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"Just scratching the surface": Mental health promotion for Punjabi seniors (Forums) Final Report
Abstract
This report summarizes findings from two forums, held in Abbotsford and Surrey, British
Columbia in April and May 2011. Their purpose was to explore the extent to which community
services targeted at Punjabi seniors at these two locations address the social determinants of
mental health, identified by Keleher and Armstrong (2005):
¨ social inclusion
¨ freedom from violence and discrimination
¨ and access to economic resources
At each of the community forums, older Punjabi men and women shared their experiences and
identified the barriers to accessing such mental health supports that they and many other
seniors in their community faced.
Service providers met in separate groups to discuss the nature and scope of the services they
provide and their perceptions of the benefits to their older Punjabi clients.
Key findings:
Punjabi older adults are hard to reach and a relatively vulnerable population in terms of their
mental health needs.
Social inclusion is an important determinant of mental health and wellness in this population,
in terms of the need to feel respected and valued, to have supportive relationships, to
participate in the community and to have access to basic human entitlements.
Family plays an essential role in Punjabi older adults’ mental health and wellbeing, both
positively in terms of providing support and sense of belonging, and negatively in terms of the
stress that dependency on other family members engenders, unmet expectations, tension
between generations that can lead to depression, conflict, violence or elder abuse, or
substance abuse, and lack of knowledge and awareness among and within family members to
assist elders with their mental health needs. Successful mental health promotion and
intervention programs inclusive of Punjabi older adults need to find meaningful ways of
involving families and younger generations.
Reaching out to Punjabi seniors by service providers and community groups is required in order
to address the seniors’ mental health needs. Knowledge of programs and services available to
this population needs to be increased, as well as awareness of mental health issues.
Access to mental health supports by this population can be improved by offering supportive
and inclusive services that reflect language and health literacy barriers, providing
transportation, child-minding for grandmothers with childcare responsibilities and employing
culturally-sensitive approaches to raising awareness of programs and mental health issues.
There are differences between the two municipalities in the way mental health supports for
Punjabi seniors are structured and delivered. In Surrey, service providers come predominantly
from the settlement sector and the same cultural background, while in Abbotsford, mental
health supports are provided mainly by mainstream community programs. It would be
beneficial to further explore pros and cons of the two approaches.
Service providers need additional supports in terms of training and resources (such as long
term funding to promote continuity of mental health supports). This team will further explore
the sustainability and capacity-building potential of promising practices and the development of
mental health promotion competencies amongst community service providers.
Supplementary resource (1)
Sikh religion emphasises that every human being, both male and female, is equally important, and each has the same position, status, rights, and opportunity to live this life as ordained by God. However, phrases like ‘one is not born, but rather becomes a woman or a man’ and ‘females and males are born, but women and men are products of enculturation’ shows that gender is not biologically determined but socially and culturally defined. This means being a man or woman is not ‘fixed’ but it is in the process of ‘being’—an active state constructed through social norms or pressures from certain authority. The discussion in many studies tend to pay more attention to men’s experience and the daily experiences of women are often not given much prominence. Thus, in this chapter, Sikh women’s experience of gender in a private domain i.e., the family institution, is explored through a phenomenological lens. This article tries to discover how Sikh women understand the concept of gender as suggested by the Guru Granth Sahib (scripture) and how it affects their behaviour so that it becomes a social reality in their lives. Qualitative data were collected via interviews with ten Sikh females to see whether the daily experience of the Sikh woman is influenced by patriarchal culture or based on the teachings of the Sikh religion. This paper also offers some recommendations to strengthen gender equality status among both genders in the private domain.KeywordsGender ideology
Guru Granth Sahib
PhenomenologyPrivate domainSikh women
Recent immigrant older adults and some visible minorities who have aged here—to whom we refer collectively as ethnic or ethnocultural minority older adults (EMOA)—both experience health inequities in Canada. These are primarily related to difficulties with the complex process of accessing suitable services and supports. However, Canadian research on the topic is extremely fragmented and hard to find, and knowledge users charged with designing policy and programs do not have the evidence they need to help them to address access barriers experienced by EMOA. This collection of literature reviews prepared by a team of multidisciplinary academics and multisectoral knowledge users begins the process of consolidating existing evidence. The Candidacy framework for understanding the complex construct of 'access' proved invaluable as a means of exploring the different questions posed by our knowledge user partners. The different dimensions of Candidacy, which take into consideration each of the micro, meso, and macro levels of analysis, unites diverse bodies of literature focusing on community networks, capacity building, community development, health literacy, patient-centred care and communications, cultural competence and responsiveness at the provider and organizational levels, and health care, cultural, housing and immigration policies.
This report is the result of a planning grant exercise which is detailed in the lay summary for the grant that supported it, below:
Recent immigrant older adults and some visible minorities who have aged here—together known as ethnic minority older adults (EMOA)—both experience health inequities in Canada. These are primarily related to difficulties with the complex process of accessing suitable care. However, Canadian research on the topic is extremely fragmented and hard to find, and knowledge users (KUs) who design policy and programs do not have the evidence they need to help them to address access barriers experienced by EMOA. Effort is needed to consolidate existing evidence and design research that fills knowledge gaps with respect to access so as to generate a decision-making tool that can guide KUs in their decisions across different health and social care contexts. Our team of 13 multidisciplinary academics and multisectoral KUs is uniquely positioned to meet this challenge. First, however, it is essential that we convene to ensure that we share a common understanding of ‘access’ and the requirements of CIHR’s ‘Partnership for Health System Improvement’ (CIHR) competition that we will target to complete this work. With the proposed planning grant, students hired by each pair of academics and knowledge users in six sites from British Columbia to Newfoundland will review the EMOA literature on topics of interest to the KU on their team. Each will produce topical reports identifying the different dimensions of access that are evident in those studies. These will inform a presentation that the KUs will make about their interests and understanding of access at a 1.5 day face-to-face meeting of team members in Vancouver in June 2014. They will also be consolidated into a single report that will form the basis of discussion at the Vancouver meeting and a peer-reviewed publication. The meeting will provide an opportunity to consolidate our understanding of access and its relationship to our KUs interests and to identify our strategy for applying for funding in Fall 2014.
Reuniting immigrant families has been considered an important goal in Canadian policy (Citizen and Immigration Canada (CIC), 2006). When an elderly relative is sponsored under the Family Class immigration category, the sponsor makes an unconditional undertaking of support for a period of ten years to the Minister of Citizenship and Immigration. This is a longer period than for any other Family Class group. In addition to their legal status as dependents, sponsored seniors–the majority from India and China–are left financially and socially vulnerable by a constellation of cultural, situational and structural factors. Based on case studies of the South Asian and Chinese immigrant populations by authors, Koehn and Hwang, and the legal expertise of author Spencer, we conclude that Canada’s laws and policies have an important effect on intergenerational tension, the senior’s status, social isolation, as well as the risk of abuse and neglect or domestic and workplace exploitation. These factors can influence access to essential services such as housing and health care services. While further evidence is needed, findings from preliminary studies indicate the need for policy-level revisions as well as other approaches to reducing the vulnerability of this significant subpopulation of ethnic minority seniors.
The ‘Barriers to Access to Care for Ethnic Minority Seniors’ (BACEMS) study in Vancouver, British Columbia, found that immigrant families torn between changing values and the economic realities that accompany immigration cannot always provide optimal care for their elders. Ethnic minority seniors further identified language barriers, immigration status, and limited awareness of the roles of the health authority and of specific service providers as barriers to health care. The configuration and delivery of health services, and health-care providers' limited knowledge of the seniors' needs and confounded these problems. To explore the barriers to access, the BACEMS study relied primarily on focus group data collected from ethnic minority seniors and their families and from health and multicultural service providers. The applicability of the recently developed model of ‘candidacy’, which emphasises the dynamic, multi-dimensional and contingent character of health-care access to ethnic minority seniors, was assessed. The candidacy framework increased sensitivity to ethnic minority seniors' issues and enabled organisation of the data into manageable conceptual units, which facilitated translation into recommendations for action, and revealed gaps that pose questions for future research. It has the potential to make Canadian research on the topic more co-ordinated. Also available at http://pubmedcentralcanada.ca/articlerender.cgi?accid=PMC3693980 (open access)
The objectives of this thesis are twofold: first, it aims to elucidate the experience of immigrant Punjabi women sponsored in their later years by sons and daughters already living in British Columbia, Canada; second, it examines the impact of immigration legislation on that experience. Family Class immigration legislation provides for the sponsorship of elderly parents on the condition that the sponsors support them for up to ten years. This stipulation, which enforces financial dependency, is examined in light of Indian cultural norms pertaining to filial duty towards aging parents and the changes that occur within the Punjabi family in the Canadian context.
The sample of sixty-two is stratified among five subsets comprised of (1) twelve elderly Punjabi Sikh women, (2) fourteen elderly Punjabi Sikh men, (3) twelve younger Punjabi Sikh women, (4) eight South Asian community leaders, and (5) sixteen South Asian service providers. All participants are currently residents of the Lower Mainland of British Columbia, Canada. Data were collected by myself in the form of open-ended interviews.
The information collected covers a broad range of topics so as to reflect the entirety of the elderly woman's experience in her new home. The application of Nancy Foner's interpretation of the Age Stratification Model, as set out in her ethnological work, Ages in Conflict: A Cross-Cultural Perspective of Inequality Between Old and Young (1984), facilitates the extraction of some prevailing trends from within this rather complex mosaic. Nonetheless, Foner does not lose sight of the multifactoral nature of relationships between individuals of different age strata. While the health and social services available to elderly Punjabi women in Canada far exceed those they might expect in India, many suffer considerable social losses once they join their children in this country. This is especially evident in the relationship between mother-in-law and daughter-in-law. Oftentimes, the daughter-in-law who sponsors and houses her husband's mother assumes the upper hand. In India, it is usually the young bride who occupies the most subservient position in her husband's home. In their efforts to secure some degree of respect in the sponsor's home, many elderly parents go out to work as farm labourers. Consistent with cultural mores which mandate that parents support, rather than extract from a daughter, elderly couples sponsored by daughters often feel they should establish some degree of independence as soon as they are able. Immigration legislation stipulating long-term dependency of the elderly couple on their sponsors further shapes their experience in this country, and may ultimately contribute to the incidence of elder abuse in this population. The term abuse is used here in its broadest sense to indicate not only physical manipulation, but also more insidious expressions such as neglect, forced confinement, or financial manipulation, for example. Several policy recommendations emerge from the study, not least of which is the suggestion that the dependency period be reduced to a maximum of five years or less.
In partial fulfillment of the requirements for the degree of Master of Arts, Department of Anthropology. Thesis (M.A.)--University of Victoria, 1993. Includes bibliographical references. Microfiche.
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