Join us for the second season of Elevate Your Relationship Fitness, where we highlight mentors who merge creativity, scholarship, and impactful societal work. In this episode, host Radhika Sundar, a registered marriage and family therapist and clinical supervisor, speaks with Dr. Eric Jarvis, Associate Professor of Psychiatry at McGill University and director of the Cultural Consultation Service at the Jewish General Hospital.
Dr. Jarvis, a pioneer in cultural psychiatry, shares his insights on the mental health challenges faced by immigrants and refugees, emphasizing the importance of integrating cultural sensitivity in psychiatric care. From overcoming language barriers through professional interpreters to creating culturally sensitive treatment approaches, Dr. Jarvis offers valuable lessons for mental health professionals working with diverse populations.
Tune in to learn how mental health care can be made more accessible and effective for all, especially for those from immigrant and refugee backgrounds.
For more information, visit www.omfamilytherapy.com, and follow us on Instagram, Facebook, and X @omfamilytherapy. Access the free Elevate Your Relationship Fitness podcast on your favorite platforms, including Apple Podcasts, Spotify, Pandora, and more!
Elevate Your Relationship Fitness
Exploring Cultural Sensitivity in Mental Health Care with Dr. Eric Jarvis
Send us a textJoin us for the second season of Elevate Your Relationship Fitness, where we highlight mentors who merge creativity, scholarship, and impactful societal work. In this episode, host Radhika Sundar, a registered marriage and family therapist and clinical supervisor, speaks with Dr. Eric Jarvis, Associate Professor of Psychiatry at McGill University and director of the Cultural Consultation Service at the Jewish General Hospital.Dr. Jarvis, a pioneer in cultural psychiatry, shares ...
- Broadcast on:
- 01 Oct 2024
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- other
(upbeat music) - Welcome to the second season of our podcast series, Elevate Your Relationship Witness, where we spotlight mentors whose lives merge creativity, scholarship and impactful work in society. Hey, I'm your host, Radi Kasunder. I'm a registered marriage and family therapist and a clinical supervisor. As a student member of the Cultural Consultation Service at the Jewish Hospital in Montreal, I had the opportunity to shadow Dr. Jarvis on a few occasions while he was consulting refugees from the South Asian community. This has taught me valuable lessons on cultural sensitivity while dealing with immigrant and refugees in psychotherapy. Today, we are honored to introduce Dr. Eric Jarvis, an associate professor of psychiatry at McGill University and director of the Cultural Consultation Service and the Culture and Early Psychosis Program at the Jewish General Hospital. Dr. Jarvis is a pioneer in cultural psychiatry, focusing on the mental health challenges faced by immigrants and refugees. His work goes beyond standard psychiatric assessments, especially incorporating patients' diverse cultural backgrounds to ensure that care is both scientifically sound and culturally sensitive. A key aspect of Dr. Jarvis' work is overcoming linguistic barriers in mental health care. He advocates for using professional interpreters and culturally sensitive communication to ensure that language doesn't hinder access to quality mental health services. In addition to his clinical work, Dr. Jarvis is a researcher exploring the intersection of religion and mental health. And he plays a significant role in shaping transcultural psychiatry. As editor-in-chief of transcultural psychiatry, he leads efforts to integrate cultural competence into psychiatric practice. Hi, Dr. Jarvis. We are very honored to have you today on our podcast today. So-- Thank you for inviting me. So let us just start this conversation on mental health awareness, especially in young adults. So how do you perceive the current state of mental health awareness among young adults, especially after COVID-19? What do you think are the main challenges that they are facing in seeking help for mental health issues? Well, I think that our young people these days, I think they're actually pretty well informed. They have access to internet resources like never before. So they actually come with a lot of information. Sometimes the information is a little bit unregulated or maybe unrefereed information. So you have to make corrections a little bit. But I encourage them to keep looking. I mean, they're interested in mental health problems. They're aware that they exist. But it's just a matter of guiding them in the right direction. And they often will leave our consultations and they'll go and look up a lot of information on their own. So I'm overall kind of proud of them as a group. There always are individual people that don't have very much information. And maybe some people don't feel very embarrassed by mental health problems. But I think that over time, slowly, mostly young people we work with come to understand a lot better and have a much different view of mental health problems than their parents might or earlier generations. So I just see that how you are talking about this population as being gifted with another tool of information for them to know about whatever they are going through. So how do you think that social media or digital platforms impact their mental health? Do you think it's positive or there are negative aspects to that influence too? Yeah, social media has great power to make available, as I was mentioning earlier, information. And so this may be contributing to an increased mental health literacy in a lot of our younger people. But as you say, there are some problems with the internet. And people have noticed this for quite a long time. There are some young people who are very deeply involved in the internet, spend much of their time during the day, even in the night, on the internet, and have maybe not so many real relationships. So sometimes they might be on the internet to the exclusion of even participating with their families. So this is, of course, a downside. So we have to kind of balance some of the good things of social media, the information that's available, the quick connections, the convenience that comes from doing therapy online, which is easier to join in than in person for a lot of people. We have to balance that with this kind of exclusionary side of the social media, where young people aren't really very involved sometimes with the outer world. I really like the way how you put it. The balance is the strength. And so now with the back-to-school season, now what science should parents or educators or peers look for to identify early mental health issues in young adults? Well, when young people are having a problem with their mental health, they often have a change in their functioning. What do I mean by functioning? I mean that their school performance might start to decline. They may not do as well as they were before. They may have less interactions with their friends. So whereas before they were kind of interested in going out and meeting people, they may just kind of retreat to their bedroom. They may not have very much motivation to do the things they did before. They may seem to have lost interest. So these are often some of the common signs that a mental health problem is developing. So is it like any early intervention that we can just address? Will it make a difference? Yeah, early intervention, the reason that we try so hard to find young people early is that when a person has a mental health problem, the time that they're ill takes them out of their regular activities. So whereas most young people are studying, they're working, they're gaining experience, they're developing friendships, intimate relationships for the first time in their lives, those are all healthy good things. When a person becomes, has a mental illness of some kind, they often sort of stop doing those things. And for a young person who's like 18, 19, 20, if you're kind of out of commission for one year, that's really a long time. So early intervention, the goal of early intervention is to bring some resources to bear on the problem. And then the young person can kind of get treatment, can get help, encouragement, and guidance. They can minimize the amount of time that they're ill and get back to their regular activities that will help them to develop properly. Well, that's an excellent piece of information that the audience are going to love. So in your vast experience, what do you think are some of the common barriers that young adults encounter, especially when trying to access mental health care? Because this is, I'm talking about the GTA area, especially post COVID, we have lots of international students who are stuck in Canada, cannot just go back to their country. And so I'm just wondering, in your opinion, what would be some of the difficulties or challenges for them in accessing care? - Hmm, that's a really important question. A lot of young people just are afraid of mental health problems. They don't want to be seen as different. They fear that mental health problems means that they really can't recover, they're going to be weird or strange or outside of the normal. Really nothing can be further from the truth. A lot of people struggle with depression and other mental health concerns, anxiety, substance use problems. These are very common conditions. So what most young people learn after a while is that they're not alone. And just because they're struggling with some of these issues, they share that with a lot of other young people. So I think that this fear is usually young people learn that it's not something to be afraid of, that they can overcome it and they can fight it. And with the proper help, they can do much better. It's also kind of a lack of general knowledge about mental health systems. So a lot of people aren't really sure where to go if they feel something really is wrong and they feel really depressed or anxious. So that can be a barrier, not knowing where to go. So a lot of young people might end up in the emergency department with their health, mental health problems and the emergency department is not really the best place for anyone really. It's kind of a place so it can be a little bit scary or people who may not know what to make of what's going to happen to them there. And going to the hospital and having a mental health problem contributes to stigma of mental illness too. So some young people feel like, as I mentioned already, a little bit that other people, if they have a mental health problem, other people will kind of not really want to be around them. So being fundamentally wrong with them. So fear of mental illness is kind of related to stigma of mental illness. And then not really knowing where to go and how to get help. These are all kind of the barriers a lot of young people face. - Well, thank you for that. And now I also understand from where you come from, the cultural backgrounds influence a lot, especially with the expressions of their symptoms and how these young adults perceive their illness if they have one and how they navigate the health care system. So how important is cultural sensitivity in mental health care, especially for young adults who come from diverse backgrounds? - Well, clinicians really only get one chance, one first chance with young people is that the first impression is so important. So when you're, you know, professionals think sometimes that they're doing the evaluating, but young people are evaluating us when we're letting them see us. So if you come across as somebody who's interested, curious, and accepting of cultural differences, that's going to come across loud and clear to our young patients and clients. For youth and their families, some kind of get the sense, I think, that their clinicians don't really want to know about their beliefs or their values. And they may not really feel very engaged in the treatment process. They may feel like they don't really fit there or they aren't going to be very accepted. So they just kind of will drop out of treatment. So that's a really common problem when working with young people. They don't stay in treatment always very easily. So this cultural sensitivity, we can develop kind of improves, sorry, I cut you off. It kind of improves our rapport with patients and with their families. And it increases the chance that the patients will participate in the treatment they need. - So as you mentioned in like in many cultures, religion and spirituality is an integral part of how people understand, especially their core belief system, how they understand their health and illness. So now, how do you think like as clinicians or for those interns who are now training to become therapists? What do you think would be a better way or direction for them to understand and build a trust when working with these students or young adults? - Well, as I mentioned, I mean, you can have building trust with young people. It really means listing what they have to say. It means not being too hurried in your evaluation. It means being authentic and genuine as a person with them. It means we don't hide behind sort of our professional identities all the time or even our professional techniques. What we want to become across is being honest, open real people with the young people that we treat. We want them to know that we're also people. We also are having our own challenges and our own issues that we face. And in an appropriate way and a clinical way, we can share those things at the right moment and the right time with our young clients. I think that can go a long way to building trust. In addition to, as I mentioned already, about listening for cultural differences, listening for different attitudes and different ideas about what's happening and accepting that to a degree that it's appropriate. And then, you know, building up the young person by showing respect and caring for them in the clinical encounter. - So I also understand from your research perspective that language is a fundamental part of how we express ourselves, understand our experiences and communicate with others. And especially for us as clinicians, as clinical supervisors, you know, we work with a diverse student interns. Like they just speak different languages. Like, you know, there are students from Korea, students from, you know, different backgrounds, you know, who just want to practice in the GTA area. So they come for clinical supervision. At the same time, they also want to work with that community group where they can use the language. So I have seen like in my experience at the Jewish Cultural Consultation Service, I think I have even sat with you in a couple of consults where there was a Tamil speaking refugee and I just was playing the translator there or the interpreter there, you know, helping this client express himself. And I really want you to discuss with us how we can just as interpreters or using interpreters, we can be able to help these clients navigate because otherwise they are not getting or they are not able to afford the care that they need. - Mm-hmm, those are excellent points. So in our Cultural Consultation Service and in other services where I work in a, through it within a cultural framework, there are two kinds of interpreters that we use. The first is linguistic interpreters. So linguistic interpreters is, you know, clearly where you can't speak very well to somebody because they don't speak, in our case, they don't speak English or French very well in Montreal, they will ask if it's okay if we can use an interpreter, an linguistic interpreter. Sometimes people are a little nervous about using an linguistic interpreter because it brings somebody into the evaluation that's culturally near to the person. Some communities are very small and so the risk of reaching confidentiality for some people is too high, they feel uncomfortable and they'll let you know that. But most people are quite relieved to have an interpreter present in linguistic interpreter. Some people for the first time will be able to really express what they're going through and what's at stake for them if there's an linguistic interpreter present. Now the linguistic interpreter sometimes develops quite a close bond with the patients that they help because they can speak in the same language, they can gain a lot of good information. So what we do is we talk to our interpreters before and after the evaluation to help them know what we need from them but also after the evaluation to hear if there's any information that they gathered while talking to the patients in the waiting room or maybe in between in breaks or something. Is there anything else they want to share with us that could be culturally helpful? We find a lot of linguistic interpreters are quite helpful and it kind of blends into the next level of interpreting which is cultural interpreting. We use also cultural interpreters or cultural brokers. We use them when there's not just a linguistic difference. People may speak the same language, someone may speak English, like I speak English but sometimes there are cultural beliefs and backgrounds may be quite different. And so I don't really understand the terms they're using or how they understand their symptoms or how they understand that their treatment should be. So a cultural interpreter can listen carefully and explain some of those ideas to me as a clinician. - Okay, that's an excellent way because I think it is possible in a larger system like a hospital but for someone in private practice or who is in a small clinic setup, what would be some of your suggestions to work with them? Can we use their family members to interpret or if someone else is able to speak English in that family, can we just use any one of those family members to act as interpreters? - Yeah, it's tough 'cause there's some settings where an interpreter is hard to find. Like we have to plan in advance for our cultural consultations to have an interpreter present or for other meetings that we have we plan in advance if we can. Sometimes we can't do that. So what do you do? You may have to fall back on occasion on what we call informal interpreters. So what formal interpreters would be people like family members, like you've said, Radika, or to maybe other people that work in the building where we work, maybe other professionals that are there may speak a given language. We can try to recruit their help. The problem with using informal interpreters is you can sometimes introduce conflicts. Like if you're using a family member to talk to somebody about their mental health problems they may disclose information that's not known for the family member. - That's right, yeah. - And be very awkward and even very inappropriate. - Yeah. - There's also now online interpreting services we can use. Like the Rio network, for example, or we can call in and get an interpreter pretty quickly, not too expensively, and they can help in many settings. - Well, that was an excellent piece of information for us, especially for us who face these challenges every day with referrals, you know, coming from people who speak very different language here in the GTA. So I would just now want to slowly move on to adults who are with their first episode psychosis. And, you know, from your vast experience can you just share with our audience? Like how do you briefly explain the first episode psychosis and how it would typically look like when we first see that? - Okay, well, an episode of psychosis, the word psychosis implies a break from reality. So it includes symptoms that are kind of well known to be linked to psychosis, like hallucinations. Like, for example, hearing voices when there are no people around speaking or delusional ideas, which means fixed beliefs that others don't share. Like, for example, being a prophet of God or being chased by the FBI when clearly there's nothing happening around a person. So these are would be delusions, paranoid ideas, so organized thoughts and speech and behavior. This is where a person doesn't really make sense when they're talking, you listening to them and they don't really, their ideas aren't coming together very well. We call that disorganized speech and their behavior can be disorganized too. They can all of a sudden walk outside in the winter with no coat or no shoes on or something. So that's like a disorganized behavior. Other kinds of issues, there are other symptoms with psychosis that are very important, like a loss of function, as I mentioned before. So some people with psychosis may just lose motivation. They may not have any interest in social, socializing anymore. They may withdraw their own house or room or apartment and they may actually lose the ability to express themselves and express their emotions in the way they used to. So these are some common symptoms of psychosis. - Well, thank you for that. And especially for our audience as the clinicians, students, you know, what do you think? Because we as psychotherapists don't do diagnoses, we only do therapy once the diagnosis has been or the assessment has been made by a psychiatrist. So sometimes we come across clients who don't disclose that, you know, they have had this. And especially in the clinics where I work or where we see referrals in the Mississauga area, they are often students and they are immigrant students, international students, like we just have students who just are unaware that they are having these symptoms and some of them are treated but they never tell us. So we just have to deal with this in the therapy situation. So what would be your advice to us or, you know, with your experience? What do you think should be our first appropriate intervention when we see that? - Well, it's like you say, I mean, if a student's here by themselves in Canada, their families aren't in Canada, that's really tricky. That's a tricky situation. Usually it's the families who are the first to notice what's happening. So they're the ones that are usually tasked with guiding the young people to timely care. If a person's here as a student without their family present, I usually try to contact their family, ask permission to contact the family, but no matter where they are, they might be in Asia or Africa or other places. And then I can recruit their help and sometimes I've even met with families on WhatsApp or FaceTime or something. And the mother has been there talking with me with the young person, kind of doing a community or family intervention, you know, a digital family intervention. And in that way, they may convince them in a way that I can't all the time to get help. If they have a family doctor, you can always call their family doctor as well. Family doctors can be very helpful. We find a lot of people don't have family doctors either. It can be really awkward. - Yeah. - Anyway, it's sort of the last thing you can do, which I know you don't like doing and isn't easy is that you can help someone if they really do need help. They're serious symptoms, they're not acknowledging that they need help. Their family's not available. You may have to help them get to the emergency department for an assessment, you know. And it's okay. I mean, the emergency room is there for that reason. It's there to help people who are really in dire need and you as a therapist will have to make that decision. You can help them to get there. And some, oftentimes I just kind of, if that's the case in my office, I just stand up and I walk them all right. My office isn't very far away from the emergency department. I'll just start walking and they often follow me 'cause they don't really know what else to do. You know, they don't really have any other way, place to go. Those are some of the things that I do. It can be hard when you're alone in your office, in a therapist's office, you see somebody and you need a lot of help. There might be some help lines you can call too to get some guidance and some advice. - Yeah. - And ultimately people sometimes call 911. Really worried about the safety of the individual, you know, it's in front of them. - Well, those are the steps that we take and we also, you know, tell our other colleagues about it. But then, you know, there are some help line that we can just refer them to, but then it's a sad scenario. And also with a system where if they are in their 20s and early 30s, then, you know, we cannot, or if they refuse that we contact their parents back home, then that just becomes an issue too. - That's harder. But I don't let it drop, you know, like they may refuse, but I keep trying to ask if I can call the family because in the end, the family may not lie. - Yeah. - So I am kind of persistent on it. - Okay, well, that's a very valuable piece of advice for us. Thank you for that. Okay, so now let us just, what would be your message to give to adults, you know, who are experiencing their first episodes and, you know, how can they maintain their relationship or their focus on recovery? - Hmm, that's a great question. I mean, I would overall like to convey a message of hope. I think that most people with new onset psychosis will recover. They may not see that it's possible at the time. They may not even really realize that they're ill sometimes, but they will recover if they participate fully in the treatments and programs that are offered to them. So that's a, I mean, it takes a bit of persistence on their part in being a little bit stubborn and following through with their treatment. So if they do that, almost everyone improves quite a bit. Even in situations where symptoms are severe, even debilitating, almost everyone who persists will eventually settle into a healthier routine in the long run. So that's kind of the message of hope I want to give. That these problems really are treatable and can benefit from interventions. - Thank you, and so as we just are coming to the close of this discussion, I just want you to share with us like what would be, what do you see as future trends in mental health care, especially for young adults? - We have pretty good tools now to help young people with mental health problems. If people can access them and the problem is often access to an access problem, if they can access the tools, they can do quite well with the majority of people. I foresee a future where there's, where stigma of mental illness will be overcome, people will feel more free to participate and getting the help that they need without being so harshly condemning of themselves or maybe with less judgment from their families or friends. I see a future with more community based programs than hospital based treatments. I see a future as well where there's a role for digital technologies. There are digital technologies that can help patients track their symptoms and their responses to their treatments in real time. And these can be made available to the clinical team and they can really fine tune interventions and treatments and make them very tailored to the individual. So I think that these things, reducing stigma, more community based programs and activities, interventions and using digital technologies can really make these treatments more relevant, you know, and acceptable. - Well, those are excellent advice. I think they will be really useful to people. And some of the community settings already have it, but it's just like you say, it's just the information or the knowledge that they can just reach out to these centers. I think this is a valuable discussion that would just reach to these people who are in need of these services. So, and let's just end our discussion with this last question. So what advice would you give to other mental health professionals who are working with young adults, particularly in multicultural settings? - Thank you for that question. I mean, I would say to those people, welcome to the modern world. I would say that rather than a problem, diversity is an opportunity. It's an opportunity because it gives us new ways to learn about, to understand mental health problems, new ways to intervene. If we embrace diversity, I'm sorry, we embrace diversity. And if we listen to our patients and their families, we'll find that our eyes are opened. We'll have new experiences, a new outcomes that we don't think would be possible otherwise. So these interactions are not only rewarding, I found them personally life-changing for me. And this diversity brings such different and new opportunities for recovery. For those who feel unsure of how to proceed in some clinical situations, maybe where diversity is complicating the path forward, clinicians can always call the cultural consultation service at the Jewish General Hospital at McGill University. Even though it's not in Toronto or not in Ontario, we can still offer help and guidance. Our number is, I can give it here, 514-340-8222. And then the extension is 2565-5. Antonella is the triage coordinator, and she can really often help people just off the bat with some practical issues or advice. Those are some thoughts that I had on that. Awesome, that's an excellent tool and service that people will be looking forward to access if they really need off it. So what are students? Because as a clinical supervisor, I have students from diverse backgrounds and also from the dominant culture coming to me. So I just want to be your supervisor so that I can just work with this multicultural clients that you have. So they always ask me, how do I have to prepare myself before I start my practicum? So is there some tools or books that we can read? I normally direct them to the cultural consultation, like working with the other in the book from the Cultural Consultation Service. Is there something else like resources for these students to get to know more about the working with the culture? I can pull it up for you. So it's a very helpful online resource. Okay. And it basically has a lot of information about how to work with diversity, how to work with different, people of different cultural backgrounds. I'm just looking at it right now online. Welcome to the MMHRC Multicultural Mental Health Resource Center. And it has different options for people about clinical tools, for example, services that may be helpful in a multicultural setting, getting help for clinicians, different policies that exist and working with diversity, different training events or different training tools that are available. Is this a Canadian-based site? Because often what we get is something that is in the U.S. And it's not very really applicable to our own, you know, Canadian setting. Yeah. This is a Canadian site. Oh, okay. I think I'll find it very helpful. It's at, let me see if I can get the address. It's multiculturalmentohealth.ca. Okay. It's multiculturalmentohealthalloneword.ca. And then there's one other one I can give you. It's called the C-SPIN. It's called Welcome to C-SPIN, Culture, Community and Psychosis Information Network. Okay. C-C-P-I-N.ca. It's also a Canadian site, working with, it's expressly about culture and psychosis. Okay. Especially early psychosis. Okay. So that's an excellent site, I think I'm very valuable for the clinicians as well. Mm-hmm. Okay. So that just brings us to the end of our discussion today. It was such a valuable discussion. And I really appreciate you taking your time to be with us and you know, chat this information with us and Dr. Jarvis. Thank you for this opportunity. It was great to talk to you. Thank you. [BLANK_AUDIO]