Community Supports for Mental Wellness of Punjabi Seniors – Punjabi Seniors Wellness Coalition Cross-Cultural Mental Hea

1. Community Supports for Mental Wellness of Punjabi Seniors – Punjabi Seniors Wellness Coalition Cross-Cultural Mental Health Conference 2011, Vancouver, BC

2. Outline • How and why the Punjabi Seniors Wellness Coalition was formed • Rationale for focusing on ethnocultural minority older adults • Two forums: the process and objectives • Punjabi Seniors focus groups • Service provider workshops and focus groups • Common themes • Next Steps

3. Punjabi Seniors Wellness Coalition

4. Older Immigrants & Mental Health • The risk of mental illness is higher among those who migrate after age 65 • In Canada, older immigrant women from Chinese-speaking and South Asian countries are especially prone to depression • Mental health of EMOA is affected by common experiences of resettlement stress, poverty, racism, intergenerational conflict and family separation • See Spence, M. & Koehn, S. Visions: BC’s Mental Health & Addictions Journal, vol.6 no.3, 2010 (http://www.heretohelp.bc.ca/visions)

5. Key factors

6. Forums • Community forums in South Fraser region: • Abbotsford (April 6th, 2011) • Surrey (May 10th, 2011) • Participants: • Older Punjabi men and women:26 (Abfd) & 20 (Sry) • Community service providers - 14 at each (also completed pre-workshop ‘inventory’)

7. Objectives • Identify sources of marginalization specific to Punjabi seniors • Identify ‘promising practices’ and community assets for mental health promotion • Identify challenges to the efficacy or sustainability of these community • Identify how community capacity can be increased and supported

8. Determinants of mental health

9. Forum Format • Guest Speaker re: mental health (Punjabi) • Outline of Day’s Events (Punjabi & English) • Group Sessions: • Punjabi Older Men & Women, separately (Punjabi) • Service providers (in English): BCHC training and inventory report; group discussion • Lunch (local, Punjabi) • Summary and questions (Punjabi & English)

10. Seniors’ focus group questions • What can you tell us about the programs you attend, if any? • We’d like to understand what’s most important to people about the programs they attend, so we’re going to ask you about different kinds of benefits that they may offer. Please can you tell us if and how the program you attend has made any difference in each of these areas for you? • What have you enjoyed the most and the least when attending these programs? • There are others that don’t or cannot attend these programs: Why do you think that is? What can we do about that?

11. Programs attended – Gurdwara, MCS (gardening, trips), libraries, cards at rec room, health forums Willingness to attend – when aware of services Barriers – lack of awareness; language; transportation; lack of social interaction; lack of guidance from doctors Lost respect - need to go to places where they are understood Promoting cultural exchange (values/cultural differences) Interested in: programs to educate youth; cultural and political gatherings; meeting new friends; learning about activities in their city; health info; more field trips; Punjabi speaking coordinators Abbotsford Men

12. Programs attended – PICS (workshops, computer classes, navigating legal system); community centres Willingness to attend – when aware of services Barriers and stressors – language; transportation and finding location; lack of financial resources; being dependent on family; lack of time if working; neighbourhood isolation; discrimination Need for independence – finding a job, driving licence, more income (pension, etc) Need to be respected (judged negatively because of others’ “bad reputation”) Interested in: programs taught by seniors in multicultural settings, trips, co-ed programs Surrey Men

13. Abbotsford Willingness to attend Respect and control Social inclusion Intergenerational gap Surrey Willingness to attend Discrimination Social class, age Bad reputation (Newton, etc.) Respect and control Work Driving Money Sharing skills Summary - Men

14. Programs attended – Sikh temple (computer, road signs, ESL, making friends, community programs for caregivers) Willingness to attend – when aware of services Barriers – lack of awareness; timing of programs (care giving responsibilities); transportation Programs helped build self-confidence, socialize, get out of the house and learn Need to feel recognized, respected, encouraged Interested in: baby-sitting with groups; more promotion (radio, newspaper, announcements at temples); trips (don’t mix) Abbotsford Women

15. Programs attended – mentorship/leadership programs, computers, temple, Indo-Canadian Seniors Centre, PICS Willingness to attend – when aware of services Barriers – lack of awareness; language; transportation; lack of resources; lack of time; care giving obligations Financial strain – stress because of low pension, high medication costs, etc. Family – both support and tension Interested in: programs to strengthen families; income assistance; health information; help with medical expenses Surrey Women

16. Abbotsford Family Barriers Timing Lack of awareness Transportation Lack of baby-sitting Respect Surrey Financial strain Barriers Lack of time Lack of baby-sitting Transportation Needs Self-esteem Family relations Summary - Women

17. Integral Capacity Building Framework & Social Determinants of Mental Health

18. Service provider questions • Given the work you have all done on the survey and what we have just discussed with respect to community capacity and the determinants of mental health, can you tell us if and how your programs and services currently address these determinants? • Is there something that you, your agency or another agency does already that is successful? (i.e. What are the ‘promising practices’ already out there?)

19. Service Providers - Abbotsford • Promising practices • Services in the community (walking distance) • Settlement workers at the ACS front desk • Services available for at least 10 years • Services for Punjabi mothers/grandmothers • Needs (field trips, baby-sitting, outreach) • Barriers • Reaching victims of violence and substance abuse • Transportation • Discrimination – groups, employers • Reliance on community services

20. Service Providers - Surrey • Holistic Programs • Need for holistic programs that address all quadrants and also “teach” the system (cultural competency) • Working together in partnership with other agencies • Family • Need to include family members to reach and help seniors • Dependence on family creates tension and can lead to violence • Barriers • Discrimination • Unreliable funding

21. Common themes • Inductive theme: family • Dependent on adult children for housing, financial support and banking, transportation to medical appointments and community programs, interpretation etc. • Challenges: role reversals, low self-esteem, ethical concerns with family interpretation, unmet expectations (busy families not available) • Families don’t recognize or ignore mental health issues: dementia, depression, etc. • Childcare: rewarding and restricting • Need to include family members, but with caution

22. Common themes • Inductive theme: reaching out • Seniors very interested in but not aware of local services and programs • Barriers: childcare responsibilities, transportation, language, shame/stigma associated with MH • Existing programs meet the needs of only 5-15% of Punjabi seniors in Abbotsford and Surrey • Raising awareness of programs and direct outreach (going to where people are) is essential • Multiple strategies needed: gurdwaras, multicultural media, translation, culturally responsive programs, addressing barriers (e.g. childcare, timing, transportation)

23. Common themes • Deductive: social inclusion • Vichealth framework: In a socially inclusive community or society, individuals are integrated into the community feeling valued, living with dignity with their basic needs met and their differences respected. • Punjabi seniors want to integrate and to be valued and respected within and beyond their own communities. • Social outings important, as are group activities, e.g. exercise programs with peers that promote friendships, combat social isolation • Cross-generational mentorship desired • Cross-cultural contact wanted but met with discrimination • Need guidance to navigate systems – health, housing, …

24. Next steps • Supports for service providers to fully promote mental health and wellness to their older Punjabi clients • Training: family violence, elder abuse and neglect issues; culturally responsive approaches to mental health promotion in diverse populations • Longer-term sustainable funding • Research • Holistic approaches to MH promotion • Pros & cons of providing services through community vs. settlement services • Evaluation of promising practices (Vichealth & Integrated frameworks)

25. Your feedback please! Contacts: • Dr. Sharon Koehn: skoehn@providencehealth.bc.ca • Satwinder Bains: Satwinder.Bains@ufv.ca • Maddie Addison: maddie.addison@cmha.bc.ca “Just Scratching the Surface” report:http://www.centreforhealthyaging.ca/documents/Just_scratching_the_surface-FINAL.pdf