Recommendations for Canadian mental health practitioners working with war-exposed immigrants and refugees

AUTHORS    Pushpa Kanagaratnam, Clare Pain, Kwame McKenzie, Nelani Ratnalingam, and Brenda Toner

LOCATION   National


This article addresses the challenges of psychological assessment and treatment of populations who flee from war and political violence. It summarizes current knowledge based on recent guidelines and best practices. It offers conclusions and recommendations to enable mental health practitioners to be more informed, reflective and competent in working with this population. As a whole, it presents a synthesis of knowledge with the aim of promoting consensus among mental health practitioners working with war-traumatized individuals in their clinical practice.

How does this research apply to my work?

Given Canada’s increasingly cultural and ethnic diversity, mental health professionals need to re-examine approaches to mental health well-being and illness in the immigrant and refugee population arriving from war-torn countries. Limitations in literature and gaps in providing culturally proficient mental health care to refugees is well-documented. There has been ongoing efforts amongst scholars and researchers to address the key issues in the field of immigrant and refugee trauma; however, this article outlines that these efforts have not been implemented in clinical practice. In response, this article emphasizes the shift towards meaningful and culturally competent care that can be integrated into the work of mental health professionals.

What should I take away from this research?

The following are key recommendations for clinical practice:

  • The social determinants of health must be acknowledged and incorporated into assessment and treatment interventions
  • The lack of evidence to date for an exposure-focus in trauma treatment should be acknowledged
  • The DSM cultural formulation should be incorporated as standard practice, and training in cultural formulation should be mandated for professionals
  • Stakeholders should be informed and educated on evidence-based practices
  • Training for clinicians in the appropriate use of interpreters and culture brokers should be mandatory

What’s the next step?

The authors indicate that future research must extend beyond individual pathology and take into account the social determinants of health; confirm the conceptualization of war trauma among people living in conflict and post-conflict zones; and, include academics and clinicians belonging to war-affected cultural groups.

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