7
Haven or precarity? The mental health of LGBT asylum seekers and refugees in Canada
Nick J. Mulé and Kathleen Gamble
Mental health challenges are an important concern for many lesbian, gay, bisexual, transgender (LGBT) asylum seekers and refugees in Canada.1 The processes of leaving their country of origin, applying for refugee status and settling in Canada often affect the mental wellbeing of many LGBT asylum-seekers and refugees. These experiences have helped to inform this examination of Canadian policies regarding asylum seekers and refugees, raising the question whether or not they effectively address mental health concerns in these populations. Canada is one of 42 countries in the world that has granted asylum to individuals on the basis of persecution due to sexual orientation or gender identity/expression (SOGIE),2 but can it be considered a haven or a place of precarity? Insights into this can be gained by looking at the mental health of LGBT asylum seekers and refugees who choose to settle there and how Canada addresses the issue through its procedures and responses to needs.
This chapter investigates and considers how homo-bi-transphobia is represented and reflected in Canadian social, political and legal structures – including the healthcare system. Moreover, homo-bi-transphobia intersects with discrimination on the basis of different categories of identity (race, gender, class, ability, religion and others) to create deeply personalised and complex experiences. Thus any consideration or discussion about how to improve LGBT asylum seekers and refugees’ access to healthcare services (including mental healthcare) must be done within an anti-racist and anti-oppressive framework that acknowledges the intersectional nature of the identities of many LGBT asylum seekers, refugee claimants and refugees. Working towards improvement through anti-oppressive practices specific to LGBTs must include a focus on diverse sexual orientations and gender identities and expressions.
Figure 11. Asylum seekers, Toronto, Canada. Photo credit: Ulelli Verbeke, 2014, Society Against Sexual Orientation Discrimination and Envisioning Global LGBT Human Rights.
We drew from data specific to the experiences of LGBT asylum seekers and refugees in Canada as well as data about sexual and gender minorities in India, Africa and the Caribbean gathered by Envisioning Global LGBT Human Rights (Envisioning). The Canadian analysis was conducted through focus groups with LGBT asylum seekers and refugees, organised in collaboration with community partners within the Greater Toronto Area (GTA). Our research findings correlate with trends in the broader literature regarding this population’s common stressors and the resulting mental health challenges.
The World Health Organization (WHO) defines mental health as ‘a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community’ (2014). Likewise, the mental health of LGBT asylum seekers, refugee claimants and refugees relies upon a sense of self-worth and belonging, stress management and coping strategies, available resources in their new country of residence, accessibility of these services, and overall acceptance in their communities among other factors (Envisioning, 2014b). LGBT people face increased mental health stress compared to people who fit within more normative categories of sexual and gender identity (that is, straight and cis-gender people). Social stigma also leads to a chronic psychological strain, expectations of rejection and discrimination, decisions about disclosure of identity, and the internalisation of homo-bi-transphobia (ibid.).
Mental health in Canada
According to the Canadian Mental Health Association (CMHA), mental illness is a major health issue for society and for government (2015). In any given year, one in five Canadians experience a mental health or addiction issue (ibid.). The onset of 70 per cent of mental health problems occurs during childhood or adolescence, and people with a mental illness are twice as likely to have a substance use problem. Canadians in the lowest income group are three to four times more likely than those in the highest income group to report poor to fair mental health, and mental illness is a leading cause of disability in Canada.
Yet discrimination persists in the organisation and provision of hospital care and community healthcare for people with mental illness. Improvements in this area are needed in all ten provinces and three territories to ensure that Canada’s healthcare system reflects and upholds the principles of universal access, comprehensiveness, portability and public administration enshrined in the Canada Health Act (ibid.).
Moreover, the stigma associated with mental illness needs to be challenged. According to a 2008 survey, just 50 per cent of Canadians would tell friends or co-workers that they have a family member with a mental illness. As a result, while mental illness accounts for about ten per cent of the burden of disease in Ontario alone, it receives just seven per cent of healthcare dollars and/or reflects an underfunding of about 1.5 billion Canadian dollars (ibid.).
Mental health and wellbeing are largely recognised as important indicators in the measurement of an individual’s overall health status. However, funding and service provision are greatly lacking in this area, a gap which can be addressed by developing a mental health policy that reflects the distinct and unique needs of various members of Canadian society. Social support for mental health services for asylum seekers and refugee claimants is limited and usually falls under the umbrella of larger resettlement organisations, which are already under-funded and under-resourced in their capacity to support this community (Envisioning, 2015).
Mental health challenges of LGBT asylum seekers and refugees
The challenges many LGBT asylum seekers and refugees face reflect their experience of high levels of stress and isolation in their countries of origin, in their early years in Canada, and as a result of the refugee claim process itself. In the absence of a safe environment and often facing social isolation, many LGBT asylum seekers are unable to process trauma and mental health issues in both the country of origin and Canada. These asylum seekers have often faced trauma and/or persecution in their country of origin, which may include isolated or repeated physical, mental, emotional and/or sexual violence. Homo-bi-transphobia leads to experiences of discrimination, social stigma and alienation from friends, family and co-workers (ibid.).
As well, LGBT asylum seekers inhabit multiple categories of identity when migrating to Canada, with the result that discrimination and stigma may be compounded. Systemic racism can have a pervasive and devastating impact on their health and wellbeing. For many LGBT refugee claimants, experiences of homo-bi-transphobia intersect with experiences of racism and lead to further marginalisation and social isolation. Additionally, LGBT asylum seekers, refugee claimants and refugees may not have the support of their country-of-origin community in Canada (ibid.).
Discrimination within these communities can trigger memories of abuse in the country of origin, create new psychological trauma and contribute to isolation. LGBT asylum seekers and refugee claimants may feel shame and fear when discussing their sexual orientation and/or gender identity (SOGI), because of the intimate and/or taboo nature of these topics in their home countries. The imperative to disclose, both socially and in certain official contexts (including the refugee process), can be extremely stressful and may cause individuals to avoid accessing support services.
Finally, mental health services for asylum seekers, refugee claimants and refugees are limited and not usually covered by federal and/or provincial healthcare financing models. Knowledge of LGBT people’s lives and health needs varies considerably among professionals working in these services. Finding a provider who is sensitive to the specific requirements of LGBT asylum seekers can be difficult, particularly outside major urban centres. Even if services are available, many LGBT asylum seekers may fear being ‘outed’ following disclosure of their sexual orientation or gender identity to healthcare providers. They may decline support from these services due to fear, guilt, and shame, as well as cultural, religious and language barriers. Mental illness itself is stigmatised in Canada and also elsewhere, so those suffering from such issues may resist seeking help for fear of being labelled themselves.
In this project we operate from the premise that mental health is a key factor in determining the wellbeing of asylum seekers, refugee claimants and refugees. Recognising that the very experience of seeking asylum or applying for refugee status presents emotional and psychosocial challenges, it is anticipated that their mental health will be compromised. Hence, it is important that a host country is perceived as offering a safe haven, an escape from persecution. For the purposes of this research, haven is linked to the LGBT asylum seeker or refugee’s perception of safety, inclusion and protection, which is not necessarily the state’s perspective. It is the state that can influence policy, often to the detriment of those seeking asylum or refugee status (Sales, 2005). Yet, the very social location of individuals seeking asylum or refugee status based on SOGIE can add an additional layer of precarity due to concerns about heteronormativity, cisnormativity, and racialisation (Ou Jin Lee and Brotman, 2013). Such forms of oppression can be perpetrated systemically in the host country via Westernised notions that are at dissonance with the cultural beliefs and socialisation of asylum seekers and refugee claimants. Our research reveals a multilevel understanding of what is involved in creating a haven or perpetrating precarity.
Factors shaping the mental health and wellbeing of LGBT asylum seekers, refugee claimants and refugees
This section focuses on three factors that directly impact on the mental health of LGBT asylum seekers, refugee claimants and refugees: escaping violence, the refugee determination process in Canada, and resettlement. Our research findings indicate that these factors and how they played out for our participants had deep implications for their mental health and sense of wellbeing. Although this section deals with each factor in turn, it is worth noting that any of them can affect the others, since some of our participants experienced them intersectionally.
Stress and trauma underscored these experiences. Again, it must be acknowledged that LGBT asylum seekers and refugee claimants commonly suffer from either or both of these, whether due to direct persecution, threats or perceived endangerment in their country of origin, the process of escaping persecution, or their heightened vulnerability to stress and trauma as a result of Canada’s determination process (Nicholson, 1997). Trauma is generally understood as experiencing a negative encounter that can have a lasting imprint on an individual to the point of producing future stress. Stress can be broadly defined as pronounced pressures, whether mental, physical or psychological, and may intersect with trauma. Whether combined or separated, experiences of both are distressing, with implications for the mental health and wellbeing of newly arrived refugees (Shannon, Vinson et al., 2015). Expressing such stressors and trauma can strengthen the mental health of such individuals under the guidance of prepared and properly trained professionals (Shannon, Wieling et al., 2015).
Escaping violence
Many LGBT refugee claimants in Canada seek asylum under conditions of considerable distress. According to a 2009 study, 45 per cent of lesbians and 24 per cent of gay men reported experiences of physical and/or sexual violence and assault in their refugee claim (Envisioning, 2014a). Similarly, the majority of participants in this study spoke openly about the persecution and violence they had experienced and/or witnessed in their homeland and how this had contributed to their decision to flee their home: ‘I’m aware of members who have been beaten, who have been stabbed, whose hands have been cut, who are currently dead . . . some situations you can see it point blank, the brutality of the beating, of the violence involved’ (Envisioning, 2015, p. 24).
Not only did many participants experience physical brutality, many had also undergone structural forms of violence which contributed to their decision to seek asylum: ‘I’ve known people who have lost their jobs when it was discovered that they’re gay’ (ibid., p. 24).
The process of claiming refugee protection, particularly on the basis of the deeply personal and sensitive topics of sexual orientation and gender identity, can be a major source of stress. Coupled with past trauma and future uncertainty, this places LGBT asylum seekers at increased mental health risk. Having to prove one’s sexual orientation or gender identity, which the asylum process demands, can cause intense shame and embarrassment. It may also be impossible for some asylum seekers to prove their sexual orientation, due to deeply entrenched survival strategies, such as hiding their identity, that were necessary in their country of origin (Envisioning, 2014b).
Canada’s refugee-determination process
Canada acknowledges persecution on the grounds of SOGI as warranting refugee protection. Envisioning’s research was conducted at the same time as significant changes were being implemented in Canada’s asylum and refugee-determination process. Bill C-31 took effect in December 2012 and is now enforced as the Protecting Canada’s Immigration Systems Act.3 The act resulted in a number of changes with significant negative effects on refugees and immigrants – including a disproportionately negative impact on LGBT claimants. These changes included:
• a two-tiered system based on a Designated Country of Origin (DCO) list
• significantly shortened timelines for the refugee-determination process
• restriction on Pre-Removal Risk Assessment (PRRA), and Humanitarian and Compassionate Consideration
Prior to the implementation of the act, refugee claimants had 28 days from making a claim at a port of entry to submit their Personal Information Form (PIF). As well, during this same timeframe, refugee claimants needed to find a lawyer, secure financial assistance and gather the required documentation and evidence to support their claim. Claimants now have only 15 days to submit their statement, renamed Basis of Claim (BOC), and for claimants making inland claims this timeframe can be even shorter.
Although the Canadian government recognises persecution based on SOGI, it also demands that LGBT refugees provide documentation not only of persecution but also ‘proof ’ of their SOGI. Not all refugee claimants have access to this kind of information (that is, police reports, medical files, other forms of testimonies). This is highly inequitable and creates an additional burden for claimants that can often have an adverse effect on their mental health. The experience of ‘proving’ one’s identity can be highly traumatising and may trigger painful memories. As one participant stated, ‘To write up your story . . . it’s very painful and someone said you’re . . . I think you’re supposed to have more time to fill out your PIF . . . it’s very painful because you have to try to live it over’ (Envisioning, 2015, p. 21).
Prior to their arrival in Canada, many LGBT refugee claimants live lives of silence and social isolation due to discrimination and fear of persecution. Canada’s immigration and refugee regime throws newcomers grappling with identity issues into highly stressful situations where identity must be demonstrated. As one participant noted,
You’re still traumatised ... You’re still worried, where do I go from here? You know no one, and nothing, then you have this officer right in front of you . . . and you’re still traumatised about everything that happened. I think I can say what I am running away from . . . but it won’t be as clear as when I am talking to someone . . . that I trust. (ibid., p. 21)
As a result, the claims process itself can have a significant and negative impact on the mental health of LGBT refugee claimants who are seeking an escape from social pressure, stigma and violence. As several service providers who participated in this research noted, the claim process itself can make LGBT refugees feel persecuted and/or threatened: ‘You feel like you are being persecuted, proving yourself. But there’s a constant fear that once it gets rejected you have openly declared as LGBT and you will be deported back to your country’ (ibid., p. 3).
For many refugee claimants the process is a major source of anxiety and fear: ‘Even the morning of the hearing I swear in my head I used the bathroom like 20 times and I haven’t been there, I was just so nervous . . . because you’re hearing all these remarks about the new system because it gives you less time for preparation’ (ibid., p. 23).
LGBT asylum seekers are often forced to relive past trauma throughout the process. Discussing past trauma and fear of future persecution with strangers such as legal counsel, asylum officers and immigration adjudicators may contribute to retraumatisation, particularly since asylum seekers may harbour mistrust towards government officials/authoritarian figures who are often the perpetrators of persecution in their country of origin.
Resettlement
As refugees navigate a highly stressful claims process, they also face the challenges and struggles of settling in a new country. These include accessing suitable housing services and basic social services (like healthcare) and finding employment. Some participants felt that being identified as a member of the LGBT community, a refugee, or a person receiving social assistance had an impact on their ability to access basic services: ‘It’s very hard to find housing in terms of being an immigrant or refugee claimant, because of the discrimination when it comes to those things’ (ibid., p. 28).
Many LGBT people seek asylum without support from family, extended family or their community as the result of homo-bi-transphobia. Building and maintaining new social support networks takes considerable energy and time for many refugees and immigrant groups.
Moreover, in 2012, the Canadian federal government introduced cuts to the Interim Federal Health Program (IFHP), which provides health coverage for immigrants seeking refuge in the country. The changes barred all refugees, excluding government-assisted refugees, from accessing medication, vision and dental coverage (Canadian Doctors for Refugee Care, 2014). For refugee claimants who participated in our study, these changes made it extremely complicated and difficult to access basic healthcare services, for example: ‘The government basically [gave] you this paper . . . it entitles [you] to have healthcare or what not . . . most health institutions [do] not recognise this piece of paper’ (ibid., p. 30) and ‘I had challenges finding an immigration doctor . . . [or] the doctor doesn’t practise immigration medicine anymore . . . it is hard to get a family doctor’ (ibid.).
In 2013, six Canadian provinces introduced individual programmes to supplement coverage. The Ontario Temporary Health Program (OTHP) came into effect in January 2014 and provides short-term and urgent health coverage to refugees and asylum seekers. However, provisions for mental health services are still lacking. As previously noted, the challenges faced by many LGBT refugees reflect high levels of stress and isolation, such as those experienced in their country of origin, the refugee claims process itself, and problems related to resettlement in Canada. In one positive development the newly elected federal government, under the Liberal party that came into power in late 2015, fully restored the IFHP in April 2016. However, much work remains to be done to address the mental health needs of LGBT asylum seekers, refugee claimants and refugees.
Many LGBT refugee claimants are unable to process trauma and mental health issues or access services and support in the country of origin and during the refugee process in Canada:
I got so depressed. I mean it was awhile, like when I came up here, I just tried to forget everything that happened to me . . . so when I had to fill my PIF, to write my story I would cry every day. I was even thinking about committing suicide. I got to the point where I was like, I couldn’t deal with it any more . . . and I had no one to talk to and it was very stressful. (ibid., p. 31)
LGBT refugee claimants face difficulties accessing safe housing, finding reliable employment and navigating the refugee claims process – all of which can have a significant impact on their mental health. As one service provider noted, ‘The process, even while they are here, compiling this documentation and they don’t have money . . . the impact on their health, their stress levels and then all kinds of health issues come up as a result. So many of them are depressed, some have PTSD because of their background’ (ibid.).
As noted in Envisioning’s 2014 information sheet ‘Mental health challenges for LGBT asylum seekers in Canada’, supportive environments are extremely important, as research has shown that resilience and self-efficacy flourish in places where there are others who openly share their experiences and where there is social support. Such individuals require access to legal, health and social service professionals experienced in LGBT matters as well as asylum and settlement issues. Mental health professionals need to be conscious of the effects of stress. Moreover, there are cultural differences in how people experience and express stress and illness and how they deal with these feelings.
For example, refugee claimants in this study used various methods to cope with their depression and/or anxiety: ‘I always prayed that night wouldn’t come . . . when I am alone, I feel cramped. I have to take medication, a sleeping pill . . . sleep is hard because of the agony I passed through back home. It’s like they are coming after me all the time’ (ibid.).
The Minority Stress Model (Meyer, 2003) describes a state of chronic psychological strain resulting from stigma that can lead LGBT refugees to turn to external coping and numbing mechanisms such as alcohol, drugs or tobacco (Hatzenbuehier et al., 2009; Envisioning, 2014b, p. 2). Access to appropriate mental health services can make a substantial difference to the mental wellbeing of LGBT asylum seekers, refugee claimants and refugees. Professionals working in these areas can assist these persons by working with them on their trauma. They can advocate for changes in the refugee-determination process to be more informed, enlightened and sensitised to the needs of LGBT asylum seekers and refugee claimants, which in turn may reduce the possibility of retraumatisation. In the meantime, as several refugee claimants noted, being able to access counselling services before, during and after the claims process would be extremely helpful: ‘I think there needs to be some counselling like from a psychologist or like from an actual counsellor . . . counselling can actually help you in a lot of ways’ (Envisioning 2015, p. 31).
However, service providers participating in this study repeatedly noted that such services are not widely available. Many challenges that LGBT refugees face in accessing services like trauma counselling are an extension of the hurdles that workers in mainstream services come up against in their work with these populations. Some service providers also grapple with developing services to meet the needs of LGBT refugees and acknowledge that more training on LGBT issues needs to occur at all levels of these organisations. In Ontario, small training projects and schemes have been introduced such as the Positive Space Initiative run by the Ontario Council of Agencies Serving Immigrants, Rainbow Health Ontario’s Training Program, and Planned Parenthood Toronto’s youth-facilitated TEACH Program. Nevertheless, mental health issues and services continue to be overlooked and underfinanced.
How can policy address these issues?
During the period the Envisioning study was being carried out, the aforementioned Bill C-31 came into effect (see Kinsman, chapter 3 for details of the act). Its impact was felt to a significant degree not only by those seeking asylum or refugee status, but also systemically in how this policy reframed refugee and immigration processes, recasting them as a burden on the nation. For example, by reducing timelines for the refugee claims process, in conjunction with budget cuts and strained resources, the government simultaneously increased stresses experienced by asylum seekers and refugees and service providers in this sector (Canadian Bar Association, 2012).
Most service providers participating in the Envisioning study criticised the impact of Bill C-31, questioning whether its intent is to actually assist asylum seekers, refugee claimants and refugees or to create a punitive environment within which to weed out ‘bogus refugees’ (Speaking Notes, 2012). Beneath the federal rhetoric of cost saving, many identified the hidden agenda to determine who is ‘legitimate’ and who is ‘illegitimate’:
I am talking about IFH. I am talking about the C-31 . . . the government has been using . . . the language of entitlements – that folks who are coming from outside are getting what Canadians don’t have . . . it’s pitting those who are deemed as a legitimate against those who are deemed as illegitimate. So it’s also impacting not just . . . refugee claims but also . . . migrant work and work permits . . . the whole language around ‘the people who are coming in to take our jobs’ . . . it’s a scapegoat to use the language of cost savings for Canadians. (Envisioning, 2015, p. 39)
Although at the time of writing the federal Liberal government has done much to redress many of the damaging components of Bill C-31, much still remains for it to do particularly in relation to LGBT asylum seekers and refugees. The current asylum-seeking and refugee claims processes demonstrate the ways in which heterosexuality, Eurocentrism and whiteness are intrinsically privileged within the social structures of Canada, as reflected in refugee and immigration policy. For many LGBT refugees, violence does not necessarily end upon their arrival in Canada, as they may experience violence, such as homo-, bi-, and/or transphobia, within their culture of origin in Canada or racism within Canadian LGBT communities. A determination process with restrictive timelines, forcing refugee applicants to relive traumatic life experiences during their initial arrival, as well as having to prove their SOGI status are examples of a systemic process that is highly Westernised and as such insensitive to the intrinsic mental, emotional and cultural implications. These circumstances can harm LGBTs attempting to resettle in Canada, where basic needs such as housing, employment and support services (health and social) are not easily found or accessed, yet must be addressed.
The Liberal government had to backtrack quickly early in its Syrian refugee crisis intervention in 2015 when it attempted to limit those permitted to enter Canada to women, children and families, initially completely overlooking the plight of gay and bisexual male Syrians by excluding single men (Lum, 2015). Driven by a precautionary security-based agenda intended to contain terrorism, such exclusionary policies risk overlooking the persecution faced by members of that population being targeted due to their SOGIE. This task calls for intricate and sensitised work in separating out security measures that may pose threats to the country and those suitable for individuals who face personal threats based on their social location during highly vulnerable circumstances. It is important for the Canadian federal government to take into serious consideration the everyday experiences of the material realities of asylum seekers, refugee claimants and refugees and the service providers who work with them, in its legal and political practices, as they in turn reflect the values of the Canadian nation state.
A further test of enacting Canadian values are laws and policy that recognise and address the inequities that operate along intersectional asymmetries of geopolitics, class, race, gender, sexuality and ability. Such laws and policies contribute to structural elements that directly affect applicants’ capacity to access travel documents, cross borders, sustain themselves and gain access to permanent status. In essence, policy must be cognisant of the fact that for many LGBT refugees, and especially those who are racialised (the case for the majority of participants in the Envisioning study), attempts to resettle in Canada often occur in precarious economic social environments that are highly racialised, gendered, sexualised and classed, with direct and negative implications on their mental health. Their endeavours to attain asylum or refugee status become an additional burden within a tightly administered system, compounding any of the above social locations. The Canadian system, which our research indicates is based on cisgendered, heteronormative, white, Eurocentric values, inevitably creates its own forms of violence sometimes blatant and other times subtle. The determination process forces LGBTs to seek documentation that is hard to obtain, not to mention the direct challenge it poses for any who have to assume a sexual or gender identity they are not culturally socialised to do. Those responsible for service provision and operation should acknowledge and factor in the unique and sensitive needs of LGBT asylum seekers and refugee claimants, as the mainstream resettlement sector lacks the knowledge, training and hence capacity to address such issues.
Discussion and analysis
The requirement for asylum seekers and refugee claimants to prove their sexual orientation/gender identity/expression is a unique challenge. The implications this burden has on mental health cannot be underestimated. What is particularly disturbing about such processes being imposed by the state is its homonationalistic tendency to frame and define such characteristics in terms of Westernised notions, with little or no respect for the international diaspora. This adds to the anxiety felt by LGBT asylum seekers and refugee claimants upon their arrival in Canada, a process that does not accommodate these populations well in general, let alone the gender and sexually diverse. An astonishing number of participants in the Envisioning study spoke of being assisted by total strangers with good hearts, rather than by a formalised systemic response which left them to their own devices.
The normative experience of seeking asylum or refugee status is psychosocially and emotionally fraught, as it is based on the very mixed feelings of having or choosing to leave one’s country of origin and all that goes with it (family, friends, career, culture, life). Such normative experiences become exacerbated by sweeping and overly simplistic structural and systemic processes such as determining designated countries of origin, having to prove one’s sexual or gender identity and accelerating the timelines of applications and processing. The state’s lack of a nuanced approach to these procedures causes the stress levels of all stakeholders to increase and challenges the mental wellbeing of asylum seekers and refugee claimants, particularly LGBTs. The state, lawmakers and policymakers would do well to listen to the voices of LGBT asylum seekers and refugee claimants as well as their service providers – such as those who participated in the Envisioning study. This would help these bodies address the settlement experiences of these individuals in Canada, including their housing, employment, general healthcare and mental health needs.
Mental health service provision to the asylum-seeking and refugee populations is a given need. Yet, sensitively and effectively meeting those needs require collaboration between the state, service providers, and most importantly asylum seekers, refugee claimants and refugees. To underscore such cooperation, a nuanced understanding is required of the many needs these populations have and how best to address them, keeping their mental health foremost. Regardless of their immediate need, such as housing, food, employment and social support, their mental health is being affected. It is crucial then that the desperately needed systemic changes take into consideration the nuances of sexuality, gender identity/expression, race, ethnicity, abilities, age, class and so on, respecting the realities and experiences of these people in their countries of origin and the opportunities that can be provided to them as they resettle in Canada.
Recommendations
The results of Envisioning’s study ‘Is Canada a safe haven?’ clearly demonstrate the need for systemic change that will swiftly address the requirements of LGBT asylum seekers, refugee claimants and refugees and their particular mental health issues. Hence, we reiterate recommendations here that would more sensitively address those needs.
First, LGBT refugees who arrive in Canada navigate and negotiate a complex claims process within a limited time which severely limits their ability to produce the documentation that supports their claim. Not all refugee claimants have access to the information necessary to prove their SOGI as the result of persecution in their home country, lack of a supportive community and lack of access to resources. A disproportionate emphasis on ‘credibility’ in the claims process forces LGBT refugees to produce highly personal evidence to prove their SOGI, a major source of anxiety and stress for many of them. As a result, the claims process can be a major contributor to retraumatisation. Therefore, we recommend that decision makers focus on proving the threat of persecution as a result of SOGI and not on SOGI as an identity. Although practical challenges can arise when such a principle is implemented, it nevertheless should be the central focus, as it is not possible to attempt a fair assessment of the SOGI of claimants during a refugee proceeding.
It is worth noting here that the Immigration and Refugee Board (IRB) of Canada, charged with determining landed immigrant and refugee status, undertook a review of its SOGI guidelines towards the end of the work carried out by Envisioning. The latter participated in the consultations process providing feedback and policy recommendations based on project findings. The new IRB Chairperson’s Guideline 9 regarding SOGI (IRB of Canada, 2017) do take into account a number of recommendations from Envisioning and other specialists in the field, including recognition of mental health concerns based on SOGI and utilisation of procedural accommodations as per the IRB’s Chairperson Guideline 8 (IRB of Canada, 2012). Nevertheless, our recommendation that proof of SOGI be dropped in favour of pursuing proof of persecution based on SOGI was rejected. This thus remains an ongoing concern regarding the refugee-determination process.
Secondly, significant gaps in settlement and support services for LGBT refugees make it difficult for claimants to access mental health services. In order to address these gaps, the Envisioning report recommended that the federal government reinstate the IFHP, in keeping with the federal court judgment. As mentioned above, this was done in 2016.
Next, provincial governments must also increase resource allocations to counselling and mental health support services that are sensitive to and aware of LGBT refugee issues. Before, during and after the BOC process is a time of particularly high stress and often traumatises LGBT asylum seekers. Adequate support mechanisms would address their mental health needs during this vulnerable time.
Finally, mental health information on LGBT refugees made available at points of entry would improve access to services for LGBT refugees and claimants. For most of these individuals, arrival and claiming asylum are shaped by incidents of homo-bi-transphobia and racism. Any mental health strategies designed for this community must incorporate a critical race perspective on LGBT asylum that considers how racialised identities intersect with LGBT issues.
Conclusion
This chapter has drawn from the extensive data gathered for this segment of the Envisioning research study to focus in particular on the mental health of the LGBT asylum seeker/refugee claimant/refugee populations in the GTA, It has provided a contextual backdrop for mental health issues in Canada in general and outlined many specific and unique mental health concerns of these LGBT populations. Our data illustrated how escape from violence, the refugee-determination process, and resettlement in Canada have a direct impact on the mental health and wellbeing of our participants. This chapter has also provided a specific critical examination of how policy can address these issues and a broader analysis and discussion highlighting the multilevel nature of many of these concerns. Mental health in and of itself is a highly complex state of being that is always in flux. Our study indicated that the quality of this state is easily and directly affected by the experiences of being an LGBT asylum seeker, refugee claimant or refugee. To this end, we believe the system needs to better accommodate LGBTs who are fleeing from persecution, and that sensitised mental health services are greatly needed.
References
Canadian Bar Association, National Immigration Law Section (2012) ‘Submission on Bill C-31: Protecting Canada’s Immigration System Act’, available at: www.cba.org/CMSPages/GetFile.aspx?guid=293bebf9-5237-4106-a26a-7d4241501a38 (accessed 5 Mar. 2018).
Canadian Doctors for Refugee Care (2014) ‘Federal Government sabotaging efforts to provide care for refugees under Ontario Temporary Health Program’, available at: www.doctorsforrefugeecare.ca (accessed 12 Dec. 2017).
Canadian Mental Health Association (2015) ‘Fast facts about mental illness’, available at: www.cmha.ca/media/fast-facts-about-mental-illness/#.VqBHAiorLIU (accessed 12 Dec. 2017).
Envisioning Global LGBT Human Rights (2014a) ‘Envisioning LGBT refugee rights in Canada: the impact of Canada’s new immigration regime’, available at: http://envisioninglgbt.blogspot.com/p/publicationsresources.html (accessed 25 May 2018).
— (2014b) ‘Mental health challenges for LGBT asylum seekers in Canada’ information sheet, available at: http://envisioninglgbt.blogspot.com/p/resources.html (accessed 25 May 2018).
— (2015) ‘Envisioning LGBT refugee rights in Canada: is Canada a safe haven?’, available at: http://envisioninglgbt.blogspot.com/p/publicationsresources.html (accessed 25 May 2018).
Government of Canada (2012) ‘Speaking notes for the Honourable Jason Kenney, PC, MP, Minister of Citizenship, Immigration and Multiculturalism’ for news conference in Ottawa, 16 Feb., available at: www.canada.ca/en/immigration-refugees-citizenship/news/archives/speeches-2012/jason-kenney-minister-2012-02-16.html (accessed 12 Dec. 2017).
Hatzenbuehler, M., S. Nole-Hoeksma and J. Dovidio (2009) ‘How does sexual minority stigma “get under the skin”? A psychological mediation framework’, Psychological Bulletin, 135 (5): 707−30.
Immigration and Refugee Board of Canada (2012) ‘Chairperson Guideline 8: procedures with respect to vulnerable persons appearing before the IRB’, available at: www.irb-cisr.gc.ca/Eng/BoaCom/references/pol/guidir/Pages/GuideDir08.aspx (accessed 12 Dec. 2017).
— (2017) ‘Chairperson’s Guideline 9: proceedings before the IRB involving sexual orientation and gender identity and expression‘, available at: www.irb-cisr.gc.ca/Eng/BoaCom/references/pol/GuiDir/Pages/GuideDir09.aspx#note5 (accessed 6 Mar. 2018).
Lum, Zi-Ann (2015) ‘How Canada will screen gay Syrian refugee men’, Huffington Post, 25 Nov., available at: www.huffingtonpost.ca/2015/11/25/syrian-refugees-canada-gay_n_8650582.html (accessed 5 Mar. 2018).
Meyer I. (2003) ‘Prejudice, social stress and mental health in lesbian, gay and bisexual populations: conceptual issues and research evidence’, Psychological Bulletin, 129 (5): 647−97.
Nicholson, B.L. (1997) ‘The influence of pre-emigration and post-emigration stressors on mental health: a study of Southeast Asian refugees’, Social Work Research, 21 (1): 19–31.
Ou Jin Lee, E. and S. Brotman (2013) ‘Structural intersectionality and anti-oppressive practice with LGBTQ refugees in Canada’, Canadian Social Work Review, 30 (2): 157–83.
Sales, R. (2005) ‘Secure borders, safe haven: a contradiction in terms?’, Ethnic and Racial Studies, 28 (3): 445–62.
Shannon, P.J., G.A. Vinson, E. Wieling, T. Cook and J. Letts (2015) ‘Torture, war trauma, and mental health symptoms of newly arrived Karen refugees’, Journal of Loss and Trauma, 20 (6): 577–90.
Shannon, P.J., E. Wieling, J.S. McCleary and E. Becher (2015) ‘Exploring the mental health effects of political trauma with newly arrived refugees’, Qualitative Health Research, 25 (4): 443–57.
World Health Organization (2014) ‘Mental health: a state of well-being’, www.who.int/features/factfiles/mental_health/en/ (accessed 12 Dec. 2017).
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1 Asylum seekers are defined here as persons fleeing persecution and seeking protection, regardless of their desire, eligibility, or attainment of a particular status within the refugee system. Refugees are individuals seeking protection who have obtained refugee status. Claimants are individuals seeking refugee status, but who have not yet attained it.
2 UNGA, 2015, ‘Annual report of the United Nations High Commissioner for Human Rights and reports of the Office of the High Commission and the Secretary-General. Follow-up to and implementation of the Vienna Declaration and Programme of Action’, A/HRC/29/23, HRC, 29th session agenda items 2 and 8, 4 May.
3 Government of Canada Bill C-31, 2012: Act to amend the Immigration and Refugee Protection Act, the Balanced Refugee Reform Act, the Marine Transportation Security Act and the Department of Citizenship and Immigration Act,’ c17 (60−1), available at: www.parl.ca/Legisinfo/BillDetails.aspx?Language=E&billid=538349 (accessed 2 Aug. 2017).