PERSPECTIVES ON MENTAL WELLNESSMEALTH OF PUNJABI SIKH IMMIGMNTS IN THE CITY OF SURREY Karin Dhaliwal-Rai B.A., Simon Fraser University, 1992 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in the Faculty of Education O Karin Dhaliwal-Rai 2001 SIMON FRASER üNIVERSITY Apri1200 1 Al1 rights reserved. This work may not be reproduced in whole or in part, by photocopy or other means, without permission of the author. Acquidoonsand Acqu&)itionset Bibliiraphic Senrices seNices bibliographiques The author has granted a non- L'auteur a accordé une licence non exclusive licence allowing the exclusive permettant B la National Li'brary of CanariR to Bibliothèque nationale b Canada de reproduce, loan, distriiute or seli reproduire, prêter, distnier ou copies of this thesis in microfonn, vendre des copies de cette thése sous paper or electronic formats. la forme de microfiche/film, de reproduction sur papier ou sur format électronique. The author retains ownershrp of the L'auteur conserve la propriété du copyright in this thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracta from it Ni la thèse ni des extraits substantiels rnay be printed or othdse de celle-ci ne doivent être imprimbs reprodud without the author's ou autrement reproduits sans son permission. autorisation. Punjabi Sikhs are the largest immigrant community in the City of Surrey. Providing culturally responsive mental wellnesdheaith services for the Punjabi Sikh community is the focus of this study. In order to document the nature of mental wellness issues, as these are understood by members of this community, four service providers and twenty recent immigrant community members were intewiewed. Theories regarding processes of resettlement and adjustment to a new language and culture framed this investigation. Concumntly, a critical perspective on mainsîream service provision is also an intrinsic part of the framework for this study. Specific issues related to accessing mainstream health sentices for minority communities are considered. The research questions that guided this analysis were: What mental wellness/heaith concems are prevaient for members of the Punjabi Sikh immigrant community? in what ways does the process of resettling and adjusting to life in Canada contribute to changes in mental wellness/health? When members of the Punjabi Sikh immigrant community encounter mental wellnessBiealth distress, which support services are accessed and what are the reasons given? The hdings of this investigation are that immigrants of Punjabi Sikh ancestry identify a wide range of social, cultural and economic issues in the process of adjusting to life in Canada. As well the social configuration of the Punjabi family, health and occupational practices, as these are re-stnictured by mainstrearn society, have implications for pattems of weliness. Changes in pattems of sociability, employment, gender relations and relations between the generations were seen as part of the new social system within which cultural beliefs and practices in health must operate. Difficulty in ui accessing familiar and mainstream mental wellnesdhealth supports could also deepen the stress of settlement. In extreme cases stress might lead to substance abuse, domestic violence, intergenerational confiicts and possibly mental illness. This research has important implications for the provision of culturally responsive services by mental health centres, hospitals and multicultural immigrant servicing agencies. The dominant biomedical mode1 in the Canadian health care system oRen ignores the farniliar mental wellnessfiealth support available and utilised in the community. This research suggests that it is critical to acknowledge these support systems as part of mental wellnesshealth assessrnent and plans for individual, family and community care. This thesis is dedicated to the joy and love of my life, my husband Gurpreet and my daughter Avneet. Thank you Gurpreet always for your support and encouragement and Avneet, for your hugs and ksses. Guru Ar@ Dev Ji's teachings, page 106, Sn Guru Granth Sahib Ji 'Man tan tapa dhan bhee tayraa Too (n) Thakur Su-aamee Prabh mayraa Jee-o pind sabh raas tumaaree Tayraa jor Gopaalaa jee-O' Interpretation God has given us a mind and body, which are 60th precious and therefore both need to be respected and maintained. By conditioning our min& and bodies we enrich our lives, strive towards a physiological and mental equilibrium. We are required to lead a balanced life in terms of filfiling our many responsibilities and aspirations in Ife, however, with an emphasis on spirittial goals. Interpretation by, Jagdeep Singh Rai Senior Teacher, Mathematics Co-ordinator Featherstone Primary School South Hall, UK 1would like to thank al1 the service providers and al1 the Punjabi Sikh comrnunity members who took the the to participate in this study and shared their valuable expenences. Also to my colleagues at Surrey Delta immigrant Services Society, 1 would like to extend thanks for providing insight and support during this investigation. 1 wish to express my sincerest appreciation and gratitude to my senior supervisor, Dr. June Beynon, for her support, guidance, and encouragement in the cornpletion of this investigation. Foremost, 1 must also acknowledge the importance of my family, especially my mother, for providing me with emotional, spiritual and childcare support. For myself, a rnother of a toddler, the collaborative workings of and the inherent interconnections of my Punjabi Sikh family unit helped me maintain and balance my academic, professional, spiritual and family life. TABLE OF CONTENTS Pages Title Page .. Approval Page ........................................................................................II ... Abstract ...............................................................................................111 Dedication .............................................................................................v Quotation ............................................................................................vi .. Acknowledgements .................................................................................vil ... Table of Content ....................................................................................vil1 Chapter 1 Accessing Health Services for MulticulturaVMultilingual Comrnunities.............. 8 Overview of Barriers in Accessing Health Service....................................... 8 National. Provincial and Regional Reports ................................................9 Community Reports: South Asian Access to Mainstrearn Services.................. 10 Culturally Responsive Strategy: Mental Health Liaison Counsellor ................. 12 Development and hplementation of the Mental Health Liaison Program ...........12 Summary ......................................................................................14 Chapter II Literature Review: Cultural and Structural Analyses of Immigrant Resettlement .. 16 The Cultural-Psychological Theories of Settlement ....................................17 Phases of Adapting to a New Language and Culture .................................19 Other factors aficting the phases of adapting to a new language and culture .... 20 Structural Causes and Cultural Remedies .................................................21 Structural Inequalities in Health Care .....................................................22 The Health Cure System: issues of class. gender and race ...........................24 Additional Pressures for Seniors. Adolescents and Women .............................25 Adolescents ...........................................................................................25 Seniors .................................................................................................26 Women .......................................................................................27 Chapter iIi Profile of Punjabi Sikh Tmmigrant Community ..........................................30 Diversity in the South Asian Community .................................................30 Histoncal Background: India ...............................................................30 Historical Background: Punjab .............................................................31 Historical Background : in Canada .........................................................32 Educational and Occupational Profile................................................... 34 Kinship and Social Community............................................................ 36 Chapter IV Methodology.................................................................................. 38 Choosing. a Methodology ....................................................................38 Qualitative Research. ........................................................................39 Researcher's Position. Location ............................................................40 Participant Interview Methods ..............................................................43 Service Providers ..........................................................................45 Communiîy Members ......................................................................46 Chapter V Interview Data Analysis .....................................................................48 Research Findings: Service Providers' Responses...................................... 49 Definition of wellness/health..............................................................