KJIPUKTUK (Halifax) - By the time Hesam Hanafi moved from Iran to Halifax in 2010, he says he was eager to get out of Iran. But that excitement turned to frustration as he realized the reality of Canada was different from how it’s portrayed in popular culture.

This went beyond simple culture shock, says Hanafi. For him, it culminated in bursts of anger that saw him escorted of NSCAD’s campus, where he was studying at the time, and having his finger broken in an altercation with the police.

Hanafi is one of the lucky ones; he was ultimately able to get help for his depression and anger in the form of both regular counseling at Dalhousie and at Community Mental Health Services – proof that adequate support services are essential in helping immigrants adjust, he says.

He’s also had his family situation improve. His parents arrived in Halifax six months after he did, and initially struggled with unemployment and isolation for years, a dynamic that affected his own well-being.

“They had more time to be worried about me and put more pressure on me,” he says.

As they’ve found work and made friends, things in his own life have gotten easier, Hanafi says.

In May, 2015, researchers at Western University in Ontario published a study in which they reported an increased risk of psychotic disorders among certain immigrant groups, particularly those who are more likely to have experienced trauma, such as refugees. Providing adequate support to immigrants experiencing these kinds of illness is essential, says Carmen Celina, Community Wellness Program Coordinator at Immigrant Services Nova Scotia (ISANS).

But she adds that it’s equally important to recognize the effect that immigration has on less acute forms of mental illness that range from depression to stress.

“It’s different to live with depression or anxiety or schizophrenia if you are an immigrant,” she says.

In Ontario, immigration status is recognized as one of the social determinants of health – the societal factors that affect the conditions of daily life. No such recognition has yet been granted in Nova Scotia.

Yet acknowledgement of the health effects of immigration is increasing. Last year, ISANS kicked off the Newcomer Community Wellness program - funded by the provincial Department of Health and Wellness - bringing together immigrants and service providers to develop culturally competent supports.

When ISANS started the consultation process for the program, Celina says they were worried it would be hard to recruit participants; as it turned out, they weren’t even enough places for all those who were interested.

This shows how eager people are to learn techniques to support friends and family experiencing mental illness, she says; it also shows how few opportunities exist for them to do so.

While many immigrants want to preserve their own culture – and resist the pathologizing of that culture by a Western model of medicine – Celina says that in the public consultation, many immigrants cited cultural stigma as a barrier to seeking help.

But overcoming this is barely half the battle, says Celina.

Addressing the mental health needs of immigrants means not only encouraging immigrants to talk about those needs, but also addressing the gaps that exist in mental health services.

These gaps can include too few interpreters; a lack of awareness about where to go, what services exist and how to access them; and a mistrust that service providers will be able to connect with immigrants from different cultural backgrounds.

For many immigrants, struggles with mental illness are compounded or even created by the circumstances they encounter when they arrive in Canada, says Celina.

This includes linguistic, cultural and social isolation, particularly among seniors. For many, this isolation also stems from protracted periods of unemployment, particularly when that unemployment is the result of discrimination or lack of credential recognition.

“When you move to another country and you need to learn a language and the system is different, it’s very easy to feel that you are incapable, that you’re not good enough,” says Celina.

The experience of racism or discrimination also exacerbates people’s experience of mental illness.

“People blame themselves for their weaknesses or their inability to deal with things, and it is important for us to understand the impact of racism and discrimination so that we understand that…what is going on in the community affects us.”

In the absence of evidence to tell them otherwise, many people blame themselves for their inability to thrive, says Celina. Given that many immigrants come to Canada understanding it as the land of opportunity, reconciling their own struggle with that idealized vision is a difficult task.

ISANS is currently in year two of the three-year Newcomer Community Wellness program. Rupesh Dhungana, mental wellness educator at ISANS, hopes that by the end of the project, they’ll have provided immigrant communities with a better understanding of the stigma associated with mental illness.

It’s also hoped that participation of immigrants in mental health programs will increase, along with the representation of immigrants on community health boards – representation that could help make health services more sensitive to the needs of immigrants. Ultimately, though, there’s no silver bullet; improving the mental health of immigrants requires demonstrating that society as a whole, and not just mental health services, cares about the needs of new Canadians.

“Cultural competency is not just being in a workshop, it’s a permanent process,” says Celina. “The host community has to acknowledge that in order to become a welcoming community it has to be open to differences in race, ethnicity, religion.”