Nerve-racking Canada

Immigrants tend to enjoy better health than the local population at the point they land in Canada. Yet the strains they have to deal with from the moment of their arrival can have a huge affect on their mental well-being.

Academics have called this phenomenon “the healthy immigrant effect.” Due to the screenings immigrants must undergo before being granted permanent resident visas, those who enter the country are typically in good shape. But as time passes, they lose that advantage. In fact, according to a study published by Citizenship and Immigration Canada (CIC), three out of 10 immigrants who have been in the country between two and four years suffer from emotional problems they didn’t have before.

Part of the challenge is the barriers that can make it hard to get jobs in their fields of expertise — particularly for those from developing countries. Many are left to take on minimum wage “survival” jobs. Studies have found that low earnings, combined with the demands of beginning a new life in a new country, can lead immigrants to live at or below the low-income cut-off during their first decade in Canada.

That can feel like a betrayal of what immigrants expected when Canada beckoned. A betrayal that produces an “unacceptable waste of human potential,” as the former Minister of Employment and Social Development Jason Kenney said at a press conference held in Vancouver in April 2014. For Kenney, the fact that so many immigrants are unemployed is “a denial of what Canada is supposed to be.”

The federal government’s main strategy for tackling this issue was the creation of the Express Entry. The new immigration program was launched in January 2015 and it is supposed to match newcomers with existing work positions in their fields. At the same time, the government launched a series of initiatives that aimed to ease barriers for existing permanent residents, including a loan program to help immigrants pay for the assessment and recognition of their foreign credentials.

But back in 2012, the same Minister Kenney revoked the Canada-B.C. Immigration Agreement, and agencies serving immigrants began experiencing funding cuts that led to the closure of projects like the Trauma Services for Immigrants and Refugees program. This despite studies like those carried out by Morton Beiser, founding director of the Toronto Centre of Excellence for Research on Immigration and Settlement, that have been warning about the correlation for more than a decade.

In 2014, the Cross Cultural Mental Health program, which benefited from CIC funds and used to run psychotherapy groups in nine languages, was integrated with the outpatient program at Vancouver General Hospital. Immigrants used to have a direct line with someone who speaks their language. Now, they must call general intake, and if there’s a language barrier, a third person is brought in to direct them. The intake must include a referral from a general practitioner and the psychotherapy provision is short term and has long waiting lists.

It takes an average of five years for a new immigration system to show its first outcomes, says UBC expert in immigration issues Daniel Hiebert. Only time will tell if the Express Entry will actually reduce underemployment rates among newcomers and all the losses that come with it, including that of mental health.

But what’s the scenario for those already in Canada who are experiencing economic constraints, intense stress, and diminished support?

As mental health services for immigrants phase down, the load shifts to general practitioner physicians, who already deal with a big chunk of the mental health cases in the general population. Now they will have to take on more cases, in which language and cultural differences may add extra layers of complexity.

María’s depression dates back to an era prior to the financial cuts. Still, she chose to rely on her Spanish-speaking family doctor to assess her situation and prescribe antidepressants. She continues to rely on the same doctor. “Please do something! I’m way too sad!” she remembers telling the physician.

María also told her doctor about a short depressive episode she had experienced back in Mexico. She had been trying to raise her children while protecting them from what she saw as opposing values in her own family, who were always feuding about cars or new houses. “I didn’t want my children to learn they could be bought out with presents,” she said. This was during the mid-1990s, when the country was led by a man María calls the “odious” Salinas de Gortari. Inflation was soaring, wages dropped by almost 60 per cent, interest rates grew almost every second and the kids clothing store María owned with her husband was struggling.

The “Tequila Crisis” turned out to be overwhelming for María. She asked a psychiatrist for help and after six months of treatment she was back on track being a mum, trying to refloat her business, exploring the possibility of opening an architecture studio, and starting to entertain the idea of moving elsewhere.

“We didn’t even consider the United States because of the racism against Mexicans,” says María. Canada was giving visas, and it only took about a year for the family to get permanent residency under the entrepreneur category. Things were starting to look up… until they landed at the Vancouver airport in December 1996.

Her husband, the main applicant, had to join a restaurant crew as a dishwasher while dealing with the paperwork that would allow them to open their Mexican crafts shop at Lonsdale Quay Market. Once the business was open, he worked in both places. María joined him at the store when she could, while also attending English lessons and taking care of their two preteens. The savings they brought after selling two trucks, two cars, one apartment, a piece of land, and the clothing business drained quickly. The craft store soon failed — a story all too common for immigrants to Canada, according to government surveys.

María’s husband went back to the job-seeking market, uncertain of whether he would find a match for his trading skills, which he had enhanced with some courses at the British Columbia Institute of Technology. He stayed on as a dishwasher and took a second gig, first as a customer service representative, then selling lottery tickets, then as a courier. “It was so difficult to find something stable because they asked us for the Canadian experience!” says María. The uncertainty triggered a regular convulsive trembling reaction in her arms. “I don’t know how to explain it, but I was feeling very, very, very insecure,” she says.

She had those tremors many times during her language classes. “People just stared at me, like saying, ‘What’s going on with her?’ And then came the laughs,” she says. María cried on her way home, she cried at home, she cried walking back to school the next day. When she had to write an essay, depression was always her first choice for a topic.

At home, she sneaked out to cry so her kids wouldn’t see her. Some days, it was too difficult to leave the bed. “I remember my daughter coming in and asking what was it that I had. I just tried to explain to them that I missed the place where we used to live way too much because I had lived there longer.” She found it difficult to explain the complexity of the situation to her two teenage children.

“I was feeling very, very, very insecure,” — María

Morton Beiser has been studying the mental health of Canadian immigrants for four decades. He says that predisposition, understood as both genetic determinants and the pre-migration stressors a person could have been subject to, should be taken into account when evaluating individual cases.

However, the psychiatrist says, when people come to Canada, their health fades due to the challenges that come with moving: having to learn the banking system, how to write a résumé or how to properly answer the phone when a prospective employer calls. Together, all of this can give many immigrants a sense of insecurity and incompetence.

Some come to feel ill in both their former and their new home. This unease threatens their identities and, for many, leads to self-rejection, experts say. This is especially the case for economic immigrants, who also face a loss of social status when they come with experience in, for example, business management, but end up behind a cab’s wheel. The study Who Drives a Taxi in Canada, prepared by Li Xu for CIC, reveals that there are more than 13,000 immigrant taxi drivers in this country who hold post-secondary degrees — in engineering, computer science, marketing, and other professional fields.

To say this plummet in status and usefulness is “just part of the whole cost of moving from one place to another, that lets us off the hook,” Beiser says. His own research shows that structural barriers that block opportunities for newcomers, especially in terms of employment, become additional stressors.

“When acculturation changes aspirations, and the means for achieving ambitions are slight, mental health disorder is a highly likely result,” Beiser has written. The most common ailment he has seen in his practice is depression. According to a report by CIC, a quarter of men and one third of women immigrants who had been in Canada between two and four years by 2012 were experiencing persistent feelings of sadness, depression and loneliness.

Beiser says the situation usually becomes a vicious cycle. The lack of opportunities to access meaningful employment results in hopelessness, and that despair further hinders an individual’s motivation to keep looking for jobs and reclaim a career.

“We select them very carefully, extremely carefully,” Beiser adds. “As a country that supports immigration, that encourages immigrants to come here and that holds itself up to the world — at least we used to — as a model of immigration, we should be doing more to ensure that those kinds of things that create mental health problems don’t occur.”

“That thing about ‘Canadian experience’ became an issue in our lives. I came to hate it! How am I going to get Canadian experience if they don’t give me a job?” María recalls.

When she realized her credentials were considered nothing more than a piece of parchment in Canada, she decided to go back to school. But while she spoke Parisian French, she first needed to improve her English to get a job in Vancouver. She completed those classes in 2002, then began retraining in computer-aided design with the hope of going back to working in architecture.

The year after she finished her courses at Vancouver Community College, María went to more than 20 interviews. But no one hired her. She worried she wasn’t interacting with employers in “a Canadian way.” So she started writing possible questions and practicing the answers. After school, her children sat down with her to listen and teach her customary things. “You shouldn’t say that you prefer to work in the mornings. You have to say ‘yes’ to whatever they ask you to do,” her son warned.

María ended up settling for “whatever.” After a couple of temporary jobs, she joined a kids’ footwear factory as a seamstress, even though she had little sewing skill. The philosophy of “saying yes to everything” eventually led her to the quality control division. Being the only employee in the afternoon shift, she dared to ask if she could put her professional skills to use. “I told my boss that our area was a little bit disorganized and that if he’d let me, I could make it spatially functional,” she says.

After she heard “go for it,” María got home and opened AutoCAD on her computer; she had barely used the software in a year or so. Still, she quickly remembered how to handle the program and started to work on an area plan. Originally, the tables and shelves in the 140-square-metre quality control room were aligned in a row; María turned that distribution into an equilateral cross. “I thought we would be more interconnected like that,” she says.

In her new configuration, employees just had to turn their chairs and walk counter clockwise to move from the station where the leather pieces were being evaluated to the table where the components of the shoes were assembled. María left the central area opened to facilitate that movement and to be used for additional tasks.

When her boss realized that the new configuration worked and that María was proficient in AutoCAD, he involved her in projects where she had to determine the maximum, minimum, and median measures of the shoes’ materials. “That is, for example, how flexible a spring has to be,” she explains. Eventually, María was asked to design the shoes’ specifications manual.

But her manual went to waste. In 2009, the factory moved to China and everybody was laid off. María’s self-confidence was crushed. By then, she says, “I was older and who knew if I was going to be lucky enough to put my knowledge into use again.”

She was right to worry. Not even with the help of settlement agencies was she able to get a second chance, so she started applying for “whatever” again. When the pharmacy offered her a stock clerk position, she didn’t hesitate. That was four years ago.

María says the work makes her joints ache. She avoids passing by the store during her days off. She barely socializes with her co-workers. Still, she is resigned to doing the job, even beyond retirement age.

It’s not just about having an income; it’s also about staying active. “I need this,” she says. Yet, keeping busy hasn’t helped María to stop taking antidepressants, as it did back in Mexico. “I start feeling anxious again and I say, no way! I don’t want to feel that thing ever again!”

María reads. She reads a lot. She reads about many things and her condition is one of them. After reading Overcoming Anxiety for Dummies, she tried keeping a notebook. “I wasn’t capable of rereading it because I was afraid of all the negative thoughts I was having. At the end, I could reread it but I didn’t burn it, which was how the therapy was supposed to go,” she says. Her biggest fears ended up ripped in the garbage. “I didn’t set them on fire because I was afraid of ending up in jail,” she jokes.

For María, information is power, and reading about depression helps her keep control over her life. “Reading allows you to know a little bit more about yourself,” she says with a smile. That’s why, too, she reads about history and political psychology. “Knowing what has happened provides you with the right perspective to make better decisions.”

This approach, she says, has allowed her to stop asking “Why me?”

“The better part of the world”

Rajesh has never asked himself “Why me?” He has tried to remain positive even in the darkest times. “When you dream big, you get big hurdles,” he says.

Since Grade 10, Rajesh wanted to move from Calcutta to “the better part of the world.” But before doing so, he thought he should have a degree and some work experience. After three years practicing accounting in his hometown, he researched the steps needed to move to the U.S. But he soon set his sights on Canada, because it “was open to all professions.” He applied as a skilled worker.

Immediately after arriving in Vancouver, one of his relatives connected him with an engineering company and he started to work. But when the company downsized, the newest workers were fired.

Soon, Rajesh learned how important it was to have Canadian qualifications. But figuring out how to pay rent was a higher priority than going back to school. Still, he applied online for as many jobs as he could while taking temporary positions — “in whatever.”

The contacts he established through the Internet led him to London, Ont., and then to Ingersoll, an industrial and cheese-producing town of some 11,000 residents by that time. There, he wore more hats — and safety goggles — than he can count: labourer at a food processing plant, mechanic coating rotors with anti-rust products, cheese maker after being told he was going to do accounting. “Ugh! If you love cheese, never work in a cheese factory!” Rajesh says. He recalls the strain of juggling two or sometimes more jobs at once — an experience that reflects more than half of skilled immigrants to Canada, according to statistics.

By scrambling for pay, he was able to rent a bachelor suite and have a car. But the aftermath of the 2008 financial crisis hit, the rotors company downsized, the temp agency he was in touch with wasn’t able to get him any more gigs, and he had to ask for EI.

Rajesh doesn’t remember the year, but says “it was when GM Place became Rogers Arena.” Being a huge Vancouver Canucks fan, he connects many dates with important events related to his team.

After the layoffs, Rajesh moved to Victoria and found a bag-boy gig at a Safeway. He was embarrassed to find himself carrying groceries and arranging carts. “That’s a job that’s only meant for bad boys, because all you do is carry bags for other people; it’s punishment,” he says with a chuckle.

For the next seven years, he took any job he could, from heavy lifting to selling second mortgages, artificial lawns, cellphone plans, and credit cards. Finally, he decided it was time to have his accounting credentials assessed and to start taking the prerequisites to get the CPA certification with Thompson Rivers University. He registered and promised to himself he would hit the books every night, after his eight-hour shifts.

But his home life proved not conducive: he had a girlfriend who was a heavy smoker and who was trying to raise her two teenagers. “The whole scenario was against the study,” he says. So he just kept throwing in the towel.

He broke up with his girlfriend and moved back to Vancouver, determined to not let another survival job become more important than his final goal. “I had to do it for myself, I had to do it for everyone who knows me, including my parents,” he says.

He started taking courses at UBC Robson Square. Everything seemed on track. He didn’t care when his boss at a 7-Eleven fired him and told him that accounting was a dying industry. He also didn’t care when he had to take tests on Saturdays and couldn’t be at his new position as a customer service representative in a cell phone company. His mind was set.

But then came the string of events that landed him in the all-night McDonald’s. His new application for employment insurance took two months to be approved, and while he waited he was thrown out from the room he was renting. He found himself lining up at 6 a.m. at the Belkin House shelter, where he slept for 15 nights in the same room with men he had never met and whom, honestly, he feared. “If someone comes and asks me how much my computer cost and what do I have on it...” he says.​

“The problem is more complex than any easy solution,” says Daniel Hiebert, who teaches Geographies of Migration and Settlement at UBC and is regularly consulted by the federal government on immigration policy.

“Why do we think it would be possible for a person coming from another set of cultural sensibilities, another education system, another work system, to come to Canada and to just carry on as if nothing has changed? Everything changes, all of those things: the language of work changes, the nature of work changes, the definition of skills changes, so I don’t think that it’s unreasonable to expect there to be a set of challenges,” he says.

Playing the role of devil’s advocate, Hiebert says it all depends on the “prism” through which people look at the issue. A different approach, he says, is acknowledging that Canada has structured its immigration system and adjusted its policies to fill gaps in the labour market supply with newcomers. “Therefore we should have this relatively smooth transition from labour market one to labour market two,” he says.

A 2006 Statistics Canada study found that around half of established immigrants who hold university degrees are working in occupations with low educational requirements. For women, the share of underemployed is six out of 10; for men, it’s four out of ten.

Skill-underemployment is usually connected with income-underemployment. This means that by not working on their professions, newcomers earn less than they should. But they also earn less than their local counterparts. In urban areas, for example, Statistics Canada found immigrants’ wages to be one third of those earned by Canadians with the same educational attainment. Most of those newcomers are college or university graduates.

Hiebert understands that the long-term non-recognition of the skills immigrants can also have severe effects on their emotional health and on the well-being of their family units. Thus, “these are not things that we should speak of as if it’s easy,” he says.

That's why, he says, the government created the Foreign Credential Referral Office in 2007 and a number of different initiatives under its umbrella. At the same time, it provides financial support — with recent cut-offs and variable reach — for free English language training and for a variety of programs led by private immigrant settlement serving organizations and agencies, like the Immigrant Employment Council of B.C. The idea is to ease immigrants’ entry into the job market and to bridge them with employers.

But employers, at the end of the day, place little to no value on labour market experience outside Canada. Also, immigrants’ credentials must be assessed by a recognized local body. That “takes time and costs money,” the CIC website states.

For Hiebert, the main problem is that the points system gives immigrants hope. “It is seen as kind of a contract. In other words, ‘If we fulfill our obligations on our side of the contract, you should fulfill your obligations on your side of the contract.’ And what has been made clear, but I think not in a way that people process, is that the government actually can’t fulfill the contract; it doesn’t have the capacity to do that, the government doesn’t give people jobs,” he says.

****

Rajesh is an example of Hiebert’s assertion. He doesn’t blame the government for his inability to put into practice his accounting background, but he doesn’t exempt it from responsibility either.

“There is no clarity,” he says. “After the interview is done, they need to sit down and tell you: ‘Your qualifications have zero value in my country. Do you still want to move there?’”

Had he been asked that question, he would have said “yes” and gone straight to school. But since he didn’t have that chance, 13 years later he finds himself putting up with whatever it takes to be recognized as an accountant, even if that means sometimes having only coffee in the morning and a little rice for dinner.

At the Belkin House shelter, the lack of privacy made Rajesh uncomfortable. He hated having to listen to the snores of strangers at night; waking up and seeing a line of men brushing their teeth at the same time; not being able to stay in the common areas without being asked what he was doing on his computer over and over again.

As soon as he’d wake up, he’d run off to UBC Robson and find a table. Tapping on his laptop, his legs fidgeting, standing up from time to time to have a smoke outside, he kept thinking about his living situation and the $1,200 he had invested in his strategy and auditing courses.

“What’s my designation for?” he would ask himself to find determination. “I have a big test this weekend. I have a big test this weekend,” he repeated every week. He wrote papers, read, talked to students, and stayed on campus until closing time at 10 p.m. If he didn’t want to lose his bed, he had to be back at the shelter by 11:30 p.m., before the lights went off. “What a waste of time! I could be studying,” he kept thinking.

But Rajesh did not pass his exams. He fell short by just five points. He didn’t show up at the Robson campus for the rest of the summer.

Resilience. It is usually defined as a series of traits that involve having hope and willingness to ask for and accept help, being resourceful, building relationships, and having flexibility to let the unattainable go in order to adapt one’s dreams to the new situations life presents.

Almost by definition immigrants are resilient… or they learn to be. After experiencing feelings of betrayal due to the impossibility of working in their professions, many pass through a phase of feeling a sense of limbo before becoming resilient.

Andrea Sola, a clinical counsellor who has worked with immigrants and refugees for a decade, explains this “limbo” as both material and existential uncertainty. “The experience with the clients, with the people I meet, is like: ‘Ok, I grieve the loss and I accept this is not going to happen. Ok, what’s next?’ And then is when ‘breaking bad’ [happens], you know?”

That “breaking bad” moment could take the form of a depressive episode or something physical, like a heart attack. It could be the result of years of worrying, of always trying to stay afloat, of having difficulties sleeping, of experiencing anxiety and stress.

Sola emphasizes the need for cultural- and language-sensitive guidance to avert that critical point. Such guidance can help new Canadians create a narrative out of the unexpected outcome of their voluntary migration, while recognizing both the peculiarities of the resettlement experience, and the fact that people from different places have different understandings of mental health. She worries about the shrinking of services targeted specifically toward immigrants’ needs.

“You have to solve this crisis and do follow up, and put the resources in place. If this is ongoing, and going, and going, you are building up,” she says.

Research supports Sola’s view. Different papers published by Ishu Ishiyama, an expert in multicultural and cross-cultural counselling at UBC, show that immigrants need specialized counselling sessions to counter pervasive unhappiness caused by experiences such as employers not recognizing their credentials, or being made to feel incompetent because of a heavy accent.

This is why Sola is against having general practitioners provide mental health care. “It’s just emergencies, crisis intervention, you know? Medication, emergency rooms,” she says. Such emergent care can have an extra cost to Canadian society, she says, as does the high risk of relapse when there is no followup care.

Accepting depression as lifelong

When María was studying at Vancouver Community College, she went to their counselling services to see if she could substitute therapy for antidepressants. But the experiment did’t work. “Maybe it was because of the language. I don’t know,” she says.

That experience discouraged her from seeking out other services. She decided to remain on medication, to assume that her condition was now lifelong. Meanwhile, she and her husband continue with their self-imposed bibliotherapy.

These days, María is revisiting authors she had read before. “Because I carried on their teachings to the letter!” she laughs. One of those authors is social psychologist Erich Fromm. A teaching that sticks in María’s mind is the idea of the revolution of consciousness. “I believe that if you want change you have to start with yourself,” she says.

A reason for mornings

Dark suit, silver tie, his hair combed neatly back.

That’s how Rajesh leaves the Burnaby house where he now rents a room. If it’s Monday, he might be sleepy after an evening of drinking beers and watching the Canucks game with his landlord, a divorced father who allowed him to move in without a cash deposit.

After knocking on accountants’ doors for a week, offering free work and getting “no” for answers, he finally landed a chance to do a practicum at a local firm. “There’s a reason now for mornings,” he thinks every time he walks through the woody area that leads him to the Skytrain.

Even if he doesn’t get paid, he’s glad he’s getting a chance to show recent Canadian experience in his field. He has flexible hours, so he’s able to continue with the courses he didn’t finish during the summer. “If you really think about it, all the hardship that I went through, not that I’m proud of it, but I can pat myself on my own back and say, if I can do it under that stress level and I missed it just by five marks, I passed!” Now, he studying auditing, IT, law and strategy modules online, outside of the usual Facebook distractions.

Once he’s done with those, he has to undergo a paid professional practice which would allow him to get into a professional education program, which will eventually allow him to get into auditing. “Ever since I can read, I’ve wanted to be an auditor,” he says.

Why start from scratch again? “Because I don’t give up. These are hurdles,” he says.

Rajesh’s fancy suit goes with a big smile, especially after he stops to get his favourite black coffee at a Tim Hortons near Vancouver’s Joyce SkyTrain station.

María also likes that coffee, and sometimes buys it at the same shop. It’s her reward for five hours of putting bottles of lotion in the correct order and, as fast as she can, tagging them with the proper price. Rajesh couldn’t do that job. He used to drop the products when he was in charge of the beauty aisle at the same pharmacy.

María and Rajesh don’t know each other. Their times working at the drug store do not overlap. But their paths invisibly intersect as they wander the same shadowy track of underemployment that consigns too many immigrants to melancholy, and gives lie to Canada’s claim to being a land of opportunity.