Caring for immigrants and refugees
As a young doctor, Cécile Rousseau worked in rural Guatemala for four years. The country was at peace when she arrived, but it was soon devastated by civil war. By the time she left, patients and friends had died. She had witnessed how the ravages of war profoundly affected survivors, particularly children.
“Being a family doctor in war is a trying experience, because you feel that you want to protect the villagers with whom you’ve worked,” says Rousseau, a professor at McGill University’s Division of Social and Cultural Psychiatry and clinical psychiatrist at the Jewish General Hospital and Montreal Children’s Hospital (MUHC), and Scientific Director, Research Center, Centre de santé et de services sociaux (CSSS) de la Montagne in Montreal, QC.
“When you’re involved in intense experiences, there’s a need to try to understand and reflect. I’ve always thought that my psychiatry orientation and choice of research career were a posttraumatic reaction.”
On her return to Canada, Rousseau trained as a psychiatrist. She began to work with torture survivors and, at a research level, with refugee children.
“That experience was a strong determinant of my choice of doing psychiatry as a way to address the issue of trauma. How can we understand and how can we repair when people are traumatized by war?”
Her research has involved refugee children and adolescents from Southeast Asia, Central America and Somalia. She works with health institutions and school boards to create programs to enhance the mental health of refugee children and immigrant families in Quebec.
“When I was a medical student, I thought research was the most boring thing in life,” she admits, she soon discovered that research was a powerful tool for transforming and adapting services affecting the mental and physical health of Canada’s refugees and immigrants.
“In terms of influencing policy, it’s absolutely a must. Research is a key leveller that shifts things at the policy level and clinical level. If you want to develop a knowledge of practices or adapt existing programs, you need research to back you up.”
Her research has influenced Canadian policies on access to healthcare for pregnant asylum seekers and undocumented children during immigration, the identification and treatment of mental health problems in refugees and immigrants in primary care, how the devastating experiences of torture survivors influence their responses during the interviewing stage of the refugee determination process, and more.
At CSSS de la Montagne, a Montreal community health and social services centre, Rousseau hopes to establish a research institute that will build local, national and international networks to support this research and influence policy.
She strongly believes in collaborative care in mental health services, an approach in which mental health professionals work with primary care teams including nurses, social workers, and GPs in neighbourhoods rather than hospital outpatient facilities.
“These models are appropriate for immigrants and refugees, who hate going to hospitals, particularly for mental health issues.”
Her early research identified gaps in research on the relationship of psychopathology and trauma. “I discovered that the medical literature was only telling half the story. The other half taught us about resilience. Trauma and adversity harm people and make them vulnerable, but they also have a ‘steeling’ (or strengthening) effect. We were perceiving people only as victims. You really have to understand both aspects to know what’s going on.”
Mental health care must be built on people’s strengths, not only on suppression of their symptoms, she states. This insight led her to another part of her research – working on solutions.
Rousseau works with schools in immigrant neighbourhoods as a consultant and advocate for art programs and non-competitive sports, which she believes are vitally important for children’s mental health. These programs should be integrated into schools, because they provide a “safe expression space” that can protect a child’s mental health, she says.
“In preschool, we work with sand play; in elementary school, with storytelling; and in high school, with theatre, dance and music. To me, this is very important. I hope to encourage other researchers to do the same with physical education.”