Canada’s commitment to multiculturalism is a defining value. Yet despite this ideal, the country’s mental health care systems have yet to fully adapt to reflect the diverse cultural realities of the populations they serve.
Known as the “Healthy Immigrant Effect” (HIE), immigrants arrive in Canada in better health than their Canadian-born counterparts, but suffer a steep decline in health after migration, often attributed to factors such as underemployment, systemic discrimination and limited access to culturally appropriate care. While most HIE research focuses on physical health, there is growing recognition that mental health also deteriorates after migration, a concept that remains comparatively underexplored.
Adding urgency to the issue is that refugees are at a significantly higher risk of mental health disorders than immigrants. Quantitative research indicates that approximately 31.5 per cent of adult refugees and asylum seekers experience depression, 31 per cent suffer from post-traumatic stress disorder (PTSD), and 11 per cent are affected by anxiety disorders, all of which far exceed the values in the general population.
Yet, despite the fact that the mental health of both groups tends to worsen the longer they reside in Canada, immigrant and refugee populations are significantly less likely to seek mental health services compared to their Canadian-born counterparts. Cultural barriers including stigma, language and unfamiliarity with Western mental health frameworks are key deterrents from seeking care.
Eurocentric norms instilled within a one-size-fits-all model of mental health care fail to address the complex and interconnected reality of immigrant and refugee populations. Standard mental health interventions often assume individualistic values and direct communication styles that may not align with collectivist worldviews held by many immigrant communities. This mismatch can decrease the efficacy of acceptability of care.
In many cultural contexts, mental health is not conceptualized in the same manner as in Western models. The influences of culture and society on mental health may be understood through a spiritual or moral lens that characterize symptoms as a consequence of wrongdoing, familial disharmony or divine punishment, resulting in shame or fear of disclosure, especially when reflected as a personal weakness or family failure. In these cases, symptoms may be somatized, meaning that emotional pain is expressed through physical complaints such as fatigue, headache and digestive issues, leading to underdiagnosis and treatment delays.
In response, researchers have developed Culturally Adapted Cognitive Behavioural Therapy (CaCBT) that modifies traditional CBT models to align with patients’ cultural backgrounds. A 2023 qualitative study of South Asian Canadians demonstrated that CaCBT was perceived as more relatable and effective than standard CBT and emphasizes the importance of integrating family roles, community dynamics and culturally grounded metaphors into therapy practice. These cultural adaptations not only increase patient engagement but also enhance clinical outcomes.
However, these services still remain scarce across Canada. Barriers include a shortage of trained professionals from diverse cultural and linguistic backgrounds, limited provincial funding streams for culturally specific programs and a lack of institutional mandates for cultural competence.
As Canada continues to welcome immigrants and refugees from around the world, its mental health care system must continue to evolve to meet the realities of those it serves. Culture shapes how distress is experienced, understood and treated, yet many of these nuances are left behind, resulting in misdiagnosis, disengagement and inequitable care.
Moving beyond symbolic inclusion toward true integration means mandating cultural competence training, funding culturally specific services, diversifying the mental health workforce and embedding equity metrics into health system planning.
Just as Canada has committed to the principles of multiculturalism, it is essential that the principle also is grounded in mental health care.
Thank you for this deeply thoughtful and evidence-based contribution. You’ve articulated what many practitioners and patients know intuitively but struggle to see addressed at a systemic level: that a one-size-fits-all approach to mental health simply doesn’t work in a multicultural society. Your discussion of CaCBT and the need for culturally adapted therapies is so timely and important, especially given the growing mental health crisis among refugee and immigrant communities. More research and investment in this space is urgently needed, and your article makes that case beautifully.
This is a powerful and timely piece. Your call for culturally responsive mental health care is crucial. Beyond clinical settings, integrating cultural knowledge into early prevention and outreach like schools, settlement services, and faith communities could further support newcomers before crisis points. Thank you for pushing this conversation forward.