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Immigration Status as the Foundational Determinant of Health for People Without Status in Canada: A Scoping Review

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Monica Gagnon
Monica Gagnon
Monica Gagnon
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Nisha Kansal
Nisha Kansal
Nisha Kansal
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Ritika Goel
Ritika Goel
Ritika Goel
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Denise Gastaldo
Denise Gastaldo
Denise Gastaldo
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Abstract and Figures

Migration is increasing at unprecedented rates worldwide, but inadequate mechanisms for granting citizenship or permanent residence have rendered many immigrants without legal status. We study the health of people without immigration status in Canada, building on a 2010 review on being without status and health. We employ an expanded definition of health, guided by the WHO Social Determinants of Health (SDoH) framework. Using a scoping review methodology, we reviewed literature from 2008 to 2018 on the SDoH of people without legal immigration status in Canada, selecting 33 articles for analysis. We found that structural determinants of health, such as stigmatization and criminalization, and intermediary determinants, such as fear of deportation and healthcare avoidance, produce ill health. We show how different social positions are produced by SDoH, finding immigration status to be the foundational determinant of health for people without status in Canada. We argue that lack of immigration status as a SDoH is missing from the WHO framework.
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Vol.:(0123456789)
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Journal of Immigrant and Minority Health (2022) 24:1029–1044
https://doi.org/10.1007/s10903-021-01273-w
REVIEW PAPER
Immigration Status astheFoundational Determinant ofHealth
forPeople Without Status inCanada: AScoping Review
MonicaGagnon1 · NishaKansal2· RitikaGoel3· DeniseGastaldo4
Accepted: 10 September 2021 / Published online: 3 October 2021
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021
Abstract
Migration is increasing at unprecedented rates worldwide, but inadequate mechanisms for granting citizenship or permanent
residence have rendered many immigrants without legal status. We study the health of people without immigration status in
Canada, building on a 2010 review on being without status and health. We employ an expanded definition of health, guided
by the WHO Social Determinants of Health (SDoH) framework. Using a scoping review methodology, we reviewed literature
from 2008 to 2018 on the SDoH of people without legal immigration status in Canada, selecting 33 articles for analysis. We
found that structural determinants of health, such as stigmatization and criminalization, and intermediary determinants, such
as fear of deportation and healthcare avoidance, produce ill health. We show how different social positions are produced
by SDoH, finding immigration status to be the foundational determinant of health for people without status in Canada. We
argue that lack of immigration status as a SDoH is missing from the WHO framework.
Keywords Immigration· Canada· Undocumented· Illegal· Social determinants of health· Access to health care
Introduction
Irregular migration, or the movement of people outside of
regular migration channels [1], is the fastest growing form
of international migration across the globe. In high-income
countries, this type of migration is associated with neoliberal
market demands for a readily available, cheap and flexible
workforce [2]. In the case of Canada, people without legal
immigration status usually enter the country with some form
of status such as a temporary work permit, student visa, or
tourist visa, which later expires, or a refugee claim which
fails or is withdrawn, leaving the person without status
[3]. The Canadian immigration system is complex to navi-
gate, with people frequently shifting in and out of status,
often dependent on third parties like employers or partners
to secure legal immigration status [4]. They have limited
options for obtaining permanent immigration status, and live
under the threats of arrest, detention, and deportation [5].
People without status are denied most health, social, and
legal services [5], with direct and wide-ranging implications
for their health and wellbeing. Because of this varied and
shifting state of belonging, not having citizenship or per-
manent residency in Canada has been referred to as having
“precarious” legal status, defined by the conditionality of
one’s presence and access to services [3]. In this paper, we
focus in particular on the population of people with precari-
ous status who have no legal immigration status in Canada,
using the terms “without status,” or “non-status.”
This paper builds on Magalhães, Carrasco, and Gastaldo’s
2010 review [5], which focused on how being without status
in Canada affects people’s health, service access, and work-
ing conditions, covering the 1999–2008 period. We reviewed
the literature published over the following ten years, expand-
ing on the previous review in order to include other social
determinants of health (SDoH) affecting people without
status in Canada. We use a broad definition of health that
incorporates social, spiritual, emotional, and physical health
and wellbeing. Our study is unique in bringing together the
health and social sciences literatures to provide a more
* Monica Gagnon
monica.gagnon@mail.utoronto.ca
1 Dalla Lana School ofPublic Health, University ofToronto,
Toronto, ON, Canada
2 Faculty ofHealth Sciences, McMaster University, Hamilton,
ON, Canada
3 St. Michael’s Hospital, Academic Family Health Team,
Toronto, ON, Canada
4 Lawrence S. Bloomberg Faculty ofNursing, University
ofToronto, Toronto, ON, Canada
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... International students and people without status are excluded from OHIP altogether. Due to the complexity of the Canadian immigration system, "people frequently [shift] in and out of status, and are often dependent on third parties like employers or partners to secure legal immigration status" (Gagnon et al. 2022(Gagnon et al. : 1029. 2 People who are uninsured in Ontario may be able to access primary care at no cost through community health centres (CHCs), midwives and dedicated uninsured walk-in clinics. Some people, however, may have trouble finding access to a CHC due to eligibility criteria (Medical Officer of Health 2013; Schmidt et al. 2023). ...
... Hospitals have resumed many of these practices in the weeks since the Ontario Ministry of Health suspended the PHSUP. Uninsured patients can also face intrusive questions and derision from some healthcare providers and administrative staff because of their immigration status (Campbell et al. 2014;Gagnon et al. 2022;Simich et al. 2007;Siu et al. 2022). ...
... Examples include signage in EDs, uninsured payment forms, informing patients about costs, asking patients for payment, denying or suspending treatment and pursuing patients for payment up to and including sending them to collections. This can be compounded by derisive and often racist and xenophobic attitudes toward uninsured patients, attitudes that are well documented in the literature and that we have seen in our own work (Campbell et al. 2014;Gagnon et al. 2022;Simich et al. 2007;Siu et al. 2022). ...
Hospital Care for Patients Uninsured due to Immigration Status during the COVID-19 Pandemic in Toronto: Lessons from Front-Line Knowledge Translation
Article
  • Jul 2023
  • Healthc Q
Before the COVID-19 pandemic, patients in Ontario who were uninsured due to immigration status faced barriers to hospital care that resulted in preventable illness and death. In March 2020, the Ontario Ministry of Health issued a memo indicating that it would pay for medically necessary hospital services for uninsured patients (Ontario Ministry of Health 2020). Front-line providers and research workers associated with the Health Network for Uninsured Clients (HNUC) set out to ensure that hospitals in Toronto implemented the ministry's memo. In this paper, we demonstrate a model of front-line worker-led knowledge translation informed by real-time data and anchored in clearly articulated values and goals. On April 1, 2023, the Ontario Ministry of Health cancelled this uninsured coverage (Ontario Ministry of Health 2023). Healthcare provider associations, grassroots groups and coalitions - including the HNUC - are mobilizing to see this uninsured coverage reinstated.
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... Other exclusion criteria included notes, editorials, books, news reports, case reports, commentaries, opinions, and letters. Qualitative research was also excluded given that previous reviews have already summarized qualitative literature on this population in Canada [5,16,33]. In addition, we were interested in synthesizing the quantitative relationship between medical uninsurance and various outcomes (i.e., health outcomes, health care use, and cost) and understanding the size of the problems affecting the medically uninsured, for which quantitative research was relevant. ...
... Among uninsured women that received care, only 55% saw an obstetrician, compared to 94% of insured women. Uninsured women were significantly more likely to have sought the services of a midwife (36.0% vs. 4.0%), to have presented at a later gestational age (18.4 weeks vs. 12.7 weeks) and to have delivered their baby at home compared to the insured (28.7% vs. 16.6%) [29,33]. ...
... Reasons for limited studies on medically uninsured populations include ethical barriers to study this population and limitations of existing data collection methods [52,53]. Gagnon et al. (2021) who conducted a narrative scoping review on immigration status as a determinant of health, which we see as a complementary study to ours, showed that studies in this area are primarily qualitative in nature [16]. Our search also highlighted that literature is limited by the definition of medically uninsured. ...
Health outcomes, health services utilization, and costs consequences of medicare uninsurance among migrants in Canada: a systematic review
Article
Full-text available
  • May 2023
  • BMC HEALTH SERV RES
Background Medically uninsured groups, many of them migrants, reportedly delay using healthcare services due to costs and often face preventable health consequences. This systematic review sought to assess quantitative evidence on health outcomes, health services use, and health care costs among uninsured migrant populations in Canada. Methods OVID MEDLINE, Embase, Global Health, EconLit, and grey literature were searched to identify relevant literature published up until March 2021. The Cochrane Risk of Bias in Non-randomized Studies – of Interventions (ROBINS-I) tool was used to assess the quality of studies. Results Ten studies were included. Data showed that there are differences among insured and uninsured groups in reported health outcomes and health services use. No quantitative studies on economic costs were captured. Conclusions Our findings indicate a need to review policies regarding accessible and affordable health care for migrants. Increasing funding to community health centers may improve service utilization and health outcomes among this population.
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... policy. Undocumented migrants and asylum seekers are held accountable for their status and are consequently kept in precarious situations with the constant threat of deportation (Gagnon et al. 2022). ...
Vulnerability of Asylum Seekers and Undocumented Migrants in Toronto
Article
Full-text available
  • Apr 2024
This article examines the underlying structural elements contributing to the vulnerability experienced by asylum seekers and undocumented migrants across two critical domains: refugee eligibility examination and accessibility of essential social services, particularly healthcare. By drawing insights from fieldwork conducted in Toronto between 2020 and 2022, this article investigates how migrants navigate and perceive vulnerability encountered both at the front-end of the refugee status determination and while trying to access social services. It discusses the perspectives of key stakeholders, including lawyers, representatives of immigrant-focused non-profit organizations, and municipal officials, shedding light on their experiences and insights regarding the challenges faced by migrants. Furthermore, this article critically evaluates Canada’s adherence to the principles articulated in the 2018 United Nations Global Compacts on Migration and Refugees concerning the mitigation of vulnerability among migrant populations.
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... Immigration status intersects with various social determinants of health, such as employment, housing, and education. For example, individuals with precarious immigration status may be more likely to work in low-paying jobs without health insurance, live in substandard housing conditions, or face discrimination, all of which can affect health outcome [29]. Eligibility for public health programs, such as Medicaid, can be influenced by immigration status as well. ...
Predictors of Chronic Debilitating Conditions Among Refugees Resettled in the United States
Article
Full-text available
  • Dec 2023
Refugees who have resettled in the United States encounter numerous challenges, including poor health conditions. However, knowledge of risk factors contributing to chronic debilitating conditions among refugees is scarce. Therefore, this study examined the prevalence and potential factors associated with chronic debilitating conditions within the U.S. refugee population. This study utilized secondary data from the 2019 Annual Survey of Refugees (ASR) involving 1007 refugees aged 16 years or older resettled in the U.S. between 2014 and 2018. The prevalence estimates were obtained using chi-square tests, and multiple logistic regression was used to determine the significant association between predictor variables and chronic debilitating conditions for refugees in the United States. About 25.5% of the refugees reported having chronic debilitating conditions. Regression results showed that being an older refugee and having adjusted immigration status to become a permanent resident was associated with higher odds of reporting chronic debilitating conditions. However, refugees who were currently working, married, and with good English language proficiency were associated with a lower likelihood of reporting chronic debilitating conditions. Gender and education levels of refugees were not significantly associated with chronic debilitating conditions after covariates adjustments. Interventions should focus on increasing access to education, employment opportunities to enhance health literacy, and financial resources to access healthcare crucial for mitigating chronic debilitating conditions. In addition, addressing the language barriers through language and interpretation services in clinical settings can also improve healthcare access, thus reducing the risk of chronic debilitating conditions among refugees resettled in the United States.
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... Canada was formed as a "nation" in 1867 through the union of British colonies, cessation of French colonies, broken Treaties with 97 Indigenous communities, and unlawful claims to unceded lands that have been continually inhabited by Indigenous peoples for thousands of years (Greer, 2018). While Canada remains a top destination for international migrants, racial disparities persist for Indigenous and nonwhite communities who face higher rates of poverty (Block & Galabuzi, 2011;Campaign 2000Campaign , 2022, overrepresentation in the criminal justice and child welfare systems (Blackstock, 2016;Maynard, 2017;Sinclair, 2019) and poorer physical and mental health (Gagnon et al., 2021;Magalhaes et al., 2010). ...
“Unless we are Native, we are all immigrants to Canada”: Tensions between multicultural inclusion and settler-colonial consciousness among Canadian social workers
Article
  • Dec 2023
  • J Ethnic Cult Divers Soc Work
This paper presents a discourse analysis of how social work values, knowledge, and attitudes toward immigrants are represented in 173 open-ended responses to a national survey (n = 1125) of Canadian social workers attitudes toward immigrants. Through discourse analysis of social workers’ commentary, we discuss notable tensions between social workers’ affinity for multicultural inclusion and their critiques of Canadian settler-colonialism. While respondents broadly emphasize “respect for diversity” and the need to advocate for immigrants as expressions of their Canadian and social work identity, some suggest that inequalities facing Indigenous communities should be addressed before Canada continues to increase its investment in immigration. We consider how dichotomizing concerns for Indigenous and immigrant communities reflect the limits of multicultural inclusion and the need to further decolonize social work education and practice.
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... Coupled with that, many state outlets seeking to facilitate access in disadvantaged groups often required access to the internet, control over work schedules, and that patients fill out forms in English where they were asked to detail their health insurance details. Individuals, such as foreign nationals who distrust governmental resources for any reason, including their legal status, see such requests as a reason to avoid accessing healthcare resources [45]. Perhaps Hispanic groups were, therefore, disadvantaged because governmental efforts to distribute the vaccine did not recognize the importance of these barriers early on. ...
Social inequalities and the early provision and dispersal of COVID-19 vaccinations in the United States: A population trends study
Article
Full-text available
  • Jul 2023
Background: In December 2020 the U.S. began a massive COVID-19 vaccination campaign, an action that researchers felt could catalyze inequalities in COVID-19 vaccination utilization. While vaccines have the potential to be accessible regardless of social status, the objective of this study was to examine how and when socioeconomic status (SES) and racial/ethnic inequalities would emerge in vaccination distribution. Methods: Population vaccination rates reported at the county level by the Centers for Disease Control and Prevention across 46 states on 3/30/2021. Correlates included SES, the share of the population who were Black, Hispanic, Female, or aged ≥65 years, and urbanicity (thousands of residents per square mile). Multivariable-adjusted analyses relied on zero-inflated negative binomial regression to estimate the odds of providing any vaccine, and vaccination rate ratios (aVRR) comparing the distribution rate for vaccinations across the U.S. Results: Across the U.S., 16.3 % of adults and 37.9 % of adults aged 65 and older were vaccinated in lower SES counties, while 20.45 % of all adults and 48.15 % of adults aged 65 and older were vaccinated in higher SES counties. Inequalities emerged after 41 days, when < 2 % of Americans were vaccinated. Multivariable-adjusted analyses revealed that higher SES was associated with improved vaccination distribution (aVRR = 1.127, [1.100-1.155], p < 1E-06), while increases in the percent reporting Black or Hispanic race/ethnicity was associated with lower vaccination distribution (aVRR = 0.998, [0.996-0.999], p = 1.03E-04). Conclusions: Social inequalities in COVID-19 vaccines reflect an inefficient and inequitable distribution of these technologies. Future efforts to improve health should recognize the central role of social factors in impacting vaccine delivery.
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Canadian social workers’ attitudes toward immigrants with different legal statuses in Canada
Article
Full-text available
  • Apr 2024
  • J Soc Work
This study contributes to the ongoing efforts to address systemic inequality within social work by examining Canadian social workers’ attitudes toward immigrants who are permanent residents (PR), refugees, temporary residents (TR), or undocumented immigrants. Using a cross-sectional design with a convenience sample (n = 653), we explore how social workers’ attitudes toward immigrants vary in relation to (a) respondents’ demographics, (b) contact with immigrants, (c) perceptions of equal opportunities among immigrants, (d) perceptions of deservingness for immigrants with different legal statuses, and (e) the impact of the COVID-19 pandemic on these attitudes. Findings While Canadian social workers generally express positive attitudes toward immigrants, there is a slightly stronger endorsement for PR and refugees to access public services compared to nonstatus (NS) immigrants and TR. Social workers who identify as conservative or have limited contact with immigrants are more likely to perceive NS immigrants as potential criminal threats or burdens on the healthcare system. Significantly, a majority of respondents feel that their social work training inadequately prepares them to work effectively with immigrants. Applications Canadian social workers advocate for principles of diversity, inclusion, and commitment to social justice. However, perceptions regarding which immigrants deserve access to social services vary based on legal status, suggesting a limitation in social workers’ professional mandate. The study discusses implications for social work education and training, emphasizing the need to address and unsettle systemic racism within the profession.
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Examining clinicians' perceptions and experiences working with diverse families in family-based treatment: Common adaptations and considerations for treatment engagement
Article
  • Jan 2024
  • INT J EAT DISORDER
Objective Family‐Based Treatment (FBT) is the leading manualized treatment for adolescent eating disorders; however, there is limited research on the adaptation of FBT for diverse families (i.e., families belonging to identity groups subject to systemic barriers and prejudices). The purpose of this qualitative study was to address: (1) adaptations made to the FBT model (if any) by clinicians working with diverse youth and families; (2) the barriers/facilitators of maintaining adherence (fidelity) to the model for these families; and, (3) the barriers/facilitators to access and engagement in FBT for diverse families. Method Forty‐one FBT clinicians were recruited globally using purposive and snowball sampling, and listservs from eating disorder networks. Clinicians participated in individual interviews or focus groups, discussing their experiences delivering and adapting FBT for diverse families. Qualitative data was transcribed verbatim and analyzed using directed content analysis. Results Some participants reported making adaptations to every phase of the FBT model, while others did not, when working with diverse families. In Phase 1, participants cited adapting the family meal, length/number of sessions provided, and addressed systemic barriers. In Phase 2, participants adapted the length of the phase and rate/level of independence given back to the adolescent. In Phase 3, participants increased or decreased the number of sessions, or eliminated this phase to address barriers to engagement in FBT. Discussion This is the first study to qualitatively examine clinicians' experiences of implementing FBT with diverse families. Results may inform future FBT planning, clinician training, clinical decision‐making tools, and opportunities for modifications to the foundational model. Public Significance This qualitative study examined clinicians' perceptions and experiences implementing FBT with diverse families, specifically what adaptations (if any) were made to the foundational model, and the barriers and facilitators to adhering to and engaging in the model. Results show that some participants reported making adaptations to every phase of FBT, while others did not, with diverse families. Findings may inform future treatment planning, clinician training, clinical decision‐making tools, and potential modifications to FBT.
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Reporting of Ethno-Racial Identity and Immigration Status in Published Studies on Newcomer Children
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  • Sep 2023
Access to health services can differ greatly based on ethno-racial identity and immigration status. We examined the reporting of ethno-racial data and immigration status in published literature on the health of newcomer children. An integrative scoping review was performed using the methodological framework outlined by Arksey and O’Malley (2005). 4147 articles were identified and 75 studies included in the final analysis. 67% (50/75) did not describe the participants immigration status at all. Most studies (65%, 49/75) also did not report participants’ ethno-racial identities. Of those that did, 65% (17/26) reported participant ethnicity alone, and 15% (4/26) reported race alone, while 19% (5/26) reported both race and ethnicity. We found that most studies on newcomer children did not report immigration status or ethno-racial identity. In doing so, studies may ignore the specific impacts of racism and xenophobia on health and access to care.
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Entrapped Bodies: Illegalized Trafficked Youth in Canada
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  • Apr 2019
  • Int J Ment Health Addiction
Over the last decade, the problem of sex trafficking has become an alarming global concern. Reports suggest that half of active cases of sex trafficking involve female children and youth. This paper considers the mental health impact of sex trafficking on illegalized female trafficked youth under the age of 29 who live in Canada without legal immigration status. It will draw on a qualitative research, including individual interview and survey questionnaires, to explore the lived conditions and mental health outcomes of illegalized trafficked youth in the Greater Toronto Area. Sex trafficking is a gender and human rights violation, as well as a total control over an individual’s body, sexuality, and livelihood. Trafficking negatively impacts the social determinants of health and mental health of trafficked persons. This paper provides three recommendations to improve mental health conditions of illegalized trafficked youth.
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Cycles of deportability: Threats, fears, and the agency of 'irregular' migrants in Canada
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  • Nov 2018
In recent decades, migration scholars have challenged reified categories of 'illegal'migrants and observed migrant 'illegalization' and deportability as exploitative sociopolitical processes. Yet, in the move away from studying 'undocumented migrants' as distinct epistemic subjects,we argue that scholars have lost sight ofmigrants as agents. Consequently, migrant lives are explained in terms of social determinants rather thanmigrants' intentional acts or cultural meaning systems. This paper shows how a cultural psychological study of migrant 'illegality' can help restore focus on the migrant as situated agent without reifying or legitimizing categories of migrant 'illegality.' To this end, we discuss ethnographic research conducted with Polish 'irregular' migrants living in Toronto and Mississauga in Canada. From a cultural psychological perspective, we examine how thesemigrants understood and navigated their unique status-related challenges to build meaningful lives in contradictory and precarious conditions. Our research reveals how Polish migrants learn to become 'irregular' as they develop common modes of being suitable for navigating the underground of Canada's Polish Canadian enclave. Importantly, becoming 'irregular' is neither a passive nor unilaterally imposed process but involves discernible psychosocial dynamics characterized by recurrent threats and fears as well as migrants' deliberate attempts to address and overcome these. We discuss these dynamics as cycles of deportability to mark their cyclical and recurrent nature and argue that they are central for the development of migrant 'illegality' and deportability. We conclude by considering the implications of our findings for understanding agency in the context of migrant 'illegalization'. © The Author 2017. Published by Oxford University Press. All rights reserved.
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Introduction to Special Section on: Precarity, Illegality and Temporariness: Implications and Consequences of Canadian Migration Management
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  • Dec 2018
Canada's current immigration, refugee, citizenship and temporary migration polices facilitate the production and maintenance of multitude forms of temporariness. The designation of temporary and precarious status means limited rights, conditionality and increased risk of abuse and exploitation. It also shapes persons’ access to rights and services and their sense of belonging. The special section includes four original articles that employ a range of qualitative methods to delve into the issue of temporariness and its implications for migrants, Canadians, and the future of migration management in Canada. The authors call for repeals, amendments and the creation of innovative programmes that leads to pathways to permanent status. The contributions are intended to provide active, pointed, and practical recommendations that would eventually lead to an immigration programme that is efficient, secure, and complies with international human rights standards while eliminating instances of abuse and exploitation.
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The End of the Cognitive EmpireThe Coming of Age of Epistemologies of the South
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  • Aug 2018
In The End of the Cognitive Empire Boaventura de Sousa Santos further develops his concept of the "epistemologies of the South," in which he outlines a theoretical, methodological, and pedagogical framework for challenging the dominance of Eurocentric thought. As a collection of knowledges born of and anchored in the experiences of marginalized peoples who actively resist capitalism, colonialism, and patriarchy, epistemologies of the South represent those forms of knowledge that are generally discredited, erased, and ignored by dominant cultures of the global North. Noting the declining efficacy of established social and political solutions to combat inequality and discrimination, Santos suggests that global justice can only come about through an epistemological shift that guarantees cognitive justice. Such a shift would create new, alternative strategies for political mobilization and activism and give oppressed social groups the means through which to represent the world as their own and in their own terms.
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Living with Compromised Legal Status: Irregular Temporary Foreign Workers in Alberta and the Importance of Imagining, Strategizing, and Inter-Provincial Legal Consciousness
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  • Aug 2018
This article highlights the manifold ways that migrants strategically use their social networks in order to survive in Alberta with compromised legal status. The conditionality of their status is affected by individual encounters and by new policy developments, showing that their ability to control their life trajectories is constrained by factors beyond their control. Nevertheless, although they experienced high amounts of stress because of their situations, the role played by cognitive processes, which include imagining, strategizing, and what I call “inter‐provincial legal consciousness”, allowed them to exercise agency. These processes allowed them to build communities and networks of support and to imagine potential life paths in other provinces through other provinces’ provincial nominee programmes.
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Borders of belonging: challenges in access to anti-oppressive mental health care for Indigenous Latinx gender-fluid border-youth
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  • Jul 2018
Many voices have called for decolonizing psychology as a profession and underscored the necessity of building and utilizing a counseling framework that rejects the rigidity of the gender binary and is mindful of the intersectional positionality that implicates subjectivities in complex vectors of oppression, invisibility, and marginalization. But how does one integrate and apply these complex constructs in a culturally relevant clinical practice? The gap between theory and practice appears to have widened, by both action and omission. Moreover, a myriad of clients run the risk of becoming re-oppressed by hegemonic practices in mental health services in Canada. Gender-fluid youth without immigration status who speak languages other than English are either pathologized or rendered invisible by academic discourses and clinical training practices in university settings. Using a critical approach to personality psychology and drawing upon extensive field research, this work discusses the challenges faced by Indigenous Latinx border-youth in accessing anti-oppressive mental health services in Toronto, Canada. The study conducted between 2010 and 2016, in which six Indigenous Latinx gender-fluid youth were interviewed, employed a qualitative narrative inquiry methodology and used a narrative story map tool to analyze data. Grounded in these research findings, this article highlights the necessity of implementing a culturally relevant and social justice–based training model for mental health care providers. Such training must include an ongoing critical examination of the socio-political underpinnings that ground clinical psychology’s epistemology, rather than adapting hegemonic therapeutic models and practices to a “population at risk.”
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‘Don’t ask, don’t tell’: examining the illegalization of undocumented students in Toronto, Canada
Article
  • May 2018
In 2007, the Toronto District School Board (TDSB) passed the ‘Students Without Legal Immigration Status Policy’, commonly known as the Don’t Ask, Don’t Tell policy. While the policy assured undocumented students’ admission to schools on paper, it remains to be fully implemented. In addition, given the discursive connection between immigration status, race, and criminalization, the TDSB has instituted procedures that further illegalize undocumented students including a more onerous and dangerous enrolment procedure. This paper examines the role of schools as border zones for undocumented immigrants in Toronto. It argues that bureaucratic processes and criminalizing rhetoric based on race actively exclude undocumented migrants from the school site.
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Uninsured Maternity Patients in Calgary: Local Trends and Survey of Health Care Workers
Article
  • Jul 2017
Objective Uninsured maternity patients comprise a small but complex group of patients and include marginalized Canadians, undocumented immigrants, visitors, and non-Canadians seeking health care and/or citizenship for their newborn. This is the first Canadian study to quantify these patients and to review health care providers' perspectives and practices of care. Methods Data for all deliveries in Calgary, Alberta over a 4-year period (2013-2016) were analyzed. All Calgary anaesthesiologists, family physicians, midwives, neonatologists, obstetricians, and pediatricians were surveyed about their care of these patients, ethical perspectives, and knowledge of liability protection when providing such care. Results This study found a trend of uninsured deliveries in Calgary (from 0.5% in 2013 to 0.8% in 2016; P < 0.0001) that is accounted for by non-Canadian patients. Midwives and physicians agree on provision of emergency care but not preventive care. Across medical specialties, fewer caregivers felt obliged to care for non-Canadian patients seeking citizenship for their newborn. Among physicians, 61% were aware of the Canadian Medical Protective Association's guidelines on liability coverage for non-Canadian patients, and only 28% consistently protected themselves legally. There is large variation regarding whether physicians bill for services when the patient is uninsured. Conclusion In Calgary, the study observed an increase in numbers of uninsured maternity patients. Differing ethical perspectives on the care of these patients may lead to conflict within health care teams because of differences on ethical perspectives of care among team members. Health care providers require education to understand the implications and challenges of obstetrical care of non-Canadians.
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