Time has run out for many Syrians needing mental health treatment

January marks Bassima Al-Jaji’s thirteenth month living in Canada. Right now she is happy to be living in the safe confines of Halifax, and says “this is a new life for me, my husband and our five children.” But speaking through a translator, she says this new life has come through difficult means.

Born in the city of Idlib, which is about an hour’s drive south of Aleppo, Al-Jaji and her family spent four years dealing with the repercussions of civil war in her native Syria.

“We spent more than one year under all kinds of bombs, airplanes and shelling,” she says. Her niece and brother-in-law were killed in the attacks. Her daughter and son were left injured.

Fearing for their lives, Al-Jaji and her family fled to Lebanon in 2012, where they found shelter in a small shack. There, they would sleep closely together on the floor for months on end.

In Lebanon, her anxiety ran high. Sometimes, Al-Jaji says she smashed “plates, dishes and glasses” as a form of stress relief. With her husband unable to work, she says her family was “stuck in limbo.”

This forced the family to try and get an interview with a representative of the United Nations High Commissioner for Refugees (UNHCR). After several meetings, the UNHCR offered to move her family to Canada.

“Today our situation is way better than in Lebanon,” Al-Jaji says. “The people here have made everything easier. Canadians are helpful.”

While she has spent the past year adjusting to life in Halifax, she has had to deal with troubles that go far beyond language barriers and the cold Canadian winter.

Like many refugee immigrants, Al-Jaji has been dealing with mental health problems brought on by the civil war.

Under the Federal Government’s Interim Federal Health Program (IFHP), refugees can seek medical treatment from a general practitioner (GP). If the GP considers the patient to have a sufficiently debilitating mental health problem then they can be referred to a psychologist for up to ten sessions of one on one treatment within the calendar year of their arrival.

Al-Jaji has been lucky enough to receive this treatment and after ten sessions says she has made progress.

“I’m not crying a lot like when I first came,” she says. “Today I’m dealing with my family and community in a better way.”

Even though her sessions are over, Al-Jaji feels more treatment for her and other refugees would be a “good thing.”

Local psychologist Lesley Hartman agrees. She says many refugees would benefit from more sessions and that ten sessions of treatment are woefully insufficient.

***

Hartman says that research suggests the bare minimum amount of treatment for an “optimum client” is 12 sessions, although “in practice, I can tell you that that optimum client does not exist.”

While the optimum client has one traumatic incident from their past, the reality for many Syrians is much different. Many have seen repeated incidents of violence and some have depression and anxiety, as well as PTSD.

In order to overcome these problems, Hartman says patients need to go through three stages of treatment.

The first involves stabilization, where they learn how to calm themselves down “when they are exposed to memories or strong emotions,” she says.

During the second stage patients need to confront and discuss their past traumas before they can move onto the third stage. The third stage tries to get them back to being their regular selves.

But, Hartman says, “you cannot move on to stage two if you are not emotionally prepared.” With refugees only receiving a maximum of ten sessions, Hartman is worried they will never fully recover — making it more difficult to hold jobs, maintain relationships and integrate into Canadian society.

***

For their first year in Canada, refugees received funding for private therapy through the IFHP program. With many entering into their thirteenth month, they are now being passed over to provincial health insurance plans where they are no longer eligible for such funding.

Lindsay Wemp, a spokesperson for the federal department of Immigration, Refugees and Citizenship, told The Signal each province must handle the care of refugees according to their own medical insurance programs.

“If a refugee has begun treatment under the IFHP program and wishes to continue their treatment when their eligibility for IFHP ends, they may do so with the same health care professional, through supplemental health coverage through their province, if they are receiving social assistance, or through their employer or other private insurance,” she says.

According to Wemp, this “supplemental” coverage is similar to what “provinces and territories provide to Canadians receiving social assistance.”

The Signal asked a spokesperson with the Nova Scotia Health Authority what this “supplemental” health coverage referred to.

That question was forwarded to Tracy Barron of the Nova Scotia Department of Health and Wellness, who responded that “Syrian refugees were given permanent residency status by the federal government. As such, they qualify for provincial health coverage, the same as every other Nova Scotian.”

This means these victims of civil war could once again be left to suffer — this time languishing on lengthy waiting lists, which can in turn lead to misdiagnosed mental health problems, as well as the reversal of any progress made during their IFHP-sponsored sessions.

According to wait times data from 2016, once a refugee receives a referral from a GP to see a mental health specialist, Halifax patients may have to wait up to 107 days in order to get a mental health treatment assessment. The wait lists are even longer for children and adolescents.

A spokesperson from the Nova Scotia Health Authority says this data is outdated, but new information is not yet available.

Barron notes that patients with mental health issues are seen in order of the severity of their symptoms — common practice in Canadian public health care — but Hartman says it can be difficult for others with lesser symptoms to get a referral for “specialized” mental health services like one on one psychologist counselling.

Once refugees are given permanent resident status in Nova Scotia, they, like all other residents, are eligible for income assistance if necessary.

But because “mental health supports are provided through the Nova Scotia Health Authority,” people on social assistance who needed treatment would be expected to go through the public system says Heather Fairbarn, Media Relations Adviser for the Department of Community Services.

If people are on a waiting list, they can still get a prescription from a GP or walk-in clinic while they await a mental health assessment and subsequent treatment.

While medication may make it easier to manage symptoms, Hartman says prescription medication is not enough. For refugees experiencing mental health problems, therapy is needed in order for them to fully “recover from their trauma.”

As for Al-Jaji, she says she “feels better” these days. She doesn’t think about her life back in Syria as much and she is developing a healthier relationship with her family and has a close community of new friends here in Halifax.

Al-Jaji says she is also happy to be here “because my kids are getting a good education.” She even wants to follow in their footsteps by learning English and has been attending a sewing workshop, hoping to one day become a dressmaker.

Al-Jaji knows of no one else who’s been getting help, “but that doesn’t mean I’m the only one.”

She says this kind of treatment “will benefit refugees in the long run.” And though she says she would like more help, “no one has told us yet how we will deal without federal support.”

This is part one of a two-part story on mental health treatment for Syrian refugees in Nova Scotia.