The role of school-based services
School-based prevention programs play a key role in promoting the mental health of children from immigrant and ethnocultural communities. Ecological models of intervention that address the whole-school environment are useful because they provide a systemic understanding, help counter concerns about stigma in accessing support, and propose support and training for teachers so that they can help their students without becoming too distressed. This model also insists on parent-school interactions, which should be understood both in terms of cultural differences and also as reflecting minority-majority relations between communities and host country institutions.
Classroom-based activities help children assimilate past and present experiences by presenting these as learning opportunities. This facilitates emotional expression of their experiences and promotes positive relationships within the classroom and society.18 Some prevention programs use specific treatment modalities, such as artistic expression, to support the transformation of past and present adversity through creativity and metaphorical representations and also to foster the development of solidarity among children.19
Consultation to remote communities: fostering resilience by supporting community strengths
Remote communities, including First Nations and Inuit, face specific challenges for delivery of mental health care adapted to local sociocultural realities. Resources are often scarce and health care professionals often assume a greater diversity of roles by addressing physical and mental health issues. Culturally specific or local interpretations of illnesses can be misinterpreted, especially if the clinician does not share the same cultural background with the community. At the same time, visiting clinicians can develop an intimate understanding of the community within a long-term relationship as allies of local care providers.
The model of collaborative care between professionals in mental health and those working in proximity with communities is a useful one to address the mental health needs of children and youth living in remote communities.20 Collaborative care models bring together expertise in mental health and in local resources and contingencies, including the frequent extra burden of multiple roles placed on service providers and the unofficial networking roles created internally by communities.
Collaborative care offers an opportunity to solidify support for children and their families within their communities. Travel to distant urban settings is reserved for particular diagnostic or treatment issues, because this can add an additional stressor to children and their families. Adapting services to community realities takes into account local strengths and traditional interpretations of mental health problems to co-construct strategies that support the healing of children within their families and communities. A collaborative approach includes addressing the need for culturally responsive services and a com-mitment to support social, cultural, and economic determinants of health.
Addressing cultural considerations in the mental health care of children from immigrant and ethnocultural communities implies that we address needs for interpreters or culture brokers where necessary and that we see our therapeutic tools and services as well as ourselves, our patients, and our communities in a new light. Cultural psychiatry proposes openness to social and cultural issues allied with good comprehensive general mental health care. Cultural issues are seen as an integral part of the assessment and diagnostic process as well as a key element in the formulation of a clinical and social intervention plan framed within culturally diverse developmental and social agendas. Culturally respectful services need to be grounded in an ecological framework of care where social, economic, and cultural determinants of heath are considered as intrinsic contributors to a person’s well-being.