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Mental Health and Well-Being Among Tamil Youth of Sri Lankan Origin Living in Toronto: a Mixed Methods Approach

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Mental Health and Well-Being Among Tamil Youth of Sri Lankan Origin Living in Toronto: a Mixed Methods Approach MENTAL HEALTH AND WELL-BEING AMONG TAMIL YOUTH OF SRI LANKAN ORIGIN LIVING IN TORONTO: A MIXED METHODS APPROACH BABITHA SHANMUGANANDAPALA A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING GRADUATE PROGRAM IN NURSING YORK UNIVERSITY TORONTO, ONTARIO July 2020 © Babitha Shanmuganandapala, 2020 Abstract Literature on the mental health of Tamil youth of Sri Lankan origin living in Canada is scant. In this study, I applied an interpretive descriptive approach to explore, discover, and understand the meanings, beliefs, practices, and experiences of health, well-being, and mental health of thirteen first and second-generation Sri Lankan Tamil youth. I used a convergent parallel mixed methods research design and applied an emancipatory approach to informing culturally competent mental health nursing practice, influenced by critical race, postcolonial feminist and intersectionality theories. Parents, the Tamil community and Tamil culture emerged as major themes reflecting the important roles they play in Tamil youth’s mental wellbeing. Experiences related to the Sri Lankan civil war/genocide and immigration appear to impact both collective and intergenerational trauma and resilience. Recommendations include applying a holistic, trauma- informed and integrated/multilevel approach, including traditional and collective methods of healing, capacity building and recognition/acknowledgement of the Tamil Genocide. ii Acknowledgement I would first like to thank my supervisor, Dr. Nazilla Khanlou for all the support and the vast amount of knowledge she shared with me during the completion of my thesis. The topic was heavy, and without such an understanding and patient supervisor, along with the support from the strong women at the Office of Women’s Health Research Chair in Mental Health, I doubt I would have brought this thesis to fruition. The Canadian Tamil community and I thank you immensely. I would also like to acknowledge my committee members Dr. Beryl Pilkington and Dr. Hala Tamim for the feedback, and suggestions they provided in enhancing the quality of this thesis. To the participants of this research study, thank you for your initiative, interest and courage to share your vulnerability and experiences with me. I hope you know that your resilience and contributions will positively impact generations to come. A warm thank you to the Tamil community for the opportunities you provided, and to those who have worked and continue to work in mental health. Thank you to the organizations and individuals who supported me with this thesis by helping with recruitment, providing space for interviews, and organizing and attending research dissemination activities. I would also like to acknowledge my friends, my managers and co-workers at the Ministry of Long-Term Care, the team at Scarborough Health Network Centenary Hospital, and Nandavanam Ayurvedic Hospital for your support. Last but not least, I would like to acknowledge my family. To my husband Latheepan and my best friend Sowsan -thank you for everything. My gratitude for you knows no bounds. To my parents, and the Shan, Benedict, Raguraman, Murugathasan and Sukumaran family, thank you for keeping me strong mentally and physically with all your love and encouragement. iii Dedication To those who fought for my right to education and freedom. Without you, I might not be alive to tell this story. To Canada, thank you for the privilege to call you home and the openness to hear our voices. To the Tamil community, thank you for the opportunities. I hope the information in this thesis challenges, teaches, and helps you in some way. To my husband Latheepan. I love you beyond measure. Ball is life, and I am so happy that it brought us together for life. May we continue to excel in life on offense, protect our family on defense, catch each other’s rebounds and always love each other through it all. To my parents Shanmuganandapala Krishnapillai and Gnanamalar Shanmuganandapala. You escaped genocide with four children, crossed oceans, started a new life in an unfamiliar country, gave us unconditional love, encouraged me to pursue nursing, and worked yourselves to the bones to provide a better life for us. I hope I did justice to your experiences. iv Table of Contents Abstract ........................................................................................................................................... ii Acknowledgement ......................................................................................................................... iii Dedication ...................................................................................................................................... iv Table of Contents ............................................................................................................................ v List of Tables ................................................................................................................................. ix List of Figures ................................................................................................................................. x List of Abbreviations ..................................................................................................................... xi 1.0 Chapter One: Introduction ........................................................................................................ 1 1.1 Background ........................................................................................................................... 3 1.1.1 The mental health status of Canadian youth. ................................................................. 5 1.1.2 Individual and societal impacts. ..................................................................................... 9 1.1.3 The Canadian mental health system and economic impacts. ....................................... 13 1.2 Significance of the Research ............................................................................................... 19 1.2.1 Evolving mosaic: Majority South Asians within the IRER population. ...................... 20 1.2.2 The young and growing IRER and South Asian population. ...................................... 22 1.2.3 Health equity and social justice for IRER populations. ............................................... 24 1.2.4 Addressing mental health equity and social justice for Tamil youth. .......................... 27 1.3 Aims/Purpose ...................................................................................................................... 28 1.4 Definitions and Conceptualizations .................................................................................... 30 1.5 Summary ............................................................................................................................. 34 2.0 Chapter Two: Review of the Literature .................................................................................. 35 2.1 Culture of Collectivism ....................................................................................................... 35 2.2 History, Politics, and Human Rights .................................................................................. 36 2.2.1 Rights of minorities. .................................................................................................... 38 2.2.2 Education and employment. ........................................................................................ 39 2.2.3 Religion, casteism and nationalism. ............................................................................ 41 2.2.4 Tamil youth’s uprising. ................................................................................................ 42 2.2.5 Culture. ........................................................................................................................ 43 2.2.6 War/Genocide. ............................................................................................................. 44 2.2.7 Tsunami. ...................................................................................................................... 45 2.2.8 Final stages of the war/genocide. ................................................................................. 45 2.2.9 Global response. ........................................................................................................... 47 2.3 Canadian-Tamil Experiences .............................................................................................. 49 2.3.1 Pre-migration experiences ........................................................................................... 50 2.3.2 Post-migration experiences .......................................................................................... 54 2.3.3 Gender .......................................................................................................................... 58 2.4 Meanings of Mental Health and Well-being ....................................................................... 65 2.5 Beliefs of Mental Health and Well-being ........................................................................... 66 2.6 Practices of Mental Health and Well-being ........................................................................ 68 2.7 Summary ............................................................................................................................. 70 v 3.0 Chapter Three: Methodology
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