The heroic mental health workers helping Syrian refugees recover from the trauma of war

In her 15 years of working with refugees and immigrants, Mary Tanielian has heard too many tragic stories. But she's also learned a lot about resilience and people's ability to overcome the harshest tragedies: witnessing the death of family members, rape, bombings and other brutalities of war.

Tanielian supports 27 Syrian families who settled this year in Langley through her work as manager of human resources and communications at the Langley Community Services Society.

A Canadian of Lebanese descent, Tanielian speaks five languages. She switches easily from English to a torrent of Arabic, peppered by colourful jokes. She greets hesitant Syrian refugees like old friends, exchanging high fives and laughter. She gives advice and coordinates with other groups to point out where there are gaps in service, where help is falling short. One of these areas is mental health for refugees.

"Mental health for refugees is huge. We're going to need more and more of it," Tanielian. "We need to understand the longevity this problem has, how the effects of trauma carries on for many years."

Resources still falling short

Settlement workers on the front lines describe a drastic reduction in funding and personnel for refugee mental health, and say that much more support is needed to deal with the 30,000 Syrian refugees who have entered Canada since last year. Federal funding of mental health care for refugees was drastically reduced under the previous Harper government, and hasn't been restored in a meaningful way, they say.

"In 2014, there was a huge de-funding of mental health. We only survived through provincial funding," says Provincial Refugee Mental Health Coordinator Mariana Vieyra Martinez, who works at Vancouver Association for Survivors of Torture (VAST). Founded 30 years ago, VAST helps not only refugees who survived torture, but also refugees in need of mental health support.

Immigration Services Society of B.C. (ISSofBC) has been one of the most important organizations in B.C. helping Syrian refugees settle.

Three years ago, ISSofBC shared $616,000 per year in provincial and federal funding between itself and three organizations offering free refugee mental health services — VAST, Family Services of Greater Vancouver and the Bridge Clinic. In April 2014, that funding was slashed to $260,000, after the federal government reduced its contribution to just $80,000.

And some non-governmental organizations are stepping in to the void where government-funded programs fall short. Earlier this year, United Way of Lower Mainland (UWLM) invested $158,000 in programs to help refugees overcome trauma. The funds were split between Surrey-based DIVERSEcity Community Resources Society, a nonprofit helping immigrants and newcomers, and MOSAIC BC, a charitable organization that assists immigrant, newcomer and refugee communities in Greater Vancouver.

B.C. Health Ministry spokesperson Lori Cascaden says that B.C.’s regional health authorities spent just under $2 million on services related to refugees from 2015 to 2016, including funding to existing clinics and the New Canadian Clinic in Burnaby and the hiring of language interpreters. It is unclear how much of that money went to refugee mental health.

"The government of British Columbia takes its humanitarian responsibilities seriously...We recognize many refugees may be suffering from post-traumatic stress and could benefit from community mental health services. B.C.’s regional health authorities have been working to develop programs that best serve the needs of incoming refugees and mental health supports and trauma counselling are one of the main areas of focus," she says.

Federal health minister Jane Philpott is now pushing for increased mental health funding, not just for refugees, but for Canada overall. And since taking office, the Liberal government fully restored the Interim Federal Health Program (IFHP), which covers basic health care for refugees, refugee claimants and certain other non-citizens, to $51 million annually.

This program helps cover "private psychotherapist services, if referred there by their primary doctor, and prescription drug coverage similar to what Canadians receiving social assistance are eligible for," according to Immigration, Refugees and Citizenship Canada spokesperson Isabelle Vigeneault.

Vieyra says government funding only covers 10 therapy sessions delivered by a psychiatrist or registered psychologist during the first year, and that the huge challenge was in finding professionals who were willing to take on refugees as clients. Vieyra says psychiatrists have to fill out all the paperwork and book language interpreters for refugees, which makes most professional psychologist reluctant to take them on as clients. She believes the current system makes it virtually impossible for refugees to seek the mental health help they need.

"We have interim federal health funding for just 10 therapy sessions for government-assisted refugees during the first year....The model is not community-based but just fosters more isolation. It doesn't work for the provider, nor does it work for the client," she says.

Some settlement workers described Syrian refugees who had emotional breakdowns and were in danger to their own safety, making it necessary for family members to keep a constant eye on them. But getting refugees help for symptoms like PTSD is a challenge in B.C.

Vieyra's team only has two full-time counsellors. She says it falls far short of the number needed to deal with the influx of refugees in B.C. this year.

"People call me and ask: 'how come there are no counsellors for refugees?' There is a gap we need to address," she says.

War and post traumatic stress

The war in Syria is an especially brutal conflict that has displaced half of Syria's pre-war population of 11 million people. As The New York Times highlighted in a recent article, a shocking number of Syrian war casualties are children. In September, 100 children died in Aleppo alone from air strikes and other attacks. Recent news footage of a distraught Syrian mother reacting to her son's death shows a glimpse into the brutal, traumatizing circumstances some families have escaped during their journey to Canada.

Even those who escaped Syria early in the conflict and took refuge in neighbouring Jordan or Lebanon experience displacement and migration trauma, says Vieyra.

Today, because of the restrictions around provincial funds, Vieyra's team is only allowed to use funds to serve refugee "claimants," which means people who come to Canada to seek protection from another country. Most Syrian refugees in Canada are not claimants, but are either government-assisted (GARS) or privately sponsored refugees.

Vieyra says that refugees suffering trauma are often misunderstood in Canada because people don't recognize the mental health impacts caused by war.

"We have Syrian kids who are triggered. They get flashbacks." Vieyra says. "Refugee kids might fight each other at schools because they've been exposed to so much violence. But is it really helpful to deal with this in the usual disciplinary way?"

Tanielian agrees that the problem goes overlooked, sometimes even by refugees themselves. Children who have experienced bombings may panic at the sound of Canada Day fireworks, while those who lived in dire poverty in refugee camps may fight desperately for supplies, believing there aren't enough to go around.

"I have some Syrian refugee parents telling me: 'My kids are acting funny, and I don't know what's wrong,'" she says. "And people laugh when I tell them their kids might have trauma. They say, 'oh, but our kids are so little.' But everything happens in the first three years. Stability, bonding, love."

MOSAIC BC, DIVERSEcity and United Way of Lower Mainland: programs to help refugees

Jeff Calbick, vice president of community impact and investment at United Way of the Lower Mainland, says support for mental health program was in line with the organization's historic mission of helping communities meet social challenges. He highlighted how United Way of Lower Mainland had partnered with DIVERSEcity in the past to help refugee families from Sub-Saharan Africa adjust to life in Canada, and were applying the lessons from that experience to help new Syrian refugees.

"We emphasize peer-to-peer support for refugees. At DIVERSEcity, we see the refugees who arrived in Canada a few years ago helping the new refugees adjust. They have the cultural nuances and language to deal with new refugees."

He says mental health support was often "woven in" to other support programs for refugees, such as parent-child education and language support.

Inside the spacious DIVERSEcity building in Surrey, a group of young Syrian refugees take part in therapy in a room filled with painting supplies. The youth smooth paint over small wooden boxes, which they will fill with items that make them feel emotionally stable. It's a well-known form of therapy known as a "self-soothing kit."

“We use this form of therapy in all of our camps for emotional regulation,” Carroll says. “The idea is that during stress or distress, a child can use the items in the box to self-soothe – it is used by many counsellors."

Carroll also says adults were benefiting from certain coping strategies taught by counsellors and therapists on site. One Syrian refugee who had settled in Surrey, Mohammed Alorfi, had previously felt unease around Canadian RCMP officers, even though they explained they were there to help newly arrived Syrian refugees. Alorfi used to work illegally while in Jordan in order to feed his young children, and was constantly in fear about being caught by police while on the job. After coming to Canada, he found himself struggling to breathe at the mere sight of a police station, and enrolled in a UWLM-funded settlement course that dealt with settlement issues "through a trauma lens."

"He talked to us about how learning to breathe through stressful times helped him, and he was using that basic technique every day," she says. "We have had a couple of other Syrian refugees agree to attend more formal counselling (prior to, I doubt they would have considered this). We are planting seeds, and some of the outcomes won’t be obvious to us for a while."

Who are you going to call?

While mental health counselling is accepted in Canadian culture, it's not a common practice in other cultures.

Syrian refugees aren’t necessarily at ease with the idea of therapy, Ruth Patta, a mental health counsellor at Langley Community Services Society who works with Syrian refugees, says.

"Most such community-oriented cultures have a 'structure' in place to take care of emotional or spiritual health,” Patta says.

Patta is a registered clinical counsellor who grew up in Kenya, where therapy and counselling is starting to become more widely accepted. Still, she says, in Kenya as well there's resistance to the idea of talking about personal concerns to strangers.

Talking about personal problems to others can feel like a betrayal or trust, Patta says.

"People would go to a great aunt or a spiritual leader in order to protect the family secrets. These are the very structures that are dismantled by war and migration. The contrast is that in Canada, if you're in need of emotional help, you would go see a counsellor. This creates a dilemma for the refugees and new immigrants,” she says.

“They need help — but who can they talk to, since their great aunt or trusted friend is no longer here with them? And how can they create new friendships when their constant fear and past experiences has taught them that war can breakout anytime, and even those perceived to be friends can turn out to be an enemies and use that information given against them? Because of these reasons, refugees may not actively seek out help even when they need it.”

While Patta may notice symptoms of depression, PTSD or trauma among refugees, that doesn't mean people recognize those symptoms themselves, she says.

Some clients describe feeling overwhelmed by a sweeping feeling of terror which comes and goes “like a storm,” even while walking in Langley’s quiet residential areas. Others report "extreme fear" that "drowns" them suddenly, in public or at home.

"Such things are likely indicators of trauma, anxiety or panic...The body remembers the original trauma and without treatment, it is stuck in that place," Patta says.

Men, she says, have a harder time seeking help than women, because of their cultural expectations and position in the family.

"Anxiety is a huge problem, though men seem to try to hide it. They're the head of the family and, they're expected to be strong for their loved ones."

While no statistics exist on how many Syrian refugees arriving in Canada have experienced torture, around 55 per cent of Syrian refugees coming to the UK have been tortured, according to a recent report from the British National Audit Office.

"There are many complexities and nuances. We've even seen people who don't want to speak their native language," Vieyra says, because it reminds them too much of a painful experience.

"When people don't smile as much as before, when they don't laugh as much as they did before, we track that, and we reflect on that together," she says.

Vieyra was optimistic that with the right services in place, refugees who have been in even the most extreme circumstances, can lead productive, happy lives in Canada.

"Some people recover in a year, other people take longer. It all depends on how we open the door."

She believes not all therapy has to take place in the form of one-on-one sessions with a counsellor, and that refugees often do better in community-based group talks that are mixed into everyday settlement programs.

Mary Tanielian from LCSS says she sees Syrian refugees in Canada are suffering from depression and deep anxiety due to missing family members. More than attending formal therapy, she suggested that they could recover much faster if Canada could bring over their relatives who could offer stability and emotional support while adjusting to a new country.

"It would be a huge relief for these families to reunite with their relatives in Canada," she says. "Many of them suffer from a deep sense of guilt for being here while things are getting worse and worse for their family. It would be a huge weight off their minds if they were reunited here."

Editor's Note: This article is part of a series on Syrian refugees in Canada produced in partnership with United Way of Lower Mainland. National Observer has full editorial control and responsibility to ensure stories meet its editorial standards.