented Research (POR) meaningfully engages patients as partners with the aims of identifying patient priorities and improving patient outcomes in health. Canada’s Strategy for Patient Oriented Research (SPOR) led by the Canadian Institutes of Health Research leverages partnerships with provinces and territories, philanthropic organizations, academic institutions, and health charities to help make POR a reality in Canada. There has been increasing awareness of the need to address POR research with diverse patient communities who face multiple barriers. Immigrant, refugee, ethno-cultural and racialized (IRER) patient groups in particular have not been adequately included in POR or mental health research. Culturally tailored curriculum based training was developed to support this initiative and build research team capacity Drawing from our patient partners’ voices, we will provide in depth analysis for a scoping review on and meaningful inclusion and cultural safety in mental health research. The scoping review will provide a culturally safe framework for meaningfully including immigrant, refugee, ethno-cultural and racialized patients and family members in mental health research. Finally, our framework will be used as a POR tool for engaging in mental health research.

Using arts-based methods to promote mental health equity

Refugee men face unique challenges to labour participation based on complex intersecting factors related to low levels of education, language ability, lack of recognized foreign credentials and social capital. These factors maybe compounded by experience of pre migration trauma, stressors related to acculturation and experience of social exclusion and discrimination. In partnership with Options BC, this SSHRC funded project will explore Syrian refugee men’s mental health through economic integration in Canada.

Understanding Syrian men’s experiences of their participation in labour employment will make a significant contribution to a gap in knowledge about the factors which shape their mental health, wellbeing and contribute to informing integration policy and practice. The goal of this research is to gain an in-depth understanding about Syrian men’s participation in labour employment and their perspectives on the impacts of labour participation to their mental health and overall well being in the context of resettlement.

We will apply principles of Community­ Based Participatory Action Research (CBPAR) and arts ­based methods of photovoice and photo­ elicitation, to use Syrian men’s narratives to inform settlement employment policy and practices on how to best support Syrian men in their labour participation. Outcomes of this research will inform labour employment and wellness programing.

Experiences of inner-city health care and social service providers during the Opioid Epidemic and Covid-19 Pandemic

A Victoria Foundation Research grant will explore health care and social service providers, front line experiences of working in inner city environments during the overlapping opioid epidemic and COVID-19 pandemic. This research will also support the Mental Health Commission of Canada’s (MHCC) national strategy to identify barriers and facilitators for supporting psychological care and trauma experiences of front line workers and protect from moral distress and grief experiences stemming from the COVID-19 pandemic and ongoing opioid crisis in Canada. According to the citizen responses in Victoria’s Vital Signs report, (2019) mental health is the leading health challenge across service sectors. Increased mental health challenges have resulted from intersecting public health crises including the national opioid epidemic, and ongoing COVID-19 pandemic. Victoria has experienced the third highest number of fentanyl-detected toxicity deaths in the province. The compounded public health emergencies have required a comprehensive set of supports that help people who use substances maintain physical distance to prevent the spread of COVID-19 and reduce overdose deaths. In addition, those who provide services at the forefront often do not have adequate protective equipment and are unable to comply with public health social distancing measures due to social, environmental and economic factors. The unprecedented deaths related to the opioid crisis and compounded COVID-19 pandemic, as well as contextual factors, has also created significant anxiety and stress amongst health care and social service providers. Recent evidence highlights mental health as a growing problem amongst crisis responders including significant vicarious trauma and secondary stress related trauma.

The Mental Health Commission of Canada (MHCC) has argued that the most significant impacts on mental health and substance use and health systems will be felt after the pandemic. This means that planning should begin to focus on the health and mental health of care providers. Supporting and building on the mental health supports offered to front-line health care providers and identifying the mental health and support requirements of professionals is key to meeting the needs of the most vulnerable members of society, during and after the crisis. The MHCC made a commitment to implement the National Standard on Psychological Health and Safety in the Workplace since its release in 2013. To guide this work, the Commission developed a Wellness Framework, a systematic approach with the purpose of continuously improving upon psychological health and safety within the organization. Fitting with the MHCC, we will co- develop resources which fit with inner-city and community contexts to raise awareness on the importance of addressing the psychosocial impacts of inner city workers during crisis.

Dr. Nancy Clark is an Assistant Professor in the University of Victoria School of Nursing