Addiction and mental health supports for South Asian community

A pilot project to provide accessible addiction and mental health supports to Edmonton’s South Asian community is making a positive impact among those who have been struggling with the effects of the pandemic.

Due to language and cultural barriers, getting help to the South Asian community has been challenging. A collaborative project that was launched last year is providing needed support, says Scott Baerg, senior operating officer for addiction and mental health and continuing care at Covenant Health.

“What we’ve been seeing is an increase in the number of South Asian people experiencing issues with addiction and mental health, including in our emergency department at the Grey Nuns Community Hospital.

“One aspect of our addictions and mental health strategy is to create a network that brings organizations together to help meet the needs of underserved populations,” he explains.

The network for this pilot project includes the Multicultural Health Brokers Cooperative (MCHB), a community agency that supports new immigrants, the Canadian Mental Health Association (CMHA) — Edmonton Region and Savera Medical Clinic, a publicly funded addictions clinic started by psychiatrist Dr. Avi Aulakh, who was previously Alberta Health Services’ Edmonton Zone clinical site chief of addiction medicine.

“Our goal is to deliver services in a culturally respectful way, and in their language, because there are significant barriers to accessing services because of stigma within the community,” says Scott.

Addiction is often considered a taboo topic, says Issac Cherian, who is of South Asian descent and is one of two part-time therapists funded by Covenant Health and contracted by MCHB to work specifically with the South Asian population.

“Usually, when you say ‘addictions’ within a South Asian family, the family will be shocked if the addiction has been hidden from them. And they don’t know how to help if that person overdoses.”

The tragic consequences of a growing addiction problem in our society continue to rise. In 2020, 1,128 people died from opioid overdoses in Alberta, surpassing the record of 806 fatalities in 2018, according to statistics released by the province.

Giri Puligandla, executive director of the CMAH in Edmonton, says domestic violence is also a growing problem. He is referring to a statistic from the Edmonton Police Service, which reported a 13 per cent increase in domestic violence calls in 2020 compared to the previous year.

He stresses the need to recognize the interrelationship between mental health, addiction and violence. “It’s a logical connection. It’s important to pay attention to how mental health is at the core of addiction and violence issues, including family violence and suicide, both as cause and effect.”

Clients who participate in Covenant’s pilot program are asked to attend seven two-hour sessions. Up until the reporting period ending October 2020, the two therapists had seen 85 clients, providing individual therapy for 73 adults and one adolescent as well as eight couples and three families. Clients were supported for mental health or addictions or both. Almost 500 sessions were provided during that period.

The therapists say two notable areas of improvement pertain to addiction and mental health. Since treatment, 32.9 per cent of family interactions are more positive, and negative behaviour symptoms are reduced by 25.9 per cent. Issac says attendance has been satisfactory, and he reports positive feedback from participants.

Avi says including family members as part of the therapy has shown significant benefits. “Families are engaged. In fact, the initiation is often done by a family member, so families are actively involved, and the outcomes are better. 

“You go to the hospital for acute care needs or when there is a crisis, but the path may end there for the patient.

"We are able to provide the continuum of care by addressing chronic issues with mental health and addictions. If they follow up and continue with us, it may lead to fewer hospitalizations.”

Due to rising COVID-19 numbers, Issac’s sessions have gone virtual to ensure the safety of his clients and their families. Until March 2021, Issac had been meeting with clients twice a week at Savera clinic in the city’s southeast, a shorter commute for many of his South Asian clients compared to downtown Edmonton, where most of the addiction treatment centres are located.

“MCHB doesn’t have an office in the south side, so Dr. Avi invited me to work from his clinic because, for most of the South Asian population, if a physician refers the client to a psychologist in a very personal way, there is a good chance that he will continue with therapy. It’s trust building; research has found that with such referrals, clients are more responsive.”

Over 40 per cent of client referrals from the project come from Savera. Avi says that his clinic, which he started in 2018, was primarily offering treatment for opioid addiction; however, he has seen an influx of patients with issues related to alcohol addiction, depression and domestic violence.

Scott says this aligns with the top five presenting issues of Covenant Health’s clients. “What we’ve seen is that there is alcoholism or mental health issues or substance abuse, and that can lead to domestic violence — it’s a whole continuum.”

He adds that family conflict has been made worse by COVID-19 because in many South Asian families multiple generations reside in the same household. Travel restrictions have made it difficult for the older generation, who typically fly to South Asia in the winter. “This is layered on top of all the mental health challenges associated with COVID.” 

Avi, whose clinic sees up to 40 patients a day, says there is a lot of work yet to be done. “There is a huge need for this. Even with two strong stakeholders (like Covenant Health and MCHB), we still can’t fill all the gaps to provide a full continuum of care for the community.”

Scott says he is hopeful that this initiative is a starting point for considering other groups whose addiction and mental health needs are currently not being met due to cultural barriers. “This pilot will let us explore if we can develop a model that we can adapt or roll out to different groups. If there are other underserved populations where their needs aren’t being met, we want to help meet them.”