Thinking Intersectionally

Although immigrants are generally healthier than people born in Canada, their health tends to decline over their time here[1]. Access to health services is therefore essential, yet multiple barriers remain in the mental health context. As Laurence Kirmayer previously blogged, the challenges are complex and significant.

At the level of service delivery, challenges may include unavailability of language interpretation; stigma or discrimination; and a lack of culturally-appropriate services or supports. Policy decisions also inform how services are delivered and whether vulnerable groups access (or do not access) care. Recent changes to the Interim Federal Health Program greatly impacted how health insurance is provided for some of the most vulnerable groups in society, with significant impacts for mental health. Other populations, including temporary workers and undocumented migrants are excluded from provincial health insurance coverage and consequently face barriers in accessing mental health services.

But factors beyond the health system also have a significant impact. The Canadian Mental Health Association (CMHA) Ontario and partners have identified income security, freedom from discrimination and violence, and social inclusion as critical determinants of mental health for Canada, all of which are critical in the case of immigrants and refugees[2].

Despite this complexity, much can be done to increase the responsiveness of the mental health system to immigrant and refugee communities. CMHA Ontario is developing a new framework to increase understanding and action about equity issues in mental health.  The framework focuses around three simple messages:

  • Equity impacts on mental health – Due to decreased access to the social determinants of health, vulnerable populations are more likely to experience poor mental health and in some cases, mental health conditions.
  • Mental health impacts on equity – Experiences of poor mental health will have a significant effect on settlement and access to key determinants, such as housing and employment.
  • Intersections matter – Immigrant and refugees are diverse and their mental health, immigration and settlement experiences will be impacted by other intersecting socio-economic factors, such as gender, sexual orientation, race and income.

The major learning: as service providers, researchers, decision-makers and other professionals, we need to consider both the impacts of immigration and settlement on mental health and the impacts of poor mental health on immigration and settlement.

[1] Edward Ng. (2001) The healthy immigrant effect and mortality rates. (Catalogue No. 82-003-XPE). Retrieved from Statistics Canada website at

[2] Canadian Mental Health Association Ontario, Centre for Addiction and Mental Health, Health Nexus, Ontario Public Health Association, University of Toronto Centre for Health Promotion. (2008) Mental Health Promotion in Ontario: A Call to Action. Retrieved at CMHA Ontario website at


2 comments for "Thinking Intersectionally"

  1. Very interesting article ! The fact is that mental health issues are more and more important and the ressources are not following this path. Today, even toddlers suffer from mental health issues !

  2. Sheela Subramanian

    Thanks for your comment, Adina. Mental health issues are critically important! In fact, just last year, a Statistics Canada study found that 1 in 3 Canadians experience a mental health or substance use issue at some point in their life. We definitely need a strong mental health system to ensure that everyone has access to the services and supports they need.


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