Mental health of St. John's immigrants: concepts, determinants and barriers

"Canada is in one respect like the kingdom of Heaven: those who come at the eleventh hour will receive the same treatment as those who have been in the field tor a long time. We want to share with them our lands, our laws, our civilization... Let them take their share in the life of this country... Let them be electors as well as citizens. We do not want or wish that any individual should forget the land of his origin. Let them look to the past but let them still more look to the future. Let them look to the land of their ancestors, but let them look also to the land of their children. Let them become Canadians ..." Sir Wilfrid Laurier, 1905.
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\n-- Immigration-related difficulties and excessive social stress are the reasons for immigrants' vulnerability toward developing mental illness. In addition, immigrants experience numerous organizational, communication and financial harriers to utilizing mental health services. Very little is known about the mental health concerns of immigrants in St. John's, where both ethnospecific infrastructure and cultural diversity is very limited. For this reason, this qualitative inquiry examines, through the personal experiences and perspectives of eight St. John's immigrants, their concepts and determinants of mental health, as well as the barriers to their utilizing mental health services. In addition, this inquiry evaluates how the local mental health promotion programs and healthcare services address immigrants' mental health needs. The goal of this study is to increase the understanding of mental health providers and policy makers about the determinants of immigrants' mental health, which can then inform the development of accessible and appropriate support mechanisms tailored to the mental health needs of the St. John's immigrant population. -- The findings that emerged from a thematic analysis of the semi-structured, open-ended interviews conducted show that St. John's immigrants understand mental health in broad holistic terms and do not see any clear-cut boundaries between mental health and illness. Moving to Canada challenges immigrants' stereotypes about mental illness, but also exposes them to the ideology of medicalization, according to which the reason for their mental unwellness lies in defective biological processes rather than in faulty sociopolitical structures. There are several key determinants that shape immigrants· mental well-being: the lack of social support, resources and information, financial difficulties, and unemployment. Furthermore, their cultural identities are often not appreciated or understood. These factors contribute to immigrants' stress, and their feelings of loneliness and isolation. As a result, some suffer from depression and seek professional medical attention. However, the mental health promotion programs and services only reflect immigrants' mental health needs and concerns to a very small extent and have a limited ability to address immigrants' vulnerability to developing mental illness. In addition, immigrants encounter several barriers to utilizing these services: for instance, lack of information, culture, language, waiting times, and finances. -- This study supports previous research calling for major changes across different levels of health care, social, economic and political systems. In order to improve the mental well-being and integration of St. John's immigrants, several suggestions arc proposed to health and social services providers so as to address the lack of support, information and resources for immigrants, as well as unemployment, cultural conflicts and the barriers to utilizing mental health services that immigrants experience. 
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