Mental Well-being and Substance Use Among Youth of Colour

March 2006

For more information, please contact Across Boundaries:

Across Boundaries 51 Clarkson Avenue Toronto, ON M6E 2T5 Tel. (416) 787-3007 info@acrossboundaries.ca

Alexander Lovell Lead researcher alexandermalcolml@hotmail.com 416 526-8325 Sara Shahsiah Co-researcher sshahsiah@hotmail.com

Cover Art: Isolation by Ajibola Fagbamiye Individuals, community and health organizations may freely photocopy the contents of this report. We ask you to please cite the source.

Acknowledgements Many people supported this research; we thank all of them. Needless to say, a study considering the experiences of youth would go nowhere without their support and participation. We greatly appreciate the input and recommendations offered by the people who took part in focus groups, and completed questionnaires and various research tasks for the project. We also thank the youth who contributed art and poetry to this project. Several community workers and agencies deserve credit for their help, especially for sharing their space and resources freely. We thank Carmen Lia Murall at the Centre for Spanish-Speaking Peoples, Kerry Wilson at Promoting Economic Action and Community Health (PEACH), Delia Ta and the staff at Youth Inc., Laila Bondugjie and Huda Bukhari at Arab Community Centre, Winston LaRose at Jane-Finch Concerned Citizens Organization, Byron Gray and Sandeep Kler at Jane-Finch Community and Family Centre, Wayne Black at Jane-Finch Boys and Girls Club, and Bashir Mohammed at We Help Youth. We also thank the Centre for Research on Inner City Health for allowing us to use their data on mental health and substance abuse services in Toronto. Thanks also to Dr. Edward Adlaf for allowing us to adapt the CAMH Ontario Student Drug Use Survey for our youth questionnaire. This report would not have been complete without the suggestions and questions from the Y-CONNECT Advisory Committee. Martha Ocampo and Aseefa Sarang, Co-Directors of Across Boundaries, were key advisors throughout the research process. We acknowledge them for their time and guidance. We thank the board of Across Boundaries , for recognizing the need for a study of youth of colour and mental health, and chair, PeggyGail Dehal-Ramson for her helpful comments and editing effort. Samiya Abdi deserves recognition for getting this project off the ground and keeping it afloat, as well as Anthony Mohammed and Evelyn Mejia at Across Boundaries for administrative support. We also thank the Y-CONNECT staff and Griffin Centre who offered us help and suggestions throughout the project. Any good coming out of this project will not occur without community support., Any mistakes or omissions are the sole responsibility of the researchers. Alexander Lovell March 25, 2006

Table of Contents EXECUTIVE SUMMARY .................................................................................................................7 INTRODUCTION ............................................................................................................................14 CONCEPTUAL FRAMEWORK ....................................................................................................16
ABOUT THE RESEARCHERS - LOCATING OURSELVES.........................................................18

LITERATURE REVIEW .................................................................................................................20 YOUTH AND MENTAL HEALTH .................................................................................................20 EMERGING SOCIAL DETERMINANTS OF MENTAL HEALTH ............................................22 MENTAL HEALTH, RACISM AND PEOPLE OF COLOUR .....................................................25 MENTAL HEALTH SERVICES: PRACTICE, UTILIZATION, AND ACCESS ........................26 MARGINALIZED COMMUNITIES IN TORONTO .....................................................................27 SOCIAL MARGINALIZATION AND MARGINAL SERVICES IN TORONTO ........................30 DEMOGRAPHIC PORTRAIT OF THE Y-CONNECT SERVICE AREA.................................31 METHODOLOGY............................................................................................................................37 SAMPLE ...........................................................................................................................................37 FINDINGS ........................................................................................................................................40 STRESS AND ANXIETY ...............................................................................................................40 DEPRESSION AND SUICIDE ......................................................................................................41 SELF-ESTEEM AND IDENTITY ..................................................................................................43 FEAR AND AGGRESSION ...........................................................................................................44 COPING STRATEGIES AND SUPPORT NETWORKS ...........................................................45 SUBSTANCE USE .........................................................................................................................46 OPPRESSION AND EXCLUSION ...............................................................................................48 RECOMMENDATIONS..................................................................................................................51 CONCLUSION ................................................................................................................................55
APPENDIX A: GLOSSARY .............................................................................................................56 APPENDIX B: REFERENCES ........................................................................................................58 APPENDIX C: QUESTIONNAIRE .....................................................................................................60

APPENDIX D: KEY INFORMANT INTERVIEW GUIDE ...........................................................72 APPENDIX E: FOCUS GROUP INTERVIEW GUIDE ..............................................................74

Tables and Figures Tables

TABLE 1: YOUTH OF COLOUR IN THE LABOUR MARKET ........................................................28 TABLE 2: PEOPLE OF COLOUR, Y-CONNECT SERVICE AREA ................................................33 TABLE 3: ETHNIC GROUP POPULATIONS, Y-CONNECT SERVICE AREA ..................................34 TABLE 4: POPULATION OF Y-CONNECT AREA BY HOME LANGUAGE USE ...............................36 TABLE 6: HOUSING AND WORK CHARACTERISTICS: QUESTIONNAIRE ....................................37 TABLE 7: IMMIGRATION CHARACTERISTICS: QUESTIONNAIRE ...............................................37 TABLE 8: CHARACTERISTICS OF KEY INFORMANTS ..............................................................38 TABLE 9: FOCUS GROUP CHARACTERISTICS ......................................................................39 TABLE 10: YOUTH FEELING UNSAFE AT HOME, SCHOOL, AND IN THEIR NEIGHBOURHOODS ...45
Figures

FIGURE 1: Y-CONNECT SERVICE AREA ..............................................................................16 FIGURE 2: MENTAL HEALTH AND ADDICTION SERVICES IN TORONTO ....................................31 FIGURE 4: RENTAL HOUSING COMPOSITION AND RACIALIZED GROUPS .................................33 FIGURE 5: NUMBERS OF LOW INCOME CUT-OFF FAMILIES AND RACIALIZED GROUPS .............34 FIGURE 6: MAP OF YOUTH 15-24 AND RACIALIZED GROUPS ................................................35 FIGURE 7: SUBSTANCE USE IN THE PAST 12 MONTHS, QUESTIONNAIRE ...............................46

This study was commissioned by Across Boundaries An Ethnoracial Mental Health Centre on behalf of Y-CONNECT, a community-based mental health program. This new program is a partnership between Across Boundaries and the Griffin Centre. Y-CONNECT supports the emotional and mental well-being of transitional-aged youth (15-24 years of age) in the community through a continuum of services, including intervention, community outreach, case management, group and individual counselling, family support and psychiatric assessment. Our guiding principle is to provide services through an anti-racism/anti-oppression framework. This framework requires that we create programs that respond to emotional and mental health concerns arising out of discrimination against people because of their race, gender, sexual orientation, dis/ability, age and class. Oppressions are often part of social and political systems; and displayed in personal interactions. In response to injustice at all levels, our anti-oppression approach causes us to seek and support community-based responses to everyday attitudes and practices of racism, sexism, etc., while confronting systemic forms of discrimination.

Executive Summary Recent research confirms a growing divide in the social and economic circumstances of people in Toronto neighbourhoods and communities. The economic conditions of people of communities of colour, especially new Canadians, have worsened in recent years (Ornstein, 2006). Reports like the United Way of Greater Torotntos Poverty by Postal Code show that this trend has left a geographic imprint. In a growing number of neighbourhoods, marginalized communities - largely made up of recent immigrants and racialized1 groups - have grown. Poverty brings many barriers that have an impact on the mental health of people of communities of colour: Youth and their families may have fewer resources to improve and participate in their communities. With stresses related to housing, food and employment insecurity, people of colour are often at higher risk of experiencing anxiety, depression, and other mental health concerns. For youth and their parents, experiences of racism and stigma may lead to feelings of inadequacy and unhappiness, and alter the way people react and cope with mental health stressors. In order to address the silence surrounding the impact of racism on youths mental health, this study considers the emotional and mental health of youth of colour living in the Jane and Finch community, a number of geographically contiguous neighbourhoods of the City of Toronto that have been identified as at-risk because large numbers of youth are excluded from employment and educational opportunities and experience other barriers that prevent their full and equitable participation in the life of their community. The purpose of this study is to provide current information about emotional and mental health conditions among youth of colour living in Y-CONNECTs service area, a large area in northwest Toronto. The findings are based on a questionnaire disseminated to 300 local youth, over 20 focus groups held with gender-specific and ethno-specific groups of youth, and 16 discussions with youth workers and mental health care providers. Social Determinants of Mental Health The connections between social and economic conditions and health are sometimes called Social Determinants of Health (SDOH). We used this framework In this study to understand the variety of interrelated factors that influence the mental health of youth of colour. Besides the eleven SDOH accepted (Raphael, 2004), we have added an emphasis on the impact of oppressions such as racial and gender discrimination as determinants in our analysis. We contend that people of colour experience social exclusion, poor working conditions and employment insecurity differently than non-racialized groups because of racism.

Racialized groups are not White, which is a normalized and privileged social category in Canada. Non-white, groups, therefore, live in a world of difference where they may experience discrimination because of skin colour, or other physical features given meaning by the enduring myth of the social construct of race. Racialization refers to the social processes through which racial differences are created and acted on.

In our study, several different factors were found to contribute to anxiety, depression and other emotional and mental concerns of youth of colour. These factors can be categorized into economic, social and cultural determinants of mental well-being. Our findings suggest the need to re-consider social determinants of mental health because the currently accepted SDOH fail to consistently consider the impact on self-esteem and mental health of stigmatization, labelling and forms of discrimination. Economic factors: Unemployment and underemployment Income deprivation Hidden homelessness and overcrowding Social factors: Racism and other forms of discrimination Stigma attached to neighbourhoods Fear and internalized negative self-images Isolation and loneliness: feeling of inadequacy and social exclusion because of difficulties of meeting social expectations (e.g. fitting-in at school) Traumatizing and disempowering relationships with authority figures such as police, teachers and counsellors Cultural factors: Disregard for youth culture and perspectives (e.g. authority figures acting on misunderstandings of youth) Generation and cultural gaps between parents/guardians and children Ethnic community pressures and expectations The following are some highlights from the study: Anxiety and Fear Youth identified the main causes of stress as not having enough money (57%), followed by family relationships (15.3%), peer relationships (5.6%) and relationships with authority figures besides parents (5.3%). Community workers identified that many youth experience great distress fitting in with their peer groups, or during instances of resolving disputes. In some cases, young men are strongly pressured to respond to disputes and insults with violence or aggression. Almost half of female respondents report never or seldom feeling safe in their neighbourhood, fewer male respondents (8%) reported this level of fear. Over 17% of youth seldom or never felt safe in their schools. The way outsiders perceive issues in the community influences the way youth think about their community and peers. For example, many youth perceived that most local youth carried weapons, and many reported fear of being a victim of violence. However, few youth actually reported carrying weapons or experiencing violence. The role of the media and public

Over 11% of youth indicated they often lost sleep because of worries

29% of youth reported feeling pressured to leave school prematurely to work full-time

discourse in perpetuating racialized images of young men as perpetrators of gun violence and neighbourhood stigma cannot be discounted as contributors to these fears. Depression About 25% of young women reported always feeling sad. An additional 23% of female respondents reported often feeling sad. 15% of male respondents reported often feeling sad. 10% of young women reported always feeling lonely. Discussions with youth suggested that newcomers may be especially at risk of loneliness and isolation. Several described their difficulties in making friends and fitting in to their school and communities. Almost half of female respondents in the questionnaire indicated that they felt they did not belong or fit in at their school. Suicide Over 20% of respondents indicated that they had considered suicide. More than 30% of young women considered suicide, half as many young men had thought of committing suicide. Focus groups indicated young men were more likely to perceive suicide as an issue that did not affect them or their peers. Gender and Sexuality Youths attitudes to sexuality and gender roles are deeply attached to self-identities influenced through peer interactions. Community workers indicated more work is needed to challenge unwelcoming attitudes towards lesbian/gay/bi-sexual/transgendered youth. Heterosexist and homophobic attitudes are sometimes reinforced by authority figures and adults who assume their youth clients are heterosexual or certain of their sexual identity. Bullying and Racial Attacks Over 17% of young men and about 8% of young women reported being the victim of bullying regularly (about once per week). Verbal attacks were the most frequent bullying behaviour experienced by youth (11.3%), followed by physical attacks (6%) and stealing (3.7%). About 26% of youth reported experiencing occasional attacks because of their ethnicity or race. Over 30% of young men and about 20% of young women reported experiences of physical attacks because of their race, Relationships with Family, Friends and Community Many youth of colour indicate difficulties navigating between their home-life with parental expectations, and the world of their More than 15% of young women, and almost 10% of males reported considering suicide in the last year

Almost 40% of youth reported feeling powerless to overcome difficulties in their life

More than 30% of females reported having thought of committing suicide

Many youth expressed reluctance to confide their problems in parents, or authority figures like counsellors or teachers

peers. Local community workers confirmed this as a major issue that contributes to stress, depression, and isolation. A small proportion of youth indicated having serious difficulties with their parents (15%), but a larger proportion, almost 50%, indicated there were cultural or generational barriers between them and their parents. Table 1: Parents Knowledge of their Childrens Whereabouts, by Gender Parents Knowledge of Childrens Whereabouts Females Males Always Know 52% 9.3% Never Know 12% 22% Support Networks More than 10% of youth reported not having anyone to confide in. The majority of youth confide their personal issues to their closest friends (58.3%). Very few youth had used help lines or other telephone support resources. Substance Use Youth familiarity with substances was limited to alcohol, cigarettes and marijuana. Most were not aware of certain substances such as Rohypnol, Ketamine, Barbiturates and LSD. About half of the questionnaire respondents reported that they did not use alcohol, marijuana or other substances in the last year. A very small number of male youth reported using glue or solvents. Focus groups indicated glue use was generally confined to middle-school students. Implications for Service Delivery Racism and Stigma More focus is needed on the issue of youth self-esteem. Programs can encourage youth to challenge negative stereotypes about themselves, their community and others and offer opportunities for youth that allow them to learn how to transcend stereotypes. The topic and terminology of mental health is highly stigmatized. Avoid using terms like counselling, support groups, and therapy. Allow youth to name their own support groups, using terms meaningful for them and that express the purpose of the program. Terms like depression, stress, aggression, and anger are acceptable to most youth. Topics of mental health should be introduced indirectly and informally. Social and Economic Barriers Better responses to material barriers to mental well-being are needed: programs should integrate employment and housing resources with counselling and communitybased health promotion.

The topic and terminology of mental health is highly stigmatized; caution is needed to prevent services from labelling youth

Over 19% of youth reported using alcohol and/or marijuana to relieve anxiety

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Family and Community An effort is needed to raise parents awareness about dilemmas youth face in their personal and social lives. More understanding of how peer pressure and social conformity affects youth self-esteem and isolation is needed from parents. Continuing support is needed for youth voicing their issues to authority figures. Discussions of violence should seek to debunk exaggerations and question some youths pride in portraying negative stereotypes. A good explanation for the reality of violence is needed: one that examines how racism and classism contribute to exclusion, and how aggression is an outcome of frustration over injustice. Alternative directions for outrage are needed, such as greater political mobilization among youth. Depression and Suicide Youths awareness of depression and suicide needs to be raised to respond to risks of isolated youth, stigma, and ignorance about depression and suicide. Provide accessible information about existing resources for those in need of suicide prevention support. Programming and Services Decorate space with accomplishments and positive images of youth; make spaces that feel more like a living room and less like a classroom or office. Youth rarely confide in family or counsellors about their issues. Support is mainly derived from close friendships with peers. Therefore, youth workers need to create trust through up-front honesty, and consistent behaviour. For example, support peer initiatives such as provision of free space for youth-led programs and events. Outreach should be done in schools, local recreation centres, commercial areas and residential communities. Outreach materials should be aware of stigmas regarding mental health; creative language should be developed. Face-to-face outreach is best. It encourages engagement by allowing youth to ask questions and get to know service-providers; flyers should only be used as a companion to face-to-face outreach. If resources do not allow face-to-face outreach, place flyers in bus stops Some media may be useful for outreach. Commercials on popular radio programs will raise the profile of community services. Conclusion This studys findings add to Canadian knowledge about mental health by providing insightful information about mental health concerns experienced by youth of colour. The results of this study generate several new questions for further research. Particularly important issues such as violence, aggression, negative self-images, loneliness, and depression require further attention to allow for a deeper understanding of these issues as they relate to the mental health of youth. The relationship between the mental health of parents and youth, such as how post-traumatic stress disorder and depression of parents (an issue that affects some refugees) has an impact on their childrens mental well-being also needs further attention. We suggest that future research also inquire into the role of parent-child relationships in youths mental health needs from the perspectives of parents as well as youth. Rather than exploring mental health outside the family unit, situating the research within the

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household would account for factors that contribute to the well-being of youth of colour that we were not able to explore in this study. Also, our inquiry into the extent of suicide ideation suggests that some youth may exhibit suicidal behaviours through risky and daring aggressive behaviours involving third parties, rather than the commonly-held expectation of suicide as self-inflicted and private. Further development and exploration of this theme is needed. We hope that this study will provide a framework and record of the issues for future research in addition to meeting its objective of informing local service provision.

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Mental Well-Being and Substance Abuse Among Youth of Colour

Youth of Colour

This study was commissioned by Across Boundaries An Ethnoracial Mental Health Centre on behalf of Y-CONNECT, a community-based mental health program. This new program is a partnership between Across Boundaries and the Griffin Centre. Y-CONNECT aims to support the emotional and mental well-being of transitional-aged youth (15-24) in our community throughout a continuum of services including intervention, community outreach, case management, group and individual counseling, family support and psychiatric assessment. Our guiding principle is to provide services through an anti-racism/anti-oppression framework. This means creating programs that respond to emotional and mental health concerns arising out of discrimination against people because of their race, gender, sexual orientation, dis/ability, age and class. Oppressions are often part of social and political systems; but they are often acted-out in our personal interactions. Antioppression, therefore, moves to challenge our everyday assumptions, attitudes and behaviours that contribute to social resistance to systems that oppress, while confronting systemic forms of discrimination.

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Introduction
Recent research confirms a growing divide in the socio-economic circumstances of neighbourhoods and communities in Toronto. The economic conditions of communities of people of colour, especially new Canadians, have worsened in recent years (Ornstein, 2006). Reports like the United Way of Greater Torontos Poverty by Postal Code2, show that this trend has left a geographic imprint. In a growing number of neighbourhoods, marginalized communities largely made up of recent immigrants and racialized3 groups have grown. With poverty come many barriers that affect the mental health of people of communities of colour: Youth of colour and their families may have fewer resources to improve and participate in their community, and with stresses related to housing, food and employment insecurity, people of colou are at-risk of anxiety, depression, and other mental health concerns. For youth and their parents, experiences of racism and neighbourhood stigmas may lead to feelings of inadequacy and unhappiness, and alter the way people react and cope with mental health stressors. Addressing the silence surrounding racism and mental health, this study considers the emotional and mental health of youth of colour living in the Jane and Finch community, a part of the city that has been identified as at-risk because large numbers of local youth of colour have been excluded from employment and educational opportunities among other barriers. The current discourse of at-risk and marginalized youth is primarily a discussion about youth of colour who live in low-income neighbourhoods and experience high rates of school drop-outs and push-outs, unemployment, poverty, and violence. Excluded from employment and educational opportunities, youth of colour living in low-income neighbourhoods face many barriers which may have a negative impact on their emotional and mental well-being. In addition to the limits brought by poverty and social exclusion, youth living in at-risk areas often have less access to health services (see below). It must be emphasized that within disadvantaged neighbourhoods, many youth of colour enjoy good mental health, as well as the support of strong families and community environments. They are able to avoid risky behaviours and experiences that may undermine their emotional and mental well-being. It is a reality, however, that many youth of colour, including many immigrant youth, experience systemic exclusion from economic and social opportunities as a result of the intersecting discrimination against them because of their race, gender, sexual orientation, ability, and neighbourhood of residence. This study attempts to respond to the lack of knowledge about the emotional well-being and mental health of racialized youth from an area of Toronto in need of more social infrastructure, and where they represent the majority of youth. The connections between the social and economic conditions of emotional and health are sometimes called Social Determinants of Health (SDOH). In this study we use this framework to understand the various and intermingling influences that determine the
This report by the United Way examined the expansion and intensification of poverty throughout Toronto. Several neighbourhoods, especially in inner-suburban neighbourhoods like Jane and Finch and Rexdale, have experienced large increases in the numbers of low-income families while also seeing a rise in lone-parent families, racialized groups, and new immigrants. 3 Racialized groups are not white, which is a normalized and privileged group in Canada. Racialized groups, therefore, live as minorities where racial stereotypes are attached to them and where they experience discrimination because of skin colour, or other physical features. Racialization refers to the social processes through which racial differences are created.
2

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mental health of youth of colour. Beside the eleven SDOH developed so far in the literature (Raphael, 2004), we explicitly add an emphasis on the impact of oppressions such as racial and gender discrimination to our analysis. It is our strong belief that people of colour experience social exclusion, poor working conditions and employment insecurity differently than non-racialized groups because these factors may occur through racism. It should be noted that one of the determinants of health, social exclusion, does include oppression as an element in its definition. Social Determinants of Mental Health Social Determinants of Health (SDOH) refer to the conditions, such as poverty and access to health care, which contribute to the health outcomes of individuals and groups. In our study, we use this framework to understand mental health. SDOH do not only have an impact on the mental health of individuals: it is important to recognize that these factors sometimes work together to affect mental health conditions. The following are the determinants of health currently accepted by Canadian officials and researchers: Social Exclusion/Inclusion Early Childhood Development Working Conditions Food Conditions Employment Security Social Safety Net Health Care Services Income and its Inequality Aboriginal Status Education Housing Conditions See Raphael, 2004

Frustration, anger, and depression can develop because of racism. But at the same time, these emotional and mental conditions can create another barrier to achieving happiness, emotional stability and a healthy self-image. Consequently, attitudes, values and perceptions borne out of experiences of poverty, racism and other mental health stressors contribute to how youth view and care for their emotional/mental health, as well as to how youth use or abuse substances, react to stressful situations, and relate to each other. This report summarizes the findings from a study of the emotional and mental health of youth of colour living in several neighbourhoods and communities in a large innersuburban area of the City of Toronto. The findings are based on a long-form questionnaire disseminated to 300 local youth4, over 20 focus groups with youth, and 16 one-on-one discussions with frontline service providers from various agencies.

The survey is adapted from the Ontario Drug Use Survey done by the Centre for Addiction and Mental Health (CAMH).

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This study was done on behalf of Y-Connect, a community-based mental health program by Across Boundaries and The Griffin Centre. The purpose of the study is to build on knowledge about emotional and mental health conditions of youth of colour who live in YConnects catchment area. Therefore the study considers the experiences of youth who live in a large area bounded by Wilson Avenue to the south, Steeles Avenue to the north, Dufferin Avenue to the east, and the Humber River valley on the western edge (see Figure 1) Figure 1: Y-Connect Service Area

Conceptual Framework Mental health is difficult to define as notions of mental health and illness tend to be contextual and culturally-bound. This report reflects a holistic approach to conceptualizing mental health by appreciating the interdependence of the spiritual, emotional, mental, physical, social, cultural, linguistic, economic and broader environmental aspects of health that affect the well being of people (Across Boundaries, www.acrossboundaries.ca). Mental health is, therefore, tied to everyday life rather than identified simply as the absence of mental illness or disease. Our foundation is to acknowledge mental well-being as part of the material well-being of people. An anti-racist/anti-oppressive approach directs us to recognize that the emotional and mental health of people of colour is determined by real influences in their material lives, such as the psycho-social impacts of racism, poverty, and other determinants of mental health. Considerable research in the United States and the United Kingdom shows that racism causes stress in the bodies and minds of racialized people5. Stress, in its turn, contributes to several emotional and mental health outcomes including depression, suicide, addiction,
5

See Fernando (1991), Henry et al. (2000), and Cauce et al. (2002).

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violence, damaged self-esteem, fear, mistrust, feelings of helplessness, hopelessness, despair, and alienation. Through an anti-racist/anti-oppressive analytical lens, we recognize that racism defines certain individuals and groups of people primarily in racial terms. It zooms in on certain identifiers like skin colour, hair texture, facial features, and other physical traits that are constructed as being representative of people from a particular race or racial group. This practice, which has been championed by psychiatrists and anthropologists, not only creates races but also classifies people into certain racial categories, designating certain groups as White and others the socially inferiors - as Black, Yellow, Red, and so on (Fernando, 1991; Satzewich, 1998). By constructing social categories in differential and unequal ways, this process of racialization then leads to social, economic and political impacts and health inequalities (Galabuzi, 2001). As Fernando put it: Unfortunately, a person so categorized is likely to be labelled and seen henceforth, not as an individual, but as a carrier of various qualities assumed to be consistent with the category. This is the danger of stereotyping and of labelling. Therefore, however useful and convenient racial and ethnic categories may be for various purposes, one important fact must be borne in mind at all times: individuals within a racial or ethnic category are all different and individual differences may outweigh group differences in extent and importance. (Fernando, 1991, 19) While the application of the term race is problematic and misleading because it has been and continues to be used to justify the subordination of certain populations, the significance of using the terminology of racialization and racialized individuals lies with our understanding that race has been assigned meaning through historically specific processes and practices (see Fernando, 1991; Henry, Tator, Mattis, & Rees, 2000). Race is realized through material practices and harmful discourses that gives subscription to the ideology of race. We often use inverted commas around race to indicate that we do not take the application of race and history of racism for granted, and stress that the biological foundation of race is a persistent myth (Cauce, et al., 2002, 45). At the same time, we are asserting that the notion of race retains significance in the current socio-political context as it continues to be socially, politically, and economically consequential for racialized people on a day-to-day basis. Belonging to a particular race or racial group is, therefore, essentially a political declaration (Fernando, 1991). In the same vein, we recognize the intersectionality of oppressions based on gender, class, age, sexuality, dis/ability, and race (Dei, 2000) that shape the lives of youth and their families. From this view, an individual does not possess a one-dimensional identity but is socialized into identities that correspond to the categories of race, gender, and class (Dei, 2000, 31). Without denying or minimalizing this reality, the scope of this study is limited to a focus on racial oppression and poverty as an entry point into an analysis of racialized youth and their mental health needs and concerns.

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About the Researchers - Locating Ourselves Part of an anti-racist/anti-oppressive approach is the acknowledgement that objectivity as far as the scientific enquiry goes, is not only unrealistic and unattainable but also undesirable, as we each bring our own identity, social location, experiences, and knowledge to all aspects of the research process (Issitt, 1999). We have to recognize how we are implicated in the social structures that privilege some by denying and oppressing others, and how this affects our work as researchers if we are to expose how power operates and marginalization occurs. In our commitment to social change, we also acknowledge ourselves as subjects in our work and in this research project. Alexander Lovell I am a Canadian-born man of colour, of mixed African-Caribbean heritage. My interest in the project stems from several personal experiences. I was raised in Toronto in a single parent Jamaican-Canadian family. I have lived in public housing, and I know well some of the frustration people in public housing feel about being depicted as dysfunctional or criminal by outsiders, as well as the everyday problems arising from the quality and bureaucracy of the system. While I was growing up, we never had much, and upon reflection, there were several times when making ends meet caused some very tense times at home. This experience gives me some personal insight into what I hope to be a thoughtful and fair representation of so-called marginalized youth. I partly take issue with this term, as well as at-risk, because these concepts naturalize conditions of working class families by failing to reveal the social and political origins of low incomes, single-parenthood, and poor educational achievement. It contributes to the surprise or disagreement some show when it is explained that poverty is an outcome of systemic, as well as personal, factors. Although I now live outside the area, I have several years of experience as a resident and volunteer in the Jane-Finch area; this includes mentorship and tutoring roles with Jane Finch Concerned Citizens Organization at Oakdale Middle School, and a mentorship program with the York University Black Students Association while I was a graduate student in geography at York University. I began this study following my work on a report about Black youths access to primary health care in Scarborough done by the Black Health Alliance. This study introduced me to the issue of cultural competence, and racism as a social determinant of health. Sara Shahsiah As a young, non-White migr woman who was born in Iran but grew up in Germany and then Canada, I have struggled with the various labels, racialized categorizations and where I am supposed to fit in, particularly in the northern German context and now in multicultural Toronto where I am part of the Other. Beyond the confusion and frustrations, I am settling with the notion of multiplicity and cultural hybridity. Iranian, German, Canadian, Iranian-Canadian, IranianGerman-Canadian or any other combination of hyphenated words that supposedly accommodate Others still impose and essentialise who I am and my experiences. In addition, being Canadian is still contested. In spite of obtaining

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Canadian citizenship and achieving proficiency in English in Canada, my phenotypic differences continue to contrast the images of Canadian-ness as portrayed and perpetuated by the media, education system, and dominant discourses. The question of social inclusion, home and belonging remain at the forefront of my thoughts and research interests as they relate to groups and individuals who experience structural disadvantage because of race, ethnicity, gender, age, class, dis/ability, sexuality, and the intersecting effects of these dimensions. In the pursuit of social justice I completed my bachelors degree in Social Work and masters degree in Immigration and Settlement Studies at Ryerson University, and have since worked as a frontline worker as well as research assistant and coordinator. In addition to my sites of oppression, I benefit from structural privileges extended to me given my fluency in English, level of education, and citizenship status. These sites of privilege enable me to be involved in this type of work which is in turn shaped by my social location. When working with disadvantaged populations, such as racialized youth from lower socio-economic backgrounds, my sites of oppression and privilege influence the overall approach and inter-personal interactions with participants.

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Literature Review
In preparation for and as part of this research study, we reviewed relevant and recent reports and articles. Because of insufficient Canadian-based literature on mental health and youth, and particularly youth from racialized communities, we have included some international literature. Studies on mental health and youth of colour in the context of the United States are particularly informative, although the findings cannot and should not be generalized to Canada. One of the major findings of our literature review is the scarcity of research studies that focus on the experiences of racialized youth, and in particular with respect to their psychological well-being and mental health. The few Canadian studies that do exist tend to focus on specific ethnoracial minority groupings or communities, and focus on culture as the central concept in their discussion of mental health outcomes. Those discussing race as a central notion, tend to use it interchangeably with ethnicity and treat it as a variable, rather than exploring the role of racism and racial stratification in and of themselves in the mental health state of youth in Canada. Nevertheless, the following literature review contextualizes the findings of this needs assessment by providing some insights into mental health, race and racism, poverty, and social determinants of health as they relate to racialized youth and their mental health. Youth and Mental Health Given the age factor and life cycle dimension of the notion youth, much of the international as well as Canadian-based literature on mental health and this population explores development-specific mental health concerns. The focus tends to be on behavioural outcomes and manifestations of mental health issues such as suicide rates, substance use, and bullying. As with the majority of this literature, the period of adolescence or young adulthood is seen as a time of transition that is associated specifically with pervasive psychological distress and generally with increased mental health risk (Aneshensel & Sucoff, 1996; Gore & Aseltine, 2003; Walker, 2005). Reporting on the Canadian context, some studies have linked loneliness, depression, and stress as some of the most common health risks that affect young people and particularly young women (Gottlieb, 2000 as cited in Khanlou, Beiser, Cole, Freire, Hyman, Kilbride, 2002; WHiWH, 2003). Austen (2003) states that the second most common cause of death among youth between the ages of 10 and 24 in Canada is suicide. Adalf and colleagues (cited in Tupker, 2004) also provide some evidence that there is an increase in the prevalence of mental health problems among young people. In a recent, extensive needs assessment study on mental health and Afghan youth in Toronto, Soroor and Popal (2005) report that the overall number of suicides among Afghan youth is increasing. Despite these concerns, assessing the mental health needs of youth appears to be an underdeveloped area of enquiry, as there is no consensus in the reviewed literature on the pathways between adolescence and adverse mental health outcomes or concerns. Literature on concurrent disorders and youth does, however, shed light on some specific mental health concerns of youth by exploring the linkages between mental health and substance use among those who have used or are using mental health services such as psychiatric in-patient care or community-based counselling6. Simply put, youth who are dealing with substance use problems often also experience other issues such as mental health concerns, a combination which is referred to as concurrent disorders in the mental
Because of its focus on consumer/psychiatric survivors, this literature does not consider the experiences of large numbers of youth who have not entered the psychiatric system.
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health field and literature (Tupker, 2004). The development of bulimia in adolescents, for example, tends to be accompanied with nicotine, stimulants, and alcohol use (Tupker, 2004). The Concurrent Disorders Ontario Network (2005) reports that, generally speaking, the prevalence of concurrent disorders is very high among those who experience mental health or substance use issues. Of the youth already receiving mental health services in Ontario, about 15% to 45% experience concurrent substance use problems, while 75% to 100% of those receiving substance use services are believed to experience concurrent mental health problems (CDON, 2005). According to Tupker (2004), while experimentation with substances during adolescence is common and expected and not necessarily problematic, there is no definite cause of substance abuse among this population. For those who become dependent on the substances they are using, psychological and/or physiological dependence soon follows (Tupker, 2004). Some studies suggest that mental health problems can become risk factors for the use of substances, especially when substance use becomes a self-medicating or coping practice (Tupker, 2004). Waughfield (2002), for example, suggests that low self-esteem among youth who are dependent on substances may have led them to using drugs in the first place, thereby problematizing low self-esteem rather than the used substance itself. Others seem to suggest that both mental health problems and substance abuse stem from common factors such as psychological distress (Tupker, 2004). Tupker (2004) suggests that in reality the risk and protective factors associated with mental health and drug use concerns probably overlap more often for youth. This interrelation of substance use problems and mental health issues can be seen in multiple forms. Mental health issues can precede substance use (i.e.: substance use as coping mechanism), mental health problems can follow substance use as a symptom, or, if predisposed to a mental illness, be triggered or exacerbated through the use of substances (Tupker, 2004). Regardless of the exact pathway, the reviewed literature highlights that both mental health concerns and substance use concerns often go hand in hand, such that one cannot be addressed in isolation from the other. In this regard, Tupker (2004) states that little is known about treating young people who experience mental health and substance use problems. According to the Concurrent Disorders Ontario Network (2005), most of the treatment and programming for those experiencing concurrent disorders is geared towards and tailored for adults. These do not adequately address the situation of youth. Compared to the service providing systems for adults, the systems for children and youth are inadequate, and need to develop an approach that accounts for the role of family and friends, developmental stages, and other aspects important to youth (CDON, 2005). Overall, little attention is paid to mental health outcomes and needs of ethnoracial minority or racialized youth and immigrant youth within the literature (Anisef & Kilbride, 2000; Gore & Aseltine, 2003; Khanlou et al., 2002). An overview of the limited contemporary literature from Canada highlights the need to focus on the mental health of immigrant youth. As Walker (2005) explains, while developmental transitions, milestones, and identity conflicts are important factors in the mental health of youth who are transitioning into young adulthood, these concerns can be even more magnified for those who experience additional distress from being uprooted from one place and relocated to another. Tupker (2004) agrees that dislocation becomes another compounding factor on the vulnerability of youth who are already marginalized. The Toronto-based study on the mental health needs of Afghan youth by Soroor and Popal (2005) found that for the majority of newcomer youth in their study, experiences of war trauma, and disruptions in education and emotional development significantly affected their psychological and emotional well being. For 31% of the youth in their study who

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reported having experienced war trauma, war trauma was highly correlated with isolation, depression, anxiety, Post Traumatic Stress Disorder, low self-esteem, difficulties in school adjustment, arguments with parents, susceptibility to peer pressure, frequent drug and alcohol use, confrontation with the police, gang involvement or having friends involved in a gang, and frequently using violence to solve disagreements (Soroor & Popal, 2005). In addition, one third reported symptoms of anxiety, more than 15% reported symptoms of depression, and more than 24% reported suicidal thoughts with 16% reporting that they had tried to commit suicide or had hurt themselves (Soroor & Popal, 2005). And yet only 9% of the respondents had accessed help, with about two thirds reporting they did not receive the help that they had sought (Soroor & Popal, 2005). Their report as well as the needs assessment report by the Griffin Centre on the larger Jane and Finch area confirms the need to focus on addressing the mental health needs of youth who are marginalized. Concerns of racialization, racial discrimination and racism are often in the forefront and behind the additional sources of psychological distress that negatively affect the mental health of racialized and otherwise marginalized youth (see Anisef & Kilbride, 2000; Griffin Centre, 2004; Soroor & Popal, 2005). Such concerns point to the social determinants of mental health, calling for a brief overview of the relevant literature on such determinants. Emerging Social Determinants of Mental Health That contextual elements and non-medical determinants of health play a significant role in shaping the mental health of individuals is not a new idea (Lavis, 2002) and can be evidenced by the abundance of international literature that exists on social determinants of health. The impact of poverty and economic hardship on health, as measured through socioeconomic status, is often at the centre of this literature. The overall agreement is that poverty has negative effects on the development and health of children and youth from families of lower socioeconomic status compared to their peers who do not experience poverty as a determining aspect in their lives (Aneshensel & Sucoff, 1996; Anisef & Kilbride, 2000; Nazroo, 2003; Samaan, 2000; Walker, 2005; Waughfield, 2002; Wu, Noh, Kaspar, Schimmele, 2003). However, there is no agreement about how socioeconomic status and other social determinants are linked to health outcomes. Aneshensel and Sucoff (1996), Ross and Mirowsky (2001), Walker (2005), and Waughfield (2002), for example, focus on the environmental aspects of living in poverty and its correlation to poorer health and mental health outcomes in the United States. Exploring how neighbourhood factors affect health in the United States, Ross and Mirowsky (2001) found that residents living in a disadvantaged neighbourhood with high levels of crime experienced daily stress. This caused physiological responses which ultimately lead to chronic health problems such as high blood pressure, asthma, and arthritis. A study by Aneshensel and Sucoff (1996) explored more specifically how the mental health of youth in a Los Angeles neighbourhood in the United States was affected by neighbourhood characteristics and parents socioeconomic status. The authors found that the more a neighbourhood was perceived as dangerous or threatening, the more common were symptoms of anxiety, depression, and conduct and oppositional defiant disorder7 among the youth. They also found that context-related mental health concerns were particularly pronounced for youth who lived in neighbourhoods that were residentially stratified according to socioeconomic status and race/ethnicity, such that mental and emotional disorders were more prevalent in those social strata that others (Aneshensel &
Refers to a pattern of hostile and negativistic behaviour lasting more than six months and including frequent temper outbursts, anger and defiance to authority figures.
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Sucoff, 1996). Similarly, Waughfield (2002) reiterates that being poor constitutes a mental health risk as those in poverty are exposed to extreme difficulties with finances, employment, isolation and many more stressors which in turn become barriers to health care access. Waughfield (2002) concludes that low socioeconomic level results in poor nutrition, crowded living conditions, material deprivation, as well as self-esteem issues. Samaans (2000) literature review on the impact of race, ethnicity, and poverty on childrens mental health in the United States, found that anxiety, depression, and antisocial behaviours are more likely to be reported by children of parents who experience poverty or extreme economic losses. Samaan (2000) reports that most studies that illustrate negative psychological effects of poverty on children focus on White populations. The author suggests that certain ethnic and cultural experiences may actually act as protective factors and have mediating effects on childrens mental health as far as lowering their experiences of psychological distress (Samaan, 2000). Close-knit families and communities, as well as culturally-specific methods of care such as religious convictions and practices may benefit youths coping strategies. Samaan (2000) reports on a study where, after controlling for socioeconomic status, African Americans, Native Americans, and Hispanics were found to report less mental health problems normally associated with poverty. Much of the literature and research studies on contextual and social determinants of health try to account for health and mental health disparities found across various ethnoracial groupings. Using data from the 1996-1997 National Population Health Survey in Canada, for example, Wu and colleagues (2003), explore three hypotheses that attempt to explain such disparities in mental health. Using a national representative sample of twelve racial/ethnic groupings, Wu and colleagues (2003) consider variations in level of depressive symptoms and experiences of major depressive episodes across these groups. They document that East and Southeast Asian, Chinese, South Asian, and Black Canadians exhibit better mental health than English Canadians, while English Canadians experience better mental health that Jewish Canadians, but have similar mental health compared to all other groups (Wu et al., 2003). Wu and colleagues (2003) review the many ways in which socioeconomic status and mental health are related in an attempt to understand their findings. Some of these are reflected in the previously reviewed literature, where low socioeconomic status is seen as a stressor because it is associated with situations that expose families to psychosocial and environmental health risks. Another way is that the accumulated stressful effects of low socioeconomic status over the life course can result in despair and powerlessness, which can then encourage the development of depression (Wu et al., 2003). Conceptualizing racial classifications as fluid and ever changing social constructs that structure the social hierarchy in Canada, Wu and colleagues (2003) argue that socioeconomic status, while important, cannot adequately account for race and therefore explanatory hypotheses based on socioeconomic status, social resources, or interaction fail to fully explain the differential mental health outcomes of various ethnoracial groups. Another segment of the literature that includes but aims to move beyond the centrality of socioeconomic status reports on immigration and acculturation as social determinants of health and mental health. In contrast to the literature on low income levels, poverty, and socioeconomic status, these studies on mental health focus almost exclusively on nonWhite populations and increasingly on youth. Emerging Canadian research studies and reports illustrate that immigrant and refugee children and youth experience an array of psychological stressors and mental health risks associated with their experiences of immigration and settlement (Al-Krenawi & Graham, 2000; Beiser, Hou, Kaspar, & Noh, 2002; Hyman, 2001; Hyman et al., 2000; Khanlou et al., 2002; Noh & Kaspar, 2003).

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Commonly reported acculturative stressors associated with immigration generally concern school, family relationships, and identity issues (Hyman, 2001). A report by Health Canada states that economic circumstances, negative attitudes, and social and personal isolation are some of the acculturative stresses that influence the physical and mental health of new immigrants and refugees in Canada (cited in Khanlou et al., 2002). While language-related difficulties are one of the main concerns and stressors for immigrant and refugee youth in Canada, they are faced with a number of multiple stressors that are often interrelated and concern school life, family, and identity (Hyman, 2001). While very little literature exists on the experiences and impact of stressors on the mental health of refugee and immigrant youth, Hymans (2001) extensive report on immigration and health reports that despite immigration and acculturative-specific stressors, the overall mental health outcomes of immigrant children are not necessarily poorer than that of nonimmigrant Canadian youth. Some studies even seem to suggest that after an initial period of mental health risk upon immigration, the mental health of immigrants significantly improves and even carries over to the second generation (cited in Hyman, 2001). The recent talk of the healthy immigrantthat is the evidence that immigrants have better (physical) health than Canadian-born groupsdoes not discount the difficulties of acculturation in immigrants experiences. Several studies indicate substantial difficulties faced by immigrants as they seek housing, employment and educational opportunities (Preston and Murnaghan, 2005). Each of these difficulties are known to contribute to mental illness. Refugee children and youth, on the other hand, experience worse mental health outcomes than their immigrant and non-immigrant counterparts (Hyman, 2001; Hyman et al., 2000; Walker, 2005). Specifically, refugee children and youth are at a greater risk of developing mental health related outcomes like drug and alcohol abuse, delinquency, depression, Post-Traumatic Stress Disorder, and psychopathology (cited in Hyman et al., 2000). In their Canadian study of Southeast Asian youth from refugee families, Hyman and colleagues (2000), found that stressors affecting the mental health of these youth included parents repression of emotions and conveyance of guilt, absence of parental role models, and, what the authors called, the we came for you syndrome or the sacrificial lamb experience. Other stressors include experiences of discrimination and imposed stereotypes, language barriers, intra-personal conflict, school adjustment difficulties, and pressure to achieve scholastically (Hyman et al., 2000). Walker (2005) explains that the absence of protective factors associated with mental health, such as reduced social isolation and supportive adults outside of the family, in addition to experiences of persecution, discrimination, racism, criminalization and suspicious treatment by the host country may account for the increased mental health risk among refugees and asylum seekers. Beiser and colleagues (2002) also found that racial discrimination, unemployment, and English language difficulties are the three most common stressors reported by Southeast Asian refugee youth in their Canadian-based study. Although these three stressors were not significantly correlated, the authors found that a strong commitment to ethnic identity resulted in experiencing greater psychological distress when faced with racial discrimination and unemployment, concluding that in the absence of these resettlement stressors, high ethnic identity consolidated mental health (Beiser et al., 2002, p.28). Given the limited and contradictory literature on this topic, little can be concluded about specific aspects of acculturation that relate to specific health behaviours (Hyman, 2001).

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Anisef and Kilbrides (2000) report on the needs of newcomer youth, as well as the literature review on racialized groups and health status by the Access Alliance Multicultural Community Health Centre in Toronto stress that racism is one of the main issues faced by immigrants and newcomer youth. Yet, the role of race, racism and racialization as social determinants of mental health is contested and unclear in the literature that exists on mental health and immigrant and/or racialized youth. A community-based research study on the health effects of racial discrimination on young women in Toronto by Womens Health In Womens Hands (2003) found that racial discrimination played a central role in shaping the health of young women of colour, and therefore constituted a major health risk. The authors assert that racism itself is a health risk as it creates barriers and determines access to quality healthcare, health education, and health formation for people of colour (WHiWH, 2003). Brown (2003) as well as Nazroo (2003) stress the importance of considering racism as central to understanding ethnic health disparities. Nazroo (2003) reviews American and British literature on racism as the underlying cause of ethnic inequalities and health, and summarizes that racism can have immediate, direct effects when experienced on a personal and individual level, but also affects health indirectly as a social force that shapes the structures that create social and economic disadvantages for ethnic minorities. Mental Health, Racism and People of Colour The literature on race, ethnicity, and/or culture tends to concern itself mainly with intergroup variations in terms of health outcomes, as described above, rather than the role and pathway of racism itself in producing disparities in mental health. By extension, studies on mental health and racialized groups are often framed in terms of cultural variations and ethno-specific communities with attention paid to culture as a stable variable rather than a fluid and flexible social construct. The Canadian literatureunlike a small but growing number of studies done in the United States and United Kingdomhas been largely silent on the issue of racism and mental health. Exploring the lower depression rates among Asian American youth and higher schizophrenia diagnosis among Black youth in the United States, Choi (2003) examines biases in the diagnosis of adolescent depression, stating that the understanding and expression of depression differs cross-culturally but is not well understood. Choi (2003) explains the neglect of such ethno-cultural variations in the symptoms of mental illness to the roots of psychiatry which is a Eurocentric, diagnostic model that is now largely accepted as universally applicable to all people. Similarly, WHiWHs (2003) report states that even when young women of colour gain access to healthcare, the healthcare system in Canada may be unable to meet their needs, as it is based on a monocultural medical model that deems them abnormal as they and their needs may not fit into the dominant cultural norm. As a result, one in five young women who participated in the study reported experiencing racism in the health care system (WHiWH, 2003). Asserting that the ways in which racism and racial stratification affect and cause mental health is not covered in the existing literature, Brown (2003) sets out to examine how mental health problems emerge from racial stratification and racism. Brown (2003) states that the concept of mental health and what constitutes poor mental health have been constructed in ways that do not properly capture the mental health status of all racial groups. The author suggests that mental health needs to be defined according to the norms of a specific community so as to allow for such variety and accuracy. After discussing the six most prevalent conceptualizations of mental health found in the literature, Vaillant (2003) also calls for a re-examination and definition of mental health in

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culturally sensitive and inclusive ways, based on evidence from empirical and longitudinal, cross-cultural studies. Beyond the immediate dissatisfaction with the inefficiency of Eurocentric, medical models and operational definitions of mental health, are concerns about the socio-historical legacy of psychiatry that continues to affect the mental health of racialized communities today (AAMCHC, 2005; Arredondo & Toporek, 2004; Desai, 2003; Fernando, 1991). Not only have mental health clients been negatively affected by historical marginalization based on ethnic, racial, cultural, socioeconomic differences but also by systemic racism that has remained entrenched in the roots of modern psychiatry (Arredondo & Toporek, 2004). This manifestation of racism has been linked to the historical construction of mental illness and the treatment of people of colour in psychiatry and by society in large (Arredondo & Toporek, 2004; Desai, 2003; Fernando, 1991). Desai (2003) states that the notion of mental illness itself is a precondition of the psyche of Black peoples given the relationship between the construct race and psychiatry. In other words, because the discourse of race and western psychiatry developed simultaneously, the representation and perception of Black people is heavily influenced by the psychiatric discourse (Desai, 2003). This becomes highly problematic as Blacks were pathologized and deemed psychologically, biologically, genetically, culturally, and otherwise inferior by the 19th century (Arredondo & Toporek, 2004; Desai, 2003; Fernando, 1991). With such social and scientific constructions of race, the normal state of Blacks became equated with madness within the ideology of western psychiatry (Desai, 2003). Arredondo and Toporek (2004) report that even as recent as the 1980s, mental health and counselling texts, studies, and training that mentioned ethno-racial minorities, viewed and approached them as genetically or culturally deficient. Desai (2003) asserts that just as it fails to refute its relationship to race and racism, western psychiatry continues to provide inappropriate and inefficient services to people of communities of colour. Mental Health Services: Practice, Utilization, and Access Literature on the provision of mental health services to people of racialized communities is largely dominated by reports on barriers to equitable access and discussions about the systems inability to meet the needs of racialized communities. It rarely moves beyond the case for culturally competent practice. Further, this literature rarely focuses on youth. Soroor and Popal (2005) found that common barriers for Afghan youth and their families in accessing mental health services included, language barriers, stigma associated with a mental health concern and the use of mental health services, lack of knowledge about mental health issues, lack of information about available services, and lack of appropriate and available services. In a recent study on mental health service use by ethnic minority seniors in Toronto, the authors found that barriers to access included limited number of trained and acceptable mental health workers, lack of information of service providing systems, limited awareness about mental illness, lack of integrated mental health services for seniors, fear of rejection, stigma associated with mental health problems, and inadequate interpreter services (Sadavoy, Meier, & Ong, 2004). Those experiencing concurrent disorders, such as youth who deal with issues involving mental health and substance use simultaneously, also face a range of barriers to quality care (CDON, 2005). According to the CDON (2005), people with concurrent disorders are constantly bouncing from one system of care to another as a result of uncoordinated care between substance use and mental health systems. These systems in turn face barriers in providing appropriate services to people with concurrent disorders due to different funding

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streams, governance and planning structures, practice models and frameworks, and professional training, certification and licensing requirements (CDON, 2005). In response to ethnic variations in mental health services used by adolescents in the United States, Cauce and colleagues (2002) discuss a model of help-seeking behaviours to understand such variations. In their discussion, the authors acknowledge the scarcity of literature available on help-seeking and particularly how the process of seeking help unfolds for ethnic minority youth and their families (Cauce et al., 2002). While culture and context play important roles in service utilization with respect to defining problems and determining where to seek help if at all, the authors conclude that the question of culturally competent services becomes irrelevant when youth cannot get to the service in the first place (Cauce et al., 2002). Cuffe and colleagues (2001) also found that cultural factors affect the use of mental health services by young teens, but could not identify or explore why or how race was correlated with the use of services in their study. They also found that the racial differences in terms of service use or contact decreased with time, such that they had become the same in adulthood. Keating and Robertsons (2004) study on the utilization of mental health services by Black people in the United Kingdom focuses on fear as the central concept in accounting for the overrepresentation of Black people using mental health services and their poorer mental health outcomes. Keating and Robertsons (2004) argue that there is a circle of fear, encouraged by prejudice, misunderstanding, misconceptions, and racism, that perpetuates the bad treatment that Black people experience in the mental health system. They contend that Black communities end up using services they dont want as they mistrust and fear services, and service providers are in turn weary of the Black community and especially of young Black men (Keating & Robertson, 2004). Cultural competency has gained considerable attention in the contemporary literature on service provision to racialized communities (see for example, Al-Krenawi & Graham, 2000; Walker, 2005; Waughfield, 2002). Discussing mental health services for Arab clients, AlKrenawi and Graham (2000), for example, set out to describe the need for specific knowledge and skills when working with ethnically and racially diverse populations. Walker (2005) states that western psychiatrys neglect of religious and spiritual aspects of culture must be recognized and addressed. Walker (2005) suggests that service providers consider the combination of factors that affect the mental health of Black children, without stereotyping and misinterpreting or minimizing emotional and behavioural symptoms. According to Walker (2005), the goal of culturally competent practice is to exclude the risk of misinterpretation, while Waughfield (2002) states that a culturally competent practitioner understands the dynamics in the helping process and assists the client by recognizing the reality of the client (p.430). Further research is needed to address the disconnect that exists in the literature on the roles of poverty and racism in affecting and determining the mental health of youth, and particularly racialized youth. The majority of the existing literature may be informative but their findings cannot be generalized to the Canadian context just as the theories developed to account for variations in mental health among racial/ethnic groupings in the United States cannot be simply applied to racialized groups in Canada. Marginalized Communities in Toronto Following major changes in Canadian immigration policy such as the Immigration and Refugee Protection Act and the introduction of the points-system in the late 1960s, there has been a steady decrease in the immigration of British and European groups to Canada.

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To put this into perspective, Canada had increasingly relaxed its immigration restriction policies by the 1960s to fill specific labour shortages in Canada. The move towards a nondiscriminatory approach to immigration practices and the liberalization of policies was due, not only to local economic needs, but also related to the changing international political climate (Arat-Koc, 1999; Kelly & Trebilcock, 2000). Globalization, the United Nations and other supra-natural bodies of authority, and emerging universal human rights discourses increasingly influenced politics on a local level. The new point-system-based immigration admission policy of 1967 replaced country of origin, race, and other personal factors that admission criteria were previously based on with an emphasis on skill, education, and other qualifications not explicitly related to origin, ethnicity, religion, race, and so on (Arat-Koc, 1999; Kelly & Trebilcock, 2000). Since the mid-1960s, the demographic profile of skilled or economic class immigrants has changed, such that the majority of immigrants to Canada are originally from so-called third world countries and are non-White. The same goes for refugees and other newcomers to Canada who typically are non-White and from disadvantaged developing countries. For many new Canadians of colour, full citizenship in the form of a high and equitable standard of living has been elusive. The well-being of racialized groups, particularly immigrants and refugees and their children, has been declining (Preston and Murnaghan, 2005). Although newcomers the majority of whom are non-Whiteenter Canada more skilled and educated than ever before, even surpassing their Canadian-born counterparts, many continue to struggle for a better life in Canada. In fact, racialized groups and immigrants are earning less in the Canadian labour market than previous immigrants (Aydemir and Skuterud, 2005; Schellenberg and Hou, 2005). The lack of recognition for their foreign credentials and work experience, and a scarcity of affordable housing have placed many households at the margins, due to unemployment and poverty (Preston and Murnaghan, 2005). In Toronto, this has resulted in marginalized neighbourhoods where the experiences of social exclusion have a detrimental impact on immigrant youth and youth of colour. As discussed previously, race matters in the social and economic lives of Torontonians in the context of access, barriers, and inequitable outcomes. Poverty rates are three times higher for non-White groups than for White residents, and unemployment rates are likewise disproportionately high. Looking at the experience of racialized youth in the labour market emphasizes the current inequalities. Table 1: Youth of Colour in the Labour Market Age 15-24 Labour Market Participation All Youth 58.4 Immigrant Youth 55.0 Racialized Youth 43.7 Racialized Youth-Canadian Born 48.4 Black Youth-Canadian Born 33.2 Source: Jackson, 2005 Employment not only offers people an income that is empowering, it improves individuals social networks and sense of accomplishment. On the other hand, being unemployed is a stigmatizing situation that contributes to a persons sense of helplessness and hopelessness and has consequences for control of ones situation. Not surprisingly, negative emotional and mental health are common outcomes associated with unemployment, as increased stress, frustration, anger and shame affect youth who are unemployed. Discrimination based on age, gender, and race in the hiring process are Unemployment Rate 13.3 14.8 16.1 15.5 21.4

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often at the root of barriers to obtaining meaningful employment as a racialized youth. As a recent Canadian Labour Congress report notes: Racial discrimination in hiring and promotions is very much a factor at play. One in five visible minority workers reported experiencing racial discrimination in the recent Ethnic Diversity Survey, and many complaints are filed before human rights tribunals each year. (Jackson, 2005, 25) Although youth are typically less likely to be employed because they are expected to attend school on weekdays, youth of colour are less likely to work for pay outside the home compared to White youth. Youth of colour are less likely to have worked in the last year, and they have higher rates of unemployment in the labour market that is, higher proportions of youth who are looking for work and not finding it (Jackson, 2005). In the case of youth living in Torontos inner-suburban communities, such as the YConnect service area, young people, especially students who work part-time, tend to work in unskilled positions in the service sector. Restaurant, retail, service, and telephone marketing are some of the labour market areas with high proportions of youth employees. Compared to the downtown Toronto area, the Jane-Finch area lacks even these kind of job opportunities outside of its malls and plazas. Combined with lack of time, money, information, and other resources available to many youth of marginalized communities, such as the Jane-Finch community, youth may not be able to travel to available employment outside of their communities resulting in higher unemployment figures for youth from low-income homes. In neighbourhoods such as Rexdale, Malvern and Jane/Finch, low income households are concentrated as a result of the locations of available rental housing, primarily public housing developments. Many Toronto Community Housing sites in Toronto lie adjacent to industrial lands or previously remote city land. In the push for affordable housing in the post-war era, public housing such as Regent Park and later Jane-Finch were developed. In addition to Toronto Community Housing sites, these neighbourhoods tend to include significant additional private market rental housing arising out of neighbourhoodism8. Such social and economic exclusions emerge out of systemic racism, such as disregard for educational achievements gained outside of Canada and other Western countries, and everyday forms of racism (such as bias and discrimination against people of colour in the labour and housing market) and classism (e.g. neighbourhoodism). As the reviewed literature points out, for immigrants who are racialized in Canada as being other than White these experiences are further emphasized by the experience of settlement and acculturation. Mental health, we suggest, is a focal point of societal, personal, and household-level exclusion from the benefits of an inclusive and fair society. Mental health is negatively affected by the manifestations of racism and social exclusion created by the on-going process of racialization in our daily lives. How we view ourselves, relate to others, and function day-to-day is intimately connected to our experiences born out of employment
8

Usually referred to as the Not In My Back Yard (NIMBY) effect, neighbourhoodism refers to prejudice and discrimination against low-income or segregated racial/ethnic groups. Typically, neighbourhoodism is heightened by local homeowners fears that housing prices will fall if subsidized housing or unwanted residents move into their area. Therefore, homeowners tend to resist the location of public housing or resources for low-income groups (such as homeless shelters) in their area. An outcome of neighbourhoodism is the isolation of public housing areas by natural boundaries or non-residential zones, such as industrial parks.

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and housing discrimination, and other traumatic events that draw our minds back to the daily reality of race. Therefore, we focus our attention on the impacts of racism on the mind and well-being, as well as approaching mental health from a holistic perspective that places racialized communities in the centre of decision-making circles of health care. Social Marginalization and Marginal Services in Toronto Recently the Strong Neighbourhoods Task Force, set up by the City of Toronto, reported that the residents of several neighbourhoods are at-risk of increasing social marginalization and poverty as a result of degrading economic and social circumstances in these neighbourhoods, many of which affect youth directly. Low levels of educational achievement, high rates of youth unemployment, and high incidence of poverty are some of the indicators that reflect the worsening condition of well-being in Toronto (Strong Neighbourhoods, 2004). Reflecting this report, the City of Toronto has recently identified 24 neighbourhoods needing more social infrastructure (Strong Neighbourhoods, 2005). Unfortunately, because of the general scope of most reports done on social need, attention has largely not been paid to youths emotional and mental health. This is unacceptable because emotional health and mental well-being are strongly implicated in every point of discussion about at-risk youth. Racism, gender and class discrimination have shaped the current debate about the safe schools act, academic streaming, and failing schools. Poverty is built on a foundation of exclusions and a lack of opportunities among families that all too often re-appear as a cycle of poverty for children. Violence, despite its highly politicized debate in the current atmosphere, cannot be disconnected from aggression, possibly arising from social and economic despair, and other emotions connected in the livedexperience. With the closing of Youth Clinical Services in 2004, Northwest Toronto lost one of its few youth mental health service providers. Figure 1 shows the locations of mental health and addiction services in Toronto. The map includes a closer-up look at the Y-Connect area; it indicates that like other inner-suburban neighbourhoods in Toronto, the study area has very few mental health and addiction services located close-by. The majority of such services are located in the central part of the city. The lack of social services in Torontos inner suburbs is a serious problem that has long heightened resident social exclusion from services. In neighbourhoods such as JaneFinch, early news reports and community research noted that the place lacked recreational spaces for the large number of youth in the area, and community services to support immigrants and low-income families (Project Rebirth, 1989). Recent studies show that this is an ongoing problem. Many of the available services are inaccessible because they are located in hard-to-reach and hard-to-find areas (Sadiq, 2004; Truelove 2000; Lovell, 2005).

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Figure 2: Mental Health and Addiction Services in Toronto

Centre for Research on Inner City Health, 2005 Demographic Portrait of the Y-CONNECT Service Area This section uses the most recent Census (2001), as well as recent research, to describe the ethno-cultural diversity and social and economic conditions of the Y-Connect Service area. Y-Connect is located in the centre of one of Torontos most socially diverse but economically excluded areas. Our service area includes several neighbourhoods where clusters of rental and affordable housing have attracted low-income households, many of which are headed by immigrants, including recent groups of refugees. The area, particularly the Jane and Finch neighbourhood, has been the target of negative media representation, including inaccurate depictions about the ethno-racial composition of the neighbourhood. Part of the troubling media image is the inaccurate description of the neighbourhood as a place where few people work. In fact, prior to the recession in early 90s, Jane-Finch had a higher employment rate than the city average (Lovell, 2005)9. The area is largely working class, including many adults holding multiple jobs. Many youth in the area are unemployed and face many challenges finding work in the area (because of a lack of jobs) and outside of the area (because of job travel and information barriers and neighbourhoodism and other forms of discrimination).

Although workers living in Jane-Finch are employed in various jobs, it is important to note that the early 1990s recessionwhich saw a severe decline in manufacturing, replaced by service sector jobsdeeply affected the neighbourhood. In some census tracts, unemployment figures tripled during the recession, a sharply worse impact than experienced at the city level (Lovell, 2005).

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According to the 2001 census, the population of this area was 149,715 persons living in 48,270 households10 about three persons per household. Youth make up a large part of the population: 9,270 persons between the ages of 15-19 and 11,105 between 20-24 years of age. Gender is split roughly evenly in the over 20,000 people between the ages of 15 and 24 in the area. Figure 3 shows the numbers and locations of people of colour in the area. Figure 3: People of Colour, Y-Connect Area, 2001

The map shows that the area includes several concentrations of people of colour. With the exception of the two large industrial areas that bound the Jane and Finch neighbourhood, people of colour are located throughout the area, and are primarily concentrated in high rise and other large-scale rental housing sites (Figure 4). Large communities, with over 500 people self-identifying as a visible minority in the 2001 Census are located near Islington and Finch, Weston Road and Finch, the south side of Weston Road and Sheppard, Jane and Wilson (in the Chalkfarm community), and at various locations along Keele Street (especially on the northwest corner of Keele and Sheppard). The largest numbers of people of colour live in, or close to, the Jane and Finch neighbourhood. Communities including over 1000 people of colour include Jane and Steeles, Shoreham Drive (Edgeley Village and the townhouses west of Jane), Jane and Driftwood, San Romanoway, Grassway and Yorkwoods south of Finch along Jane, Finch and Tobermory and Driftwood south of Finch, Weston and Finch, Dufferin and Sheppard, and Chalkfarm located close to Jane and Wilson.

10

Although it is not certain what the population is currently, between 1996 and 2001 the population was relatively stable, rising by 1.3 percent.

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Figure 4: Rental Housing Composition and Racialized Groups

Although much is made of the growing cultural diversity in Toronto as a whole, it is really neighbourhoods such as Jane-Finch, Chalkfarm and Keele and Sheppard that reflect this diversity. While people of colour make up about 36% of the Toronto region, in our service area racialized groups are over 57% of the population. Table 2 describes the composition of racialized groups in the area. Table 2: People of Colour, Y-Connect Service Area Racialized Groups Percent All People of Colour 57.8 Black 16.2 South Asian 13.2 Latin American 7.7 Chinese 5.6 Southeast Asian 5.4 Filipino 1.8 Arab 1.5 West Asian 1.2 Korean 0.6 Other People of Colour 3.3 2001 Census of Canada, Visible Minority Status Total Population 86,500 24,275 19,795 11,590 8,435 8,115 2,615 2,190 1,860 940 5,005

The above census categories indicating race obscures much of the ethno-cultural diversity of the area through groupings such as South Asian or Black. Nevertheless, the table shows that the Y-Connect area is very diverse. Blacks, South Asian and LatinAmerican groups are the largest racialized groups in the area, and each of these groups include further diversities of ethnicity, place of origin, language and culture. Other Asian groups make up more than 12 percent of the population as well. It is estimated that racialized youth make up about 12,000 persons or about 13% of the total population (or

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of racialized residents11). Table 3 offers the existing data on ethnicity and nationalities for the area. Table 3: Ethnic Group Populations, Y-Connect Service Area Ethnicity/Nationality Population Italian 34,120 Jamaican 11,805 Chinese 9,860 Vietnamese 6,855 Portuguese 2,365 Russian 1,040 Filipino 2,770 Spanish 6,250 Guyanese 2,975 Pakastani 2,455 Latin American 2,245 African (Black) 2,240 West Indian 2,195 Sri Lankan 2,030 Black 1,655 Punjabi 1,210 South Asian 1,195 Trinidadian 1,145 Korean 965 Arab 935 Lebanese 705 Figure 5: Numbers of Low Income Cut-off Families and Racialized Groups

This is based on an estimation of racialized youth as 57.8 percent of the population, or following the incidence of People of Colour in the area.

11

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Figure 5 shows the numbers of family households living on low incomes with proportions of people of colour in the total population. In 1996, almost four in ten racialized immigrant households earned less than the Low-Income Cut-Off (LICO), a measure of poverty used by researchers and government officials (Preston, Lo and Wang, 2003). Since then this proportion appears to have remained stable (United Way, 2004). In 2004, the LICO for a family of three living in a city with more than 500,000 residents was $25,542. The map shows that the highest proportions of people of colour also live in areas where there are substantially high numbers of low-income families (in the appendix, a map of the incidence of poverty bears this reality as well). The locations of young people also reflect this pattern (Figure 6). Figure 6: Map of Youth 15-24 and Racialized Groups

Several parts of the area have higher proportions of youth than the average for the Toronto region, which was about 13 percent of the population in 2001. Along Jane Street, and Finch Avenue as well as the area bordering the Humber River, there were also large proportions of people between the ages of 15-24this is also evident in the York University area which is located at Jane and Shoreham. Residents of the area speak several languages and many speak more than one language (Table 5). One might assume that the second language cited in the table above is English on account of its primacy in the Toronto labour market, however this is not necessarily true. In some communities, such as the Vietnamese and Somalian communities, older adults sometimes speak two non-English languages more fluently than English, but the youth in these communities are often most comfortable speaking English.

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Table 4: Population of Y-Connect Area by Home Language Use Language Single Response Multiple Response Italian 9,320 29,675 Spanish 4,935 14,145 Vietnamese 3,710 8,090 Punjabi 2,975 6,435 Chinese n.o.s 2,475 4,690 Tamil 2,140 3,880 Arabic 1,830 4,265 Cantonese 1,520 2,835 Urdu 1,230 3,585 Farsi 710 1,305 Russian 555 1,465 Gujarati 510 1,170 Tagalog 490 2,205 Mandarin 470 1,575 Korean 470 880 Portuguese 380 1,765 Khmer 315 1,105 Turkish 255 840 Lao 255 510 Hindi 150 4,110 Bengali 150 430 Armenian 135 395 Swahili 210 Sinhalese 320 Other Languages 3,830 7,800 Available data about language usage does not allow us to consider language preferences of youth. This was one of the tasks set out on in the research.

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Methodology
This study uses several different sources of information to examine the emotional and mental well-being of racialized youth living in the Y-Connect service area. These include a youth questionnaire, focus group discussions with several ethno-specific groups of youth, and interviews with youth workers who have experience with mental health and substance abuse issues. The overall methodology of the study is qualitative, but where appropriate, we draw material from the census. Our survey also uses tables and maps to describe local conditions. The aim of this mixed methodology was to gain rich, in-depth insights from participants; their recommendations, concerns, opinions, and attitudes to several issues relevant to the topic of youth, mental health and substance abuse, and to enable each source of information to corroborate, qualify, and enrich the other data. This method is sometimes called triangulation. Sample In all, over 400 people were consulted for our study, the questionnaire was completed by 300 youth, 100 youth were involved in the focus groups, and 16 community workers offered their insights into our project through in-depth interviews. Below are charts describing some characteristics of the questionnaire sample. The survey and focus groups included a near-split in the gender make-up, and a somewhat even balance of age groups. Consistent with the census records which suggest most people of colour in the area are renters, almost all of the respondents lived in rental housing, and over 50 percent lived in Toronto Community Housing (Table 6). Table 5: Age and Gender: Questionnaire (%) Ages 15 16 17 18 19 20 21 22 23 24 Female 4.0 5.3 4.5 5.5 5.7 6.3 5.8 4.3 3.5 3.8 Male 4.7 5.9 6.1 5.8 4.7 5.1 4.7 5.4 5.1 3.8

Table 6: Housing and Work Characteristics: Questionnaire Housing and Work Percent Living in rental housing 89.0 Living in Toronto Community Housing 56.3 In Intermediate School 3.8 In High School 57.5 In Post Secondary School 17.5 Out of work, looking for work 58.8 Working more than 15 hours a week and in school 17.5 Living with both parents or stepparents 31.3 Living with mother only 41.3 Living with father only 3.8 Living alone or with friends 10.0 Frequency of school changes 15.0 The questionnaire sample also included a diverse number of youth from several ethnicities and immigrant experiences (see Table 7). Table 7: Immigration Characteristics: Questionnaire Total Female Male Immigrants 67.6 70.6 64.6 Refugees 27.5 24.2 30.8 Median year of migration 1995 1995 1995 Neither parent born in Canada 98.9 98.4 99.4

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The community questionnaire is a large non-random sample survey (n=300) completed by local youth drawn through a self-selection process. Adapted from two Centre for Addiction and Mental Health (CAMH) surveysthe Ontario Student Drug Use Survey and The Mental Well-being of Ontario Students, the survey documents various indicators of emotional and mental well-being, as well as responses about drug use and attitudes towards violence (see Appendix A). The questionnaire was done over three months, with considerable advertisement and an honorarium reward. It aimed to document responses from marginalized youth living in the service area. One method we used to draw the sample could be called walk-in self-selection. At a local youth employment agency located in Jane-Finch Mall a table was set up with advertising that explained our study and the purpose of the questionnaire. A space was made for people to complete the survey, and quality of the responses was checked by a trick question12. Besides this method, about half of the survey was done in local youth programs, and with youth recruited from two local high schools. In most cases, the questionnaire was answered in a quiet space, where each respondent was made aware of the time it would take for the questionnaire and given a chance to ask any questions. Sixteen in-depth interviews were also done with youth workers who either had experience with youth in the Y-Connect area, or who could offer insights about the needs of youth in ethno-specific communities. Using the 2001 Census as a guideline, as well as the researchers knowledge of the area, we identified several ethnic communities that we wanted the study to highlight. For practical purposes, however, it was impossible to reflect all of the diversity of the area (there are over 80 ethnic groups living in the area). Therefore, we sought to include voices from youth workers working in ethno-specific communities that reflect the local population. Where possible, we discussed issues with youth mental health workers, but seven of the interviews were done with youth support workers who had experience and knowledge of youth issues. Time constraints limited our ability to meet these objectives. Table 8 describes some characteristics of the people we were able to interview. Table 8: Characteristics of Key Informants Job Title Gender Youth Worker Female Street-involved youth worker Male Family Support Worker Female Mental Health Support Worker Female Family/Youth Support Worker Female Youth Mental Health Worker Male Substance Abuse Worker Male Youth Worker Male Youth Worker Male Youth Worker Female Youth Mental Health Worker Female Youth Violence Prevention Female Youth Worker Female Settlement Worker Female Settlement Worker Female Youth Mental Health Worker Male
12

Ethnicity Hispanic Somalian Indian Afghan African-Caribbean African-Caribbean Italian African-Caribbean Hispanic Hispanic Chinese Hispanic South Asian Sudanese Iraqi West African

Youth Clientele African-Caribbean Somalian South Asian Mixed Mixed African-Caribbean Mixed Mixed Hispanic Spanish-speaking Mandarin-Chinese Mixed South Asian Arabic-speaking Arabic-speaking West African, mixed

The question appeared at about the halfway point of the questionnaire and asked the respondent not to mark the question. All questionnaires including a marked trick question were discarded. In total 323 surveys were completed, of which 300 (150 each for male and female) were used in the analysis.

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The interviews lasted approximately one hour and loosely followed an outline that included discussion of local and community issues, criticism of current policy and practices of youth counselling, reflections on specific conditions of mental health and substance use with attention to age and gender-specific conditions, and recommendations for outreach, programs and services to youth. The interview objectives were strongly tied to the focus groups. Discussions were held with one group of women and one group of men from 12 ethno-specific communities; in total over 20 focus groups were held. Table 9: Focus Group Characteristics Ethnic Origin Male Female Afghan Arab Cambodian Ghanaian Indo-Guyanese Iraqi Jamaican Latino Pakastani Somali St. Vincentian Tamil The groups were fairly small including between 5-8 youth. This number was determined through two pilot discussions where we found that larger groups were chaotic and hard to mediate. Each discussion lasted over one hour, and participants were paid honoraria for their time; and when possible refreshments were served. As with other parts of the research, the questions were developed through a grounded method. The questions and order of topics were revised as findings emerged and we gained insight into topics and techniques that drew a good response from the groups.. In the end, we found that starting the discussion with an open-floor for participants to criticize misconceptions about their group, and to reflect on the diversity of their communities engaged the participants. Following this, questions were asked about day-to-day issues faced by youth, sources of stress, anger and frustration, relationships with family, friends, peers, and authority figures, and gender differences. The second half of the discussion considered issues of depression, isolation, suicide, body image and substance use.

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Findings It is not suitable to make a general statement about the mental well-being of youth living in the area since mental well-being is deeply personal. The most meaningful consideration for providing the appropriate services for youth of colour living in Y-Connects service area is to understand that youths needs differ according to their group and individual identities. Differences in age, gender, ethnicity, and economic situations contribute to the diversity of emotional and psychological conditions of youth. Instead we are left with several impressions of issues that influence emotional well-being in the area. The line between meeting basic needs and experiencing a lifestyle that is socially acceptable is often blurred with grave consequences for many youth we talked to in our research. This is especially true for youth who may experience not only difficulty finding food, clothing and shelter, but also experience taunting and isolation from friends and peers because of their type and quality of clothing, which might be viewed as out-of-style or a sign of poverty. For youth, emotional and mental health are especially linked to community and social acceptance. Often in the midst of finding themselves, young people may seek approval from their peers or feel deep isolation as a result of rejection. This can lead to conformity about attitudes to sexuality, gender roles, aspirations, and personal expectations. In some cases, adopting socially accepted attitudesfor example, an unwillingness to resolve disputes by non-violent meansmay be harmful for individuals. On the other hand, challenging such harmful, but socially accepted, attitudes, can lead to isolation, depression and victimization. This dilemma is a key issue that has some impact on the emotional well-being of many youth in the area. Stress and Anxiety Stress was the most acceptable topic of discussion for youth. Most participants in the focus groups and respondents to the questionnaire were willing to admit feeling stressed or identifying sources of stress in their lives. In our questionnaire and focus group discussions, youth indicated that a lack of enough money and their relationships with family, friends and authority figures were key causes of stress in their lives. In the questionnaire survey, over 57% of youth reported that not having enough money was their greatest source of stress, followed by family relationships (15.3%), personal relationships (5.6%) and relationships with authority figures besides family (5.3% each). In the focus groups, some said that not having enough money sometimes leads to disputes in their home. Some mentioned that their homes lacked private space, and so disputes happened often because of frustrations about privacy. Consider this comment from a community worker that emphasizes these concerns: Hidden homelessness is a huge problem for the community, because of the size of the apartments, and the number of relatives living together. Sometimes because of disagreements, kids will run away from their mother to other relatives. Sometimes crowding eight people into a two-bedroom apartmentyou can imagine the frustration even something as simple as someone taking someone elses food from the fridge can blow up and lead to argument. (Community Mental Health Worker) Money problems, as well as unsatisfactory conditions in the home, also created pressures for youth of colour to quit school and work. Twenty-nine percent of respondents reported that they felt pressure to leave school prematurely. Most of these respondents, about 34% reported financial burdens as the main reason for this pressure followed by parents

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expectations (28.8%). 18.8% indicated that working was the only way to leave a bad situation, and 12.5% because of threat of eviction. Although the desire to work is strong, youth acknowledged that finding work is very difficult. Community workers emphasized the limits placed by economic barriers. In the words of one family counsellor, she often observed families moving from one crisis to another, a reality that sometimes masks deep emotional issues taking place in the home. She explains how crisis creates a barrier to her work as a counsellor: The reality is that, with a lot of families, there are multiple barriers, there are multiple issues. So I find myself helping them find housing, I find myself connecting them with the food banksconnecting them with immigration lawyers or lawyers for court dates that are outstandingSometimes I feel like a crisis manager more than a family counsellor. (Family Counsellor) Social pressures differed considerably among youth, but usually were related to economic conditions. For some, fulfilling obligations and expectations set by parents placed a lot of pressure on them. This may include responsibilities such as paying household bills or contributing to the rent. Youth also mentioned that generational and cultural differences between themselves and their parents, or between their parents expectations and the expectations of their peers led to disputes in the home. Some told stories about family conflicts arising out of the dilemmas of fitting in at their school or with their peers, and following the expectations of parents and community. The following comment from a community worker describes a common narrative of tension between parental and community values and peer expectations. Our youth live in two cultures. They live the culture at home. [For example, if a youth is] from El Salvador, his mom, his dad, will raise him and discipline him and do some things the way they do them in El Salvador and the way they were brought up. But at the same time, when the youth goes out on the street and the world, he or she will go to the world of McDonalds, Taco Bell, Burger King, what have you. At the same time, also he or she will go to the world of their peers, where if you want to belong, you will have to follow what they do. If you dont smoke, you are not in the group and you are ostracized. When that happens and the youth begins to question his parents, begins to rebel, begins to assert himself, thats when the parents react. Thats when the parents get upset, and thats when the [domestic] fights begin. (Community Youth Worker) Difficulty getting sufficient sleep because of worry is a symptom and contributor to stress, as well as depression. 17.5% of women and 7.5% of men reported often losing sleep because of worry; over 35% of women (37.3%) and men (35.7%) of men reported sometimes missing sleep because they were worried about something. Almost half of female respondents who were in high school reported feeling that they didnt belong in their school. About 23% of male high school students felt they didnt belong in their school. Depression and Suicide Talking about depression to youth was often difficult. Many of the participants in the focus groups, especially men were unwilling to identify themselvesor others in their communityas depressive, or having mental health problems in general. It also seems

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that many youth may be unable to easily relate their emotions of sadness, frustration, or anger with depression. In some instances, youth suggested that depression is a sign of weakness, or a condition that is not experienced outside of the White community. Furthermore, young men sometimes considered themselves unlikely to be depressed or viewed depression as a feminine trait. Although many in the focus groups did not acknowledge depression as an issue affecting themselves or other youth, community workers saw this to be a key issue needing response. One youth worker explained it this way: People are depressed every day around here, but you wont even know. In the community, as a man, you have to maintain a soldier image, cause its a hard community. You cant go around whining about this and that. Sometimes you might wonder: Oh wheres J___ B___? Oh, he moved to Muskoka, or he jumped off a building. Its depression. People deal with it on different levelssure you have people that commit suicide, but in this community, people dont run to you to tell their problems, they usually keep it inside. (Community Youth Worker) A community mental health worker supports this view with the explanation that social expectations affect the way depression is felt and externalized by youth in the area: For the youth that I work with, it is more socially accepted for them to be angry then for them to be sad. So that what they do is project their depression as anger. Its still depression its just angry-depression. (Community Mental Health Worker) Because depression may be experienced through other emotions or symptoms, it is difficult to determine the extent of depression among young men and women. Mental health workers should also be aware that depression affects women more than men, especially when women are physically and socially isolated. As with depression, some youth perceived suicide as uncommon or absent from their communities. But in reality, suicide was acknowledged in all of the focus groups and interviews. In the focus groups, several people knew peopleeither personally or by associationwho had committed suicide or had tried. Several reasons for suicide were identified: not fitting in, having no friends, being rejected by a boyfriend/girlfriend, being gay, and unhappiness with family expectations to marry someone outside their wishes. In our questionnaire, over 20% of respondents indicated that they had considered suicide before, with 12.5% reporting that they considered suicide in the last year. More than 30% of women considered suicide: half as many men had thought of committing suicide. In some cases debates emerged between people who could not understand why people commit suicide, and who sometimes made insensitive remarks about depression and suicide and those who understood how peoples depression and unhappiness could lead to suicidal thought or actions. Here is a very personal reflection from a young woman. My friend killed himself two years ago he was an addict, but he wasnt an angry person at all. He was the nicest person, sweetest, happiest, funniest person you would ever meet. He was good-looking; he had a kid, a beautiful girlfriend. He had everything. He comes from a group of S___ people who played a lot of soccer, and he was never lonelyhe had love

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all over. Friends, sisters, cousins, everything. But when depression takes over its over. Its a disease I forgive him for what he did. Even though he left two kids without a dad. Because I have been at those points when you dont know what else to do. You dont see no other way, and nothing makes you happy and you feel like you are burden. I guess thats what he felt. (Young Woman) Self-Esteem and Identity Self-esteem is a big issue. Like [youth] not being able to identify that and what it means. And youth not associating being in an abusive relationship, whether as the victim or as the abuser, with love of ones self and being mentally stable and emotionally stable... and its also [apparent in] misconceptions that they have of certain things. So I think that its one dimension that needs more attention. (Community Youth Worker) Self-esteem refers to feelings and thoughts about ones selfa persons satisfaction with their life, their body and mind. Self-esteem is an internalor emotionalfactor; but like all emotions, self-esteem contributes to behaviour. In the discussions held with youth, we found that racism, body image and stereotypes about the neighbourhoods youth live in contribute to how they feel about themselves. In several of the focus groups, youth regularly voiced concern that they were discriminated against by employers, teachers and police because of their race, and the place that they live. For some youth who took part in the questionnaire or focus groups, the reputation of their neighbourhood is a major issue they face. Youth living in communities identified with Jane-Finch, such as Driftwood, Firgrove, and Grandravine, often expressed anger at the opinions held of Jane and Finch, but some also took pride in the negative reputation, and sometimes individuals would move between these positions. Several local community workers raised points about the effect of the outside reputations on youths self-esteem. The following comment from a local youth worker puts the relationship between place-discrimination and self-esteem into perspective: Sometimes theyll [youth in her program] say: only bad people live in Jane and Finch, Miss, we know. But then I ask is your mom bad? Is your dad bad? Are they bad people? Do they own a gun? So why would you say everyone owns a gun and were all bad? And I know at that age its cool to be a rebel[to identify with being] bigger and better than youbut you know, its really, really, trying to put things in perspective with youth, and challenging them. (Community Youth Worker) Frequently community workers recommended challenging the negative self-image that youth were confronted with, images some youth embraced or sought to re-define. The following comment describes how some youth may project a negative self-image. Both females and males have low self-esteem. They just show it in different ways. Some young males are very angry, and some of the young women I see are very boastful. In both I see a faade of over-confidence. Another common problem between them is not being able to look at the real issues or talk about their feelings Some really have a hard time talking about their feelings or their emotions. (Community Mental Health Worker)

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Masking emotions and responding to conflicts in a socially-acceptable manner is explained by one community worker to be a source of great stress as well as influence on identity and behaviour. Reputation, peer pressure: most of these same kids are not bad boys, theyre not gangsters But when they are with the group its a different ball-game. A lot of pressure: in this community you gotta stand up. Thats why a lot of these kids act the way they do, the pressures on them. If they dont stand up people will see them as a punk. The minute you get dissed in this neighbourhood, and you dont stand upespecially if you are knownyoure a punk, and you will be punked. Not only by the girls, but by the guys too. And the pressure is on. You cant even sleep: its either I do something or I gotta move out of this neighbourhood. And even if they avoid school they will hear about until they react. And the same people that did that to you, if you dont step on them, they are going to come back and step on you. (Community Youth Worker) In the focus groups these issues raised a lot of responses. Consider this comment about how some youth mask their emotions because of peer expectations. You see most of these girls that go on like they bad, and top-a-top seen? Trust me, when they get hung, when anything happens to themwhen they go home and they take their life in, do you know how much of those girls cry each night, wish to be this, wish to be that? I dont know why people put on a show for each other. I dont know why? Just be yourself, just be you Its all about popularity. But you know when youre really popular? When youre yourself all the way. And people respect you for being you. (Young Woman) She continues with this explanation: Its all about how you look. Your shoes, your clothes, everything. Its all about the outside. If you have nuff clothes, trust me you are gonna have nuff haters In ____ people wear uniforms so it doesnt really matter about their clothes, but if they look down on your feet and see Payless shoes theyre not going to respect you because you have on Payless shoes. (Young Woman) Fear and Aggression Focus groups and discussions with community workers suggested fear of violence, and the reality of violence, are important issues for youth. In the questionnaire, over 16% of male respondents indicated that they were very worried about their safety, and feared being harmed, and about 7% of women reported the same. Over 11% of respondents reported sometimes and frequently experiencing racial attacks in the form of angry attacks. A large proportion of men reported that they had been in physical fights that were incited by racial slurs or because of their race (30%). The proportion was a bit smaller for women (17%). One specific example of how the intersections of racism, and discrimination based on neighbourhood origin, age and gender affected youth was regarding assumptions about weapon-carrying behaviours. Many youth in the questionnaires and focus groups

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perceived that most local youth (esp. men) carried weapons, and many reported fear of being a victim of violence; however, few youth actually reported carrying weapons or engaging in violent behaviours. There appears to be a gap between the perceptions and fears of local youth and the reality that this sort of violence is largely confined to small numbers of youth. The role of the media and popular everyday discourse in perpetuating racialized images of male youth as perpetrators of gun violence and neighbourhood stigmas cannot be discounted in these fears. Table 10, below, shows the proportion of young men and women who never feel safe in their homes, schools and neighbourhoods. Table 10: Youth Feeling Unsafe At Home, School, and in their Neighbourhoods Male Female Home 4.7 8.0 School 11.3 10.7 Neighbourhood 8.0 42.0 Youths sense of safety in their homes, schools and neighbourhoods differed substantially between men and women. Women were more likely to report feeling unsafe at home, and in their residential neighbourhoods (almost half of women indicated never feeling safe in their neighbourhood). Men were slightly more likely to report feeling unsafe in their schools. Discussions with youth and community workers suggest that aggressive behaviours usually occur as a response to fear, or an attempt to exercise power in order to mask insecurities. Few youth indicated that they took part in aggressive physical behaviours regularly, but many admitted being verbally abusive to their friends or peers. The majority of youth reported never having problems controlling their tempers. About 17% of men, however, said that they often had trouble controlling their temper, while about 12% of women said the same. Coping Strategies and Support Networks Ways of coping or responding to emotional experiences differed among youth. Some youth in the focus groups had a difficult time trying to identify how they usually responded to stressful, depressing, or anger-inciting situations. Overall, a variety of coping methods were identified including crying, physical activities like playing sport or dancing, listening to music, writing down their thoughts, prayer, eating, using mind-altering substances, and talking and being close to their friends or family. Generally-speaking, youth expressed reluctance to talk about their problems with parents, or authority figures like counsellors or teachers. Overwhelmingly, youth preferred to talk about their problems to their closest friends (58.3%). About 20% reported always or usually discussed their problems with a parent. Most youth had at least one person they felt they could turn for support, but over 10% of youth felt they had no one to confide their problems to. In one of the focus groups, participants voiced concern that some women in their community were physically isolated from emotional supports because of strong limits on their freedom to travel outside their homes. They explained that often these women were kept inside their home by male parents or spouses who did not trust them visiting (or having friends), or going out in public. In the focus groups, several reasons were given why confiding in friends is the most common support choice. The following quote from a young female explains some of these reasons:

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You are around them most of the time. If you are not going to school, youre working. When you have free time youre around your friends. (Young woman) Self-medication was frequently identified in the discussions and questionnaire. Over 19% of questionnaire respondents reported that they responded to anxiety by using marijuana or alcohol. Few participants in the focus groups indicated that were willing to seek support from counsellors. The main reasons given were a lack of trust, and fear that their problems would not be kept confidential. About 8% of questionnaire respondents reported having visited a doctor, nurse or counsellor about emotional or mental health in the last year, but it is not known whether these visits were chosen or enforced by teachers, justice officials, or parents. Throughout the discussions, comments were often made that speaking with a counsellor about emotional or mental issues was a sign of being crazy or having mental problems, both of which were labels youth usually wished to avoid. Substance Use The questionnaire and focus groups were consistent in their indication that few types of substances are used by youth in the area (Figure 7). Figure 7: Substance Use in the Past 12 Months, Questionnaire
70 60 50 40 30 20 10 0
Al co ar hol ij C uan ig ar a et C tes oc M us ain hr e o St om im s ul an ts Kh R oh at M yp et no ha l m G ph l et ue Ba am rb ine itu at es PC P Tr an Cra qu ck illi Ke zer ta s m in e LS D H er oi n I Ec ce st So asy lv en ts

Female Male

Local youth mainly use alcohol and marijuana. Higher proportions of young men used substances than women, with the exception of ecstasy. The frequency of alcohol and marijuana also differed between women and men. 24% of men and 6.3% of women reported drinking more than once a week. 21% of men reported drinking more than 5 beers or coolers during one period; only 1.6% of women drank this much or more at a time. 10.6% of men indicated they drank more than 4 drinks containing hard liquor each time. 17.7% of men reported using marijuana each week, while only 3.4% of women indicated the same.

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The focus groups confirmed that substance use is quite different between men and women, different age groups and ethnic backgrounds. In some cases, such as with Afghan, Arab and Tamil background youth, women rarely drank or used other substances, while some men did. Female youth in these communities generally avoided substance use because of personal choice and/or fears about damaging their personal and family reputations in their communities by engaging in a highly taboo practice. A small number of participants mentioned that they have observed glue use among a small number of men during their time in intermediate school. Some in the focus groups also acknowledge observing or knowing about youth who use magic mushrooms, ecstasy, cocaine, and crack cocaine. Each of these observations were usually made with the disclaimer that this was not commonly seen. Very few youth in the focus groups expressed acceptance for using substances besides alcohol and marijuana. Usually respondents (male and female) took the perspective that around here its not cool to use crack or cocaine or anything like that. More times you will find people drinking or smoking weed (Young Male). Participants frequently criticized heavy drug use, or the use of hard substances such as crack; some saw heavy users or those they considered as dependent on substances as custies, a derogatory term for a person needing drugs. There were mixed opinions about the use of alcohol and marijuana. Some had strong feelings against using these substances, usually for moral or religious reasons, while a few expressed pride regarding heavy use of alcohol and marijuana13. Consider this comment from a sixteen year-old male who says he uses marijuana to cope with his dislike for school: I cant go to school soberits like jail if youre sober. If youre highlike this morning I went to school really high, and I had a good day. If you wake-n-bake you have a good day. Even if the worst s___ happens, as long as youre high, its all good. (Young Man) In a few discussions, men freely and somewhat proudly expressed being alcoholics. For example this comment: Sober? I used to be never sober. Actually I used to be a big-time alcoholic, now I drink now-and-then, but beforeevery day at school, Id have a forty and Id have three mickeysevery day. And plus all the weed. (Young Man) Although such views are not commonplace, and some of the above comments may well be exaggerated, there is cause for concern because of the pride some men placed in heavy use of alcohol and marijuana. A local substance abuse worker warns about the risks of such attitudes.
13

Generally-speaking, young men in some of the focus groups would proudly identify with stereotypes about the drinking, or marijuana smoking, abilities of their ethnic group. Young women, on the other hand, more frequently criticized such stereotypes for misrepresenting their community. Consequently, I was left with the impression that some men considered being able to consume a lot of certain substances (such as being able to hold their liquor or handle being high) a positive sign of masculinity. This was supported by occasional comments from women that men were the most likely to drink or use other substances in their communities, even when they were strongly discouraged from this behaviour (e.g. Indo-Guyanese, Afghan, Arab, Pakistani, Sri Lankan, Ghanaian and Somalian).

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Some want to enter into a debate about whether marijuana is the gateway drug? Is alcohol a gateway drug? Is proline a gateway into a gambling addiction? I dont want to enter into this debate. For me the issue is beyond that. It is not about the alcohol, its not about the drugs: my question would be, why do you need it? Why do you need the alcohol to take the edge off? Because some peopleprofessionalswill say, well, you know, a couple of drinks will take the edge off, and I can relax and kick-back. Why do they need that? It becomes a crutch. And those [behaviours and rationales], for me, would be early signs that if at some point in the future, if the stress becomes more difficult, or they develop a tolerance to those two drinks that take the edge offit may become a drinking problem or a drug problem or a gambling problem. (Substance Abuse Worker) Oppression and Exclusion Young Male #1: I dont even know what the word normal means. Normal to me is just like a fantasy word. There is nothing normal about anything. Even me, like I used to feel that I needed to get high everyday just to go to school. To me its just because school is just a bunch of lies, a bunch of b____. Its not helping our people, our community. It has nothing to do with us as a people. It has to do with their society. ***Others in the group voice agreement *** Young Male #2: Its like school is just there to transform you into a white person. You go in there coloured, and come back half-bleached. ***More agreement from others in the group*** Young Male #3: Then on the other hand, there are good aspects of school too. Like if you get far in school, like university, you get to learn what you want to. Young Male #1: Naw man, I say if you know the streets, school is a breeze. If you learn school and you go into the streets, youll die man. Cause the streets can teach you more. It can teach you mathematics, if youre a dealer. It can teach you phys. ed. if youre a gangster. It teaches you drama, when a cop stops you. It can teach you geography, cause you knowoh 52 division is that way, and cops hang around this blockso having street smarts is more important than school. (from discussion with group of male youth)

Exchanges like the one above occurred occasionally in the focus group discussions. The dominant view in this particular debatethat street smarts are more important that schoolcan be quickly read as a self-destructive attitude that contributes to exclusion by placing youth on the social and economic margins. But, more than that, this young males opinion recognizes that the education system has failed to make itself relevant to many youth of colour. Consequently, for some youth, it is possible to convincingly portray a myth that there is a trade-off between street smarts and school knowledge. This discussion also acknowledges how oppression in the form of cultural exclusion penetrates the social views of individuals leading some to accept attitudes that further entrench social exclusion. One community worker described how not understanding students social circumstances leads to disputes between students and the school system: A lot of teachers cant relate to these kids. These kidstheir minds are so developed because they have seen so many thingstheyre really mature.

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And the only way these teachers know how to deal with it is by suspension or to call the police. A lot of kids get their criminal records at school. Imagine that. (Community Youth Worker, Male) Part of the reason some youth view schools as part of an oppressive system is likely because of the close relationship between the schools and police in the area. According to one respondent, ____ (school) is like a jail. You got cops roaming the halls. The least little thing, the teachers call the cops. He follows with this comment: There is no way you should have an institution where people supposed to be learning and you are locking them for stupid thingslittle thingsthings that you should be sending them to the guidance counsellor for. In that case, what do you need the guidance counsellor for? Fire him! Because hes not serving his purpose if you are going to catch some kid because you smell marijuana and you find a little roach in his pocket, and then you call the cops. And these cops will charge you for anything, especially if you are a Black kid. (Community Youth Worker) Throughout the discussions with youth and community workers, even when not voiced directly, the reality of racism was present. Police brutality and discrimination is a commonly experienced problem that was often voiced by men in the focus groups. Cops always harass you: ask you where you been. Where you going, said one, who added that baggy jeans and black skin were sure to attract the attention of police. According to a local community worker who grew up in the area, there is a long history of police discrimination. He observes: In this community its a daily thing: almost every time the police come hereand it seems they never leavethey harass kids. And if its your child, or a friend of your childthe minute you step up, you say something and get involved, you are gonna get grappled up, you are going to get draped up, thrown against a car, a wall or a tree. Thats how they work down here: in other communities its different, in white neighbourhoods this would never happen. (Community Worker, Male) Facing these sorts of experiences daily, some youth are cynical about the ability of community workers, or youth programs to alter their situation. Even the pursuit of antioppressive discussion is challenged by the perception that there are so many issues that plague this community, its going to take a lot more than talk, research and workshops to make a differenceits the system that allows this to happen (Community Youth Worker). For many youth of colour racism is so deeply rooted in the experiences of youth that youth sometimes have difficulty identifying it. Consider these comments from another community worker: Sometimes when I focus on anti-oppression, and I ask them their experiences, it gets really hard the room is very heavy.... A lot of times they dont know how to identify it, because no one has ever asked them. They dont get asked this question by their parents. Their teachers are never going to ask them, or their principals... Who is going to ask them Have you ever experienced racism? But after you start talking to them theyll identify certain things. For instance, Well would it be like if my probation officer says Im never going to be anything in life, is that

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oppression? Of course thats oppression, you know. So they dont even know sometimes what it looks like. But not all of them. Some of them are very aware of these things. And some of them dont really want to do anything, they feel so disenfranchised Oh well miss, what can you do? (Community Youth Worker) Racism is identified by youth in two main ways: how they are perceived by authority figures, especially police and teachers, and how they are discriminated against by employers because of their race, ethnicity or their neighbourhood. Both feed the anger, pessimism, and negative self-images that sometimes affect youth of colour living in the area. Therefore, an anti-oppressive framework must confrontand empower youth to confrontthese systems of power (racism and oppression in schools, the justice system, police and employers) with the intent of transforming school, policing and acceptable views that enable discrimination to continue to bar youth of colour from opportunities. When asked their opinion about solutions to respond to youths needs, one female made this clear recommendation, using the topic of drug dealing and the eventual risk of violence. I would stop the key reason. The reason why people take up the drugs and start dealing is because they dont have a job. If you have a criminal record youre not bondable, you cant get a job, stuff like that. Why do you think they go out there? They hustle, they make moneyits because they cant get a job. They need money to eat. And they rob each other because theyre not going to go to the police when they get robbed, so they retaliate on their own. (Young Woman) In white neighbourhoods, kids can be kidsthey can experiment with drugs and petty crime and it doesnt follow them: but here, the system doesnt forgive. The real sad thing is that a lot of these kids do not find themselves until theyre twenty-five. Thats when you start seeing who you areyou remember oh I cant believe I used to do this, or I used to do that. They dont get a chance. You know why? Because by the time theyre twenty, theyre in jail and their manhood is going to meet them there. When they realize whats going on, and the road theyre traveling, its too late. Im looking at 15 years, its too late; Im looking at 10 years, Im looking at Life. (Community Youth Worker)

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Recommendations Good mental health is an essential part of overall well-being. Suicide and other healthdamaging behaviours often result from unidentified and untreated mental health issues, such as deep depression. This study indicates that several key issues need to be addressed to help improve the emotional and mental well-being of youth of colour living in Y-Connects service area. Chiefly, poverty undermines mental well-being by creating stress and anxiety over meeting basic needs on a day-to-day basis, as well as contributing to social isolation, disputes in the home, and personal despair. Before judging how best to create programs for a group of youth, service providers should always recognize the social and economic situation of youth. Several recommendations can be made from the findings (see Table 5). Service providers must initially help to address immediate needs of youth such as offering information, helping youth find employment, and safe and affordable housing. As mentioned by one community worker, improving emotional and mental well-being in the community cannot occur without helping people get their basic needs met. Part of addressing poverty and unemployment in the community also means challenging policy that exacerbates economic and social barriers for youth of colour, and joining local voices advocating for better community-based policy by government. Table 5: Findings and Recommendation Issue Recommendation Money, unemployment, and Service providers should make an effort to understand meeting basic needs, are each clients financial situation, and to help them meet sometimes over-riding their basic needs. Service providers should offer concerns for youth current information about employment and housing resources Mental health is not a topic Develop trust and friendships with youth by opening up that can be directly your personal life to them. Rather than questioning and approached with youth, and focusing on them, at first, encourage youth to question many youth are resentful of you and your motives and begin to feel comfortable authority figures prying into expressing their opinions with you. their personal lives, or assuming what their issues are Mental health language is Avoid terms like mental health, therapy, angerhighly stigmatizing management, and support group. Name programs according to relevant symbols and ideas, or allow participants to name their own groups Printed materials assume Depend on face-to-face outreach in popular places literacy in English and do not attended by youth (commercial, recreation and give youth an opportunity to education spaces) rather than printed materials. ask questions about the Incorporate different media in outreach to publicize programs to those isolated in their homes details. Negative self-image Enable youth to respond to media representations; contributes to low self- Support youths resistance to dominant views in their esteem, aggression and other peer groups, neighbourhoods, and beyond Youth face dilemmas between Try to transcend the generation gap by providing a families and peers space for youth and parents to engage and develop better understanding about their views and values

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Youth dislike spaces resemble clinical offices

that Make spaces that are more like living rooms than like classrooms or doctors offices. A effort should be made to create spaces that embrace democratic group dynamics, and oppose symbols of authority, such as classrooms, offices and clinics Youth are cynical of authority Work to diminish symbolic and real power differential in figures service; avoid being seen as the authority figure, embrace youth to lead discussions, and the nature of program, embrace youth to challenge and criticize your position and identity. Some youth are isolated and Work towards building friendships and trust; be honest may not have people to turn and acknowledge your inability to change some to in times of need situations on your own Provide alternatives to meeting in office space; meet people in their communities, use available and more accessible modes of communication Depression is sometimes Recognize that people are angry for a reason; and reflected through anger sometimes good reasonsprovide other options to voice resistance against systems and figures of authority Some youth, particularly men, Encourage complimenting peoples successes and perceive violence as a manly putting perceived failures into perspective way to resolve conflict; anger Try to expose youth to alternatives to these viewsuse and frustration is sometimes film, music and other relevant interests to open up projected through put-downs discussion on gender roles and attitudes and negative comments to friends, and peers; some youth have a hard time expressing positive comments about themselves or other people Discussions with youth indicate the topic of mental health is largely avoided for fear of being seen as mentally unstable or diseased. Few youth want to be labelled as having something wrong with them, and usually youth were sceptical of the idea that mental wellbeing is relevant to everyone. Even in some discussions with community workers, it was apparent that mental health is typically viewed in normal and abnormal dichotomies, with only those that are mentally ill needing mental health services. Consequently, outreaching to youth in the community using mental health terminology is unlikely to produce good results. Terms like mental health, counselling, anger-management, and therapy are likely to discourage participation from youth and other community members. Instead, it seems that mental health promotion and community outreach requires an indirect approach to gain the attention of youth. Especially in a situation where some youth feel that their ethnic or residential communities are stigmatized, mental health is best approached through the immediate concerns of people, such as unemployment, racism and stereotyping, and unfair media coverage. Many youth expressed a desire to voice their opposition to media representations of their neighbourhoods and ethnic communities. Programs that enable youth-led responses to media representations would be welcomed. Another recommendation about outreach is to avoid using printed materials whenever possible. There is a place for flyersthey can provide a record of information for youth that can be shared between people; but relying on postering or even handing out flyers, without face-to-face outreach about their content and making the important first person-to-

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person contact, does not address the fact that some youth prefer to ask questions about whatever program or issue is being publicized. Ideally, outreach would include canvassing areas popular among youth. Commercial spaces such as local malls and plazas, recreation centres, and schools are the best locations for finding youth. Even these common places may exclude certain youth. In some cases, youth are restricted from traveling away from their home areas. Other methods, such as advertising on radio, television and radio, are needed to outreach people in this situation. A possible way to transcend barriers on travel and passive health seeking behaviours may be to offer a discreet and confidential email counselling service which could allow people who are not able to physically attend programs, or people with schedules that bar them from participating in the programs to ask questions, or receive support from mental health service providers. One drawback is that many youth may not have Internet access in their homes (About 55% of the questionnaire respondents had the internet at home). For service providers, who are sometimes outsiders in their service community because of where they live, and their socio-economic characteristics such as age and ethnicity, gaining the trust of their clients is easier said than done. Youth services providers are usually not youth, and often come from outside the neighbourhoods they serve. So how then can mental health service providers improve their relationships with their clients? Quite simply, respect is earned over time through consistent behaviour and approaches that are based on equality and fairness. Our discussions with community workers emphasized that service providers need to begin by creating friendships with youth, and reducing the sense of differences between them. To create trust, service providers need to be on the same level as youth, both literally and figuratively. Whether addressing a group or individuals, service providers should sit when the groups sits, and stand when they stand. By joining the group, service providers remove themselves from being a self or institutionally-imposed centre of attention. However, being the centre of attention is not all bad. One of the awkward practices that reinforces the initial distrust youth might have towards service providers is that often service providers feel obligated to ask a lot of questions, and usually this is well-meant as a gesture of caring and wanting to help. However, asking questions puts youth on the spotand in a group setting this can be an embarrassing and difficult moment. A barrage of questions may remind youth of other authority figures, such as parents, teachers or police. Instead, allow the group to question you. Allow yourself to become the centre of their questions, so that people feel they can express themselves and question your judgment, position, motives, etc. Use self-effacing humour to diminish your perceived and real power, and give the group a chance to know more about your identity, background, neighbourhood, origins, etc. Finally, dont deny the reality of your differences. Admit your ignorance, but also show that you can learn. Avoid using language that is not your own. Dont put on a youth identity, with popular phrases because you think they will relate; people see through fakes. Instead, use the language you are comfortable with. If you try to relate by mimicking the symbolic culture of the group you may miss the deeper meaning and values that are more universal. Stick to simple ethics of respect, honesty, and caring. Sometimes service providers may feel that they are not getting anywhere or that clients are not responding. Be aware that silence and the appearance of a lack of concern or assertiveness, does not necessarily mean that your program is failing. Even in the worst case scenario where the relationship between a counsellor and a client is strictly dictation

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of how to, and not to, behave, you should assume the client is listening. Avoid using language that places the blame on the clientor suggests how far they go is up to them. Be aware of issues that might cause their apparent lack of interest: Do they have a secure place to live? Are they hungry? Have they slept well lately? How is their relationship with their family and friends? How is their physical health? Assuming their behaviour is only a matter of their attitude dismisses a number of other possibilities some of which are invisible to a person in a more privileged situation. Many youth are quite cynical about the interests of service providers, who they might see as part of the system. If we dont recognize the impact of poverty, and other oppressions, we can reinforce any initial views that service providers dont understand. Sitting at a desk, when a person is standing (or sitting) in front indicates a position of power just as much as standing before a sitting audience. Ideally, group discussions should take place in circles, where the symbolic power of a leader is diminished, or in an environment where people can find a relaxing space. Once again, less like a classroom, and more like a living room. Many of the issues youth face arise out of their vulnerability to authority figures and to pressures from peers and family. Some youths face powerful behavioural and attitudinal expectations. These pressures can lead a variety of harmful emotional conditions and behavioural responses. These include stress, anxiety, depression, anger, abuse of substances, and even violent and suicidal behaviours and attitudes. There are no easy answers to addressing these problems because each individual may have her or his own way of coping, responding or resolving the emotional impact of peer, family and community pressures. However, throughout the study, some common issues were identified. Pressures on youth to respond to violence, frustration, insults and peer expectations usually affected men and women differently. Men are under a lot of pressure from friends and peers to man up and respond to conflicts in an aggressive way. Resisting this pressure is not easy for men because walking away from conflicts may be seen as weak and unmanly. Working to disempower such negative peer pressures cannot be confined to workshops about other ways of resolving conflict. This is needed, but workshops that challenge how and why youth identify with these expected behaviours is also needed. Emotional and mental health promotion should therefore interrogate dominant constructions of gender, especially focusing on accepted views about manhood. An effort is needed to show young men that being male is not synonymous with aggressive behaviour. Helping youth to develop healthy attitudes to themselves and one another is important, but so is recognizing that transition and change is a regular part of growing up. Most youth will reject unhealthy attitudes and behaviours as they mature. Instead of enforcing certain directions or attitudes, youth should be given different alternatives from which they can make their own decisions. An underlying issue for youth of colour living in communities where poverty and exclusion are deeply entrenched is that they do not have the resources to pursue their interests and to develop their talents. Supporting and expanding the alternatives of youth is therefore critical to resisting the hopelessness that undermines the mental well-being of youth of colour.

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Conclusion The study findings add to Canadian knowledge about mental health by providing insightful information about the range of mental health concerns experienced by youth of colour. The results of this study generate several new questions for further research. Particularly striking issues such as violence, aggression, negative self-images, loneliness, and depression require further attention to allow for a deeper understanding of these issues as they relate to the mental health of youth. The relationship between the mental health of parents and youth, such as how posttraumatic stress disorder and depression of parents (an issue that affects some refugees) affect their childrens mental well-being also needs further attention. We suggest that future research also inquire into the role of parent-child relationships in youths mental health needs from the perspectives of parents as well as youth. Rather than exploring mental health outside the family unit, situating research within the household would account for factors that contribute to the well-being of youth of colour that we were not able to tap into this study. Our inquiry into the extent of suicide ideation suggests that some youth may exhibit suicidal behaviours through risky and daring aggressive behaviours involving third parties, rather than the commonly-held expectation of suicide as self-inflicted and private. Further development and exploration of this theme is needed. We hope that this study will provide a framework and record of the issues for future research. We also hope that we have met our objective of informing local service provision.

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Appendix A: Glossary
Developing language within an anti-racism framework continues to be a challenge. Sometimes, the attempts of non-dominant people to find positive ways of defining themselves from their own perspective is minimized or labelled political correctness. The challenge of developing inclusionary language which validates the experiences of all people is even greater in the context of mental health terminology which continues to reflect the perspectives of Western psychiatry and stigmatizes others with psychiatric labels. (Ethno/Racial Mental Health Committee, Orientation Package) With these sentiments in mind, the following glossary provides a conceptualization of terms and definitions that have been used throughout this report. For the most part they have been drawn from sources that complement the perspective of this report as reflected in the framework section. Acculturation refers to a multidimensional process, resulting from intergroup contact, in which individuals whose primary learning has been in one culture take over characteristic ways of living (attitudes, values and behaviour) from another culture (Hazuda et al., 1988, cited in Hyman, 2001). Anti-racism is not just an ideal but also a practice. It is an active and consistent process of change to eliminate individual, institutional and systemic racism as well as the oppression and injustice racism causes (Canadian Race Relations Foundation). It is an approach that fights racism in all its forms, based on the assumption that racism has to do with power structures and is caused by historical, social, cultural, political, ideological, and economic factors. To fight racism we need to identify and change systems which maintain racism (Ethno/Racial Mental Health Committee, Orientation Package). Culture is everything we learn by growing up in a particular society which is reflected in the way we live. It includes all aspects of identities such as geographical, political and family links; values, beliefs, traditions, history, language, religion and race (Ethno/Racial Mental Health Committee, Orientation Package). Ethnoracial Communities is a term that is often used to refer to ethno-specific, non-white communities that are often racialized, such as Arabs, Black/Africans, South Asians, West Asians, South-East Asians, and Latin Americans. (Across Boundaries, http://www.acrossboundaries.ca). Health is the state of complete physical, mental and social well-being not merely the absence of disease or infirmity. (World Health Organization (WHO): http://www.who.int/about/definition/en/). Internalized Racism occurs when disadvantaged groups or individuals who are racialized adopt and accept the stereotypical characteristics and behaviours that are socially and politically constructed and ascribed to them. This tends to lead to behaviours/performances that confirm and perpetuate these stereotypic portrayals. Mental Illness is a recognized, medically diagnosable disorder that results in the significant impairment of an individuals cognitive, affective or relational abilities. Mental illnesses result from biological, developmental and/or psychosocial factors (Canadian Mental Health Association (CMHA), http://www.cmha.ca/mh_toolkit/intro/glossary.htm).

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Mental Health, according to the World Health Organization, is a state wherein the person is well adjusted (WHO http://www.who.int/topics/mental_health/en/). This state is affected by the interdependence of the spiritual, emotional, mental, physical, social, cultural, linguistic, economic and broader environmental aspects of health and thus necessitates a holistic approach when dealing with mental health problems (Across Boundaries, http://www.acrossboundaries.ca). People of Colour is a term used by some people who are not seen as white to name themselves. It originated in the United States in an attempt to replace terms such as nonwhites, minorities, visible minorities or ethnics, with a positive identity (Ethno/Racial Mental Health Committee, Orientation Package). In the Canadian context, the term refers to a group of people who because of their physical characteristics are deemed non-white and subjected to differential and unequal treatment. (City of Toronto Task Force on Community Access & Equity, www.torontoartscouncil.org/downloads/City_Glossary_Access_Equity_Terms.doc). Privilege involves unearned power that provides certain groups (e.g. white, heterosexual Anglo-Saxon men) economic, social and political advantages in society at the expense of oppressed groups. (Ethno/Racial Mental Health Committee, Orientation Package). Race is a social and political construct (not scientific) which categorizes people on the basis of physical or biological characteristics such as skin colour, shape of eyes, texture of hair, body size and physique (Ethno/Racial Mental Health Committee, Orientation Package; Multicultural Association of Nova Scotia, 1995). Categorizations of races are contextual but remain central to the identity-formation of many people who are deemed Other. Racialization is the process by which racial categories are constructed as different and unequal in ways that lead to social, economic and political impacts and health inequalities (Galabuzi, 2001). Racialized Groups refers to non-dominant ethnoracial communities who, through the process of racialization, experience race as a key factor in their identity (Galabuzi, 2001). Racism refers to a system in which one group of people exercises power over another group on the basis of skin colour; an implicit or explicit set of beliefs, erroneous assumptions, and actions based on an ideology of the inherent superiority of one racial group over another, and evident in organisational or institutional structures and programs as well as in individual thought or behaviour patterns (Henry et al., 2000, p.410). White is a social rather than scientific construct that is used to refer to dominant groups in a society. White people enjoy skin privileges, although they may face discrimination because of their class, gender, ethnicity, sexual orientation, religion, age, language, disability or citizenship (Ethno/Racial Mental Health Committee, Orientation Package).

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Appendix B: References
Access Alliance Multicultural Community Health Centre (AAMCHC). (2005). Racialized groups and health status: A literature review exploring poverty, housing, race-based discrimination and access to health care as determinants of health for racialized groups. Toronto, ON: Access Alliance Multicultural Community Health Centre. ACPH (Federal-Provincial-Territorial Advisory Committee on Population Health). (2000). The opportunity of adolescence: The health sector contribution. Minister of Public Works and Government Services Canada. Al-Krenawi, A., & Graham, J. R. (2000). Culturally sensitive social work practice with Arab clients in mental health settings. Health & Social Work, 25(1), 9-22. Aneshensel, C. S., & Sucoff, C. A. (1996). The neighborhood context of adolescent mental health. Journal of Health & Social Behavior, 37(4), 293-310. Anisef, P, & Kilbride, K. M. (2000). The needs of newcomer youth and emerging best practices to meet those needs: Final report. Toronto, ON: CERIS. Arat-Koc, S. (1999). Gender and race in non-discriminatory immigration policies in Canada: 1960s to the present. In E. Dua & Robertson (Eds.), Scratching the surface: Canadian anti-racist feminist thought. (pp.207-233). Toronto: Womens Press. Arredondo, P., & Toporek, R. (2004). Multicultural counseling competencies = Ethical practice. Journal of Mental Health Counseling, 26(1), 44-55. Austen, P. (2003). Community capacity building and mobilization in youth mental health promotion. Ottawa: Health Canada, Mental Health Promotion Unit. Beiser, M., Hou, F., Kaspar, V., & Noh, S. (2002). Ethnic identity, resettlement stress, and depressive affect, among Southeast Asians in Canada. CERIS Working Paper Series. #17-2002. 37 pp. Brown, T. N. (2003). Critical race theory speaks to the sociology of mental health: Mental health problems produced by racial stratification. Journal of Health and Social Behavior, 44(3), 292-301. Cauce, A. M., Paradise, M., DomenechRodriguez, M., Cochran, B. N., Shea, J. M., Srebnik, D., Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethic minority youth. Journal of Consulting & Clinical Psychology, 70(1), 44-56. Choi, H. (2002). Understanding adolescent depression in ethnocultural context. Advances in Nursing Science, 25(2), 71-85. Concurrent Disorders Ontario Network (CDON). (2005). Concurrent disorders policy framework. Concurrent Disorders Ontario Network. Cuffe, S. P., Waller, J. L., Addy, C. L., McKeown, R. E., Jackson, K. L., Moloo, J., & Garrison, C. Z. (2001). A longitudinal study of adolescent mental health service use. Journal of Behavioral Health Services & Research, 28(1), 1-12. Dei, G J.S. (2000). Towards an anti-racism discursive framework. In G. J. S. Dei & A. Calliste (Eds.), Power, knowledge and antiracism education (pp.23-39). Halifax: Fernwood Publishing. Desai, S. (2003). From pathology to postmodernism: A debate on race and mental health. Journal of Social Work Practice, 17(1), 95-102. Fernando, S. (1991). Mental health, race and culture. New York: St. Martins Press. Galabuzi, G.-E. (2001). Canada's creeping economic apartheid: The economic segregation and social marginalisation of racialized groups. Toronto, ON: CSJ Foundation for Research and Education. Gore, S., & Aseltine Jr., R. H. (2003). Race and ethnic differences in depressed mood following the transition from high school. Journal of Health & Social Behavior, 44(3), 370-389.

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Griffin Centre. (2004). Jane Finch Neighbourhood Action Plan Report. Toronto, ON: The Griffin Centre. Henry, F., Tator, C., Mattis, W., & Rees, T. (2000).The colour of democracy: Racism in Canadian society. Toronto: Harcourt Brace. Hyman, I. (2001). Immigration and health. Health Policy Working Paper Series. Ottawa, ON: Health Canada. Hyman, I., Vu, N., & Beiser, M. (2000). Postmigration stresses among Southeast Asian refugee youth in Canada: A research note. Journal of Comparative Family Studies, 31(2), 281-293. Issitt, M. (1999). Towards the development of anti-oppressive reflective practice: The challenge for multi-disciplinary working. Journal of Practice Teaching, 2 (2), 21-36 Keating, F., & Robertson, D. (2004). Fear, black people and mental illness: A vicious circle? Health and Social Care in the Community, 12(5), 439 447. Kelley, N. & Trebilcock, M. (2000). The Making of the Mosaic: A history of Canadian immigration policy. Toronto: University of Toronto Press. Khanlou, N., Beiser, M., Cole, E., Freire, M., Hyman, I., & Kilbride, K. M. (2002). Mental health promotion among newcomer female youth: Post-migration experiences and selfesteem. Ottawa, ON: Status of Women Canada. Lavis, J. (2002). Ideas at the margin or marginalized ideas? Nonmedical determinants of health in Canada. Health Affairs, 21(2), 107-112. Nazroo, J. (2003). The structuring of ethnic inequalities in health: Economic position, racial discrimination, and racism. American Journal of Public Health, 93(2), 277-284. Ornstein, M. (2006). Ethno-racial groups in Toronto, 1971 2001: A demographic and socio-economic profile. Toronto, ON: Institute for Social Research, York University.

Ross, C. E., & Mirowsky, J. (2001). Neighborhood disadvantage, disorder, and health. Journal of Health and Social Behavior, 42, 258-276. Sadavoy, J., Meier, R., & Ong, A. Y. M. (2004). Barriers to access to mental health services for ethnic seniors: The Toronto study. Canadian Journal of Psychiatry, 49(3), 192-199. Samaan, R.A. (2000). The influences of race, ethnicity, and poverty on the mental health of children. Journal of Health Care for the Poor and Underserved, 11(1), 100-111. Satzewich, V. (1998). Race, racism, and racialization: Contested concepts. In V. Satzewich (Ed.), Racism and social inequality in Canada: Concepts, controversies and strategies of resistance, (pp.25-45). Toronto: Thompson Educational Publishing. Soroor, A., & Popal, Z. (2005). Bridging the gap: Understanding the mental health needs of Afghan youth. Toronto, ON: Ministry of Children & Youth Services. Tupker, E. (2004). Youth & drugs and mental health: A resource for professionals. Toronto, ON: Centre for Addiction and Mental Health. Vaillant, G. E. (2003). Mental health. American Journal of Psychiatry, 160(8), 1373-1384. Walker, S. (2005). Towards culturally competent practice in child and adolescent mental health. International Social Work, 48(1), 49-62 Waughfield, Claire G. (2002). Mental health concept. (5th Edition). Australia ; Clifton Park, NY : Delmar/Thomson Learning. Womens Health in Womens Hands Community Health Centre (WHiWH). (2003). Racial Discrimination as a Health Risk for Female Youth: Implications for Policy and Healthcare Delivery in Canada. Toronto: Canadian Race Relations Foundation. Wu, Z., Noh, S., Kaspar, V., & Schimmele, C. M. (2003). Race, ethnicity, and depression in Canadian society. Journal of Health and Social Behavior, 44(3), 426-442.

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Appendix C: Questionnaire

Y-Connect Questionnaire
Hello. On behalf of Y-Connect Addiction and Mental Health Services, we thank you for your interest in our survey. Y-Connect is a new non-profit community agency located at 10 San Romanoway Drive, on the northeast corner of Jane Street and Finch Avenue that is dedicated to providing addiction and mental health care for youth between the ages of 15 and 24 living in our local area. Our staff recognizes racism is a barrier that restricts many of us from achieving our goals, and that racism causes us to experience poor health and a sub-par quality of life. Therefore, Y-CONNECT IS DEDICATED TO PROVIDING SERVICES FOR YOUTH FROM A HOLISTIC APPROACH WITHIN AN ANTI-RACISM/ANTI-OPPRESSION FRAMEWORK. THIS QUESTIONNAIRE IS PART OF A COMMUNITY-BASED STUDY THAT IS INTENDED TO CREATE NEW SERVICES THAT ARE APPROPRIATE FOR THE NEEDS OF LOCAL YOUTH. Our study is interested in knowing what are the main issues our services should address, what languages and cultural values we need to represent, and how best we can encourage youth to use our services when they need to.

Below we ask you questions about drug use and addiction as well as your feelings about such issues as depression, stress, body image and suicide. This survey is completely anonymous: THE INFORMATION YOU RECORD IN THIS SURVEY WILL BE KEPT COMPLETELY SECRET AND CONFIDENTIAL. We ask you, therefore, to be completely honest and accurate when you answer the questions. If you do not wish to answer a question leave it blank. Also, you may withdraw from the survey at any time. INSTRUCTIONS FOR COMPLETING THIS QUESTIONNAIRE MOST QUESTIONS ARE FOLLOWED BY A LIST OF ANSWERS. PLEASE CHOOSE THE ANSWER THAT IS RIGHT FOR YOU AND INDICATE YOUR CHOICE IN ONE OF THE BOXES TO THE LEFT. FOR EXAMPLE: Which of the following best describes the reason you have chosen your subjects while in school? 1. I will need them to go further in school 2. They will help me get the sort of job I want later on 3. I like them and I find them interesting 4. I am good at them 5. My friends will be taking them 60

1. How old are you? 1) 2) 3) 4) 5) 6) 7) 8) 15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years

8. With whom are you currently living? (Please choose only one answer) 1) 2) 3) 4) 5) 6) 7) 8) 9) Both biological/birth parents Biological/birth mother only Biological/birth father only One biological/birth parent and one stepparent Shared custody Adoptive parent(s) Foster parent(s) Other relative(s) Living in a group home

9) 23 years 10) 24 years 2. Are you male or female? 1) 2) Male Female

10) Living on my own or with a friend 9. How many times have you moved to a different home in the last 5 years? 1) 2) 3) 4) 5) Never Once 2 or 3 times 4 or 5 times More than 5 times

3) Trans-sexual 3. What is your current job status? 1) Out of work, looking for a job 2) Out of work, not looking for a job 3) Working full-time 4) Working part-time 4. What school do you go to? 1) 2) 3) 4) 5) Junior high school High school College University Not in school

10. Does your household have the internet? 1) Yes 2) No 11. During the LAST 5 YEARS, how many times have you changed schools (Do not include changing from elementary or middle school to high school)? 1) 2) 3) 4) 5) Never Once 2 times 3 times 4 or more times

5. If you were NOT born in Canada, what year did you arrive in Canada? Year: _____________ 6. If you were NOT born in Canada, where were you born? Country: ____________________________________ 7. What is your ethnic/racial background. (e.g. Jamaican, Tamil, Chinese, Arab, Black, etc.) Feel free to list more than one Ethnicity: ___________________________________

12. In the LAST 4 WEEKS (that is during the last 20 school days), how many days of school did you miss because of your health? I missed ______ days of school during the last 4 weeks because of my health

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13. How would you describe your familys financial situation? 1) 2) My household is wealthy We have enough money to live, but not much more than that

18. If your family came to Canada as refugees, what was the source of upheaval in your homeland 1) Political violence (civil war)

2) Ethnic violence 3) 4) 5) Disaster or famine Poverty and social disruption Other:

3) Often my household lacks enough money, but we usually get-by ok 4) We have many hard times paying rent and buying food and clothing 14. Does your family/household currently rent or own your home? 1) Rent 2) Own 15. Do you live in a Toronto Community Housing apartment? 1) Yes 2) No 16. What language are you most comfortable speaking? 1) 2) 3) 4) 5) 6) 7) Arabic Dari English Lao Malayam Mandarin Pashtun

______________________________ 19. Would you say that there is a cultural or age barrier between you and your parents that effects your relationship? Yes No 20. How well would you say you are getting along with your parents? 1) I am getting along very well with my parents 2) I am getting along OK with my parents

3) I am not getting along well with my parents 21. On average, how many hours A WEEK do you spend working for pay outside the home? 1) 2) 3) 4) 5) 6) 5 hours or less a week 6 to 10 hours a week 11 to 15 hours a week 16 to 20 hours a week More than 20 hours a week Dont work for pay outside the home

8) Punjabi 9) Somali

10) Spanish 11) Swahili 12) Tagalog 13) Tamil 14) Twi/Ashanti 15) Urdu 16) Vietnamese 17) Other language: Please identify ___________________________________ 17. Were your parents born in Canada? 1) 2) 3) Both parents were born in Canada One parent was born in Canada Neither parent was born in Canada

22. In your free time away from home, how often does one of your parents know where you are? 1) 2) 3) 4) 5) Always Usually Sometimes Seldom Never

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23. When you have problems, how often do you talk to your mother about them? 1) 2) 3) 4) 5) 6) Always Usually Sometimes Seldom Never No mother

29. In the LAST 12 MONTHS, how many how times have you seen a doctor about your physical health or for a check-up? ___________ times (Write in 0 if you have not seen a doctor for your physical health in the last 12 months) 30. In the LAST 12 MONTHS, how often have you seen a doctor, nurse or counsellor about your emotional or mental health? ___________ times (Write in 0 if you have not seen any of the above in the last 12 months) 31. Do you feel in control of your life? 1) Yes 2) No 3) Not sure 32. How often do you have trouble facing up to your problems? 1) Never 2) Rarely 3) Sometimes 4) Often 33. How often do you lose sleep because you are worried about something? 1) Never 2) Rarely 3) Sometimes 4) Often 34. What is the biggest cause of stress in your life? 1) Money problems (financial problems) 2) Friendships 3) Personal relationships 4) Family relationships 5) Relationships with authority figures (such as teachers and police officers) 6) Other. Please _____________________ 35. How often do you feel under stress? 1) Never 2) Rarely 3) Sometimes 4) Often state:

24. When you have problems, how often do you talk to your father about them? 1) 2) 3) 4) 5) 6) Always Usually Sometimes Seldom Never No father

25. How soon would you like to move out of your guardians home? 1) As soon as possible 2) In the next few years, after I graduate from high school 3) In the next few years 4) I am in no hurry to leave home 26. Do you ever feel pressured to quit school and start working full-time? 1) Yes 2) No 27. If you feel pressured to work, why is that? (you may check more than one) 1) Financial burdens 2) Threat of eviction 3) Parent(s) expectations 4) Only way to leave a bad situation 5) Other: ________________________________ 28. Remembering your last full year of school, how many days did you miss because of SUSPENSION? 1) 1 day 2) 2-4 3) 4-6 4) More than 6 days 5) None

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36. Over the LAST FEW WEEKS, have you felt you couldnt overcome difficulties? 1) No 2) Yes 37. Over the LAST FEW WEEKS, have you been feeling unhappy and depressed? 1) No 2) Yes 38. In your ENTIRE LIFE, have you ever considered attempting suicide? 1) Yes 2) No 39. Remembering a time when someone you care about had died, how did you feel? (Feel free to list more than one.) 1) Angry 2) Sad 3) Depressed 4) Indifferent 5) Confused 40. During the LAST 12 MONTHS, how often have you felt sad? 1) Never or rarely 2) Sometimes 3) Often 4) Always 41. During the LAST 12 MONTHS, how often have you felt lonely? 1) Never or rarely 2) Sometimes 3) Often 4) Always 42. In the LAST 12 MONTHS, have you been prescribed medicine to treat anxiety or depression? 1) Yes, for anxiety only 2) Yes, for depression only 3) Yes, for both anxiety and depression 4) No 43. During the LAST 12 MONTHS, did you ever consider attempting suicide? 1) Yes 2) No

44. When you feel anxious, stressed or tense, Do you do any of the following? (Feel free to list more than one.) 1) Talk to a close friend 2) Smoke a joint 3) Seek counseling 4) Have a drink 5) Pray or meditate 6) Speak to a religious/spiritual counselor 7) Other, please state: ______________________ 45. To indicate that you are still paying attention to our questions, please do not mark this question. 1) Rarely 2) Sometimes 3) Often FOR THE NEXT FEW QUESTIONS, PLEASE INDICATE HOW OFTEN EACH OF THE FOLLOWING STATEMENT IS TRUE FOR YOU. 46. I feel safe in my home. 1) Almost always true 2) Often true 3) Sometimes true 4) Seldom true 5) Never true 47. I feel safe in my school. 1) Almost always true 2) Often true 3) Sometimes true 4) Seldom true 5) Never true 48. I feel safe in my neighbourhood. 1) Almost always true 2) Often true 3) Sometimes true 4) Seldom true 5) Never true

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49. I live a stressful life. (Leave blank if never true) 1) Almost always true 2) Often true 3) Sometimes true 4) Seldom true 50. My parent(s) are proud of me. 1) Almost always true 2) Often true 3) Sometimes true 4) Seldom true 5) Never true 51. I dont belong or fit in with my school or with other youth in my area 1) Almost always true 2) Often true 3) Sometimes true 4) Seldom true 5) Never true 52. I have trouble controlling my temper. 1) Almost always true 2) Often true 3) Sometimes true 4) Seldom true 5) Never true 53. About how many people do you know that you can talk to about your problems? I know about ___________ people I can talk to about my problems. 54. In the LAST 12 MONTHS, have you phoned any telephone crisis helpline (for example, Kids Help Phone) because you needed to talk to someone about a problem? 1) Yes 2) No 55. Do you think of yourself as being too thin, about the right weight, or too fat? 1) Too thin (underweight) 2) Too fat (overweight) 3) About the right weight

56. Which of the following are you doing about your weight? Feel free to list more than one. 1) Not doing anything 2) Dieting 3) Working out 57. Have you or you family ever been involved with any Childrens Aid Society? 1) 2) 3) Yes No Dont know

58. How likely is it that you will stay in school until you graduate? 1) 2) 3) 4) Not at all likely Not very likely Fairly likely Very likely

5) I have already graduated from secondary school 59. Which type(s) of people are you attracted to sexually? 1) Men 2) Women 60. In the LAST 12 MONTHS, how often have you been bullied or picked-on at school or in other places outside your home? 1) Was not bullied in the last year 2) Daily or almost daily 3) About once a week 4) Less than once a month 61. In the LAST 12 MONTHS, in what way did YOU BULLY other people the most at school or other places outside the home? 1) Did not bully other students in the last year 2) Physical attacks (for example, beat up, pushed, or kicked them) 3) Verbal attacks (for example, teased, threatened, or spread rumours about them) 4) Stole from them or damaged their things

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62. In the LAST 12 MONTHS, how often have you taken part in bullying other people at school or other places outside the home? 1) Did not bully other students since September 2) Daily or almost daily 3) About once a week 4) About once a month 5) Less than once a month 63. On a day-to-day basis, how worried are you that someone will harm you, threaten you, or take something from you? 1) 2) 3) 4) Very worried Somewhat worried Not very worried Not at all worried

69. If you could change your sexuality, would you? 1) Yes 2) No 3) Not sure 70. What other forms of discrimination do you face in your life? 1) Disability discrimination 2) Homophobia 3) Religious or faith-based discrimination 4) Gender discrimination 5) Age discrimination 6) People treat me differently because of where I live 7) I dont face discrimination THE NEXT FEW QUESTIONS ARE ABOUT ACTIVITIES YOU SOMETIMES TAKE PART IN. 71. Please check each of the following activities you enjoy doing. 1) Playing sports 2) Socializing with my friends 3) Reading novels 4) Smoking a joint with my friends 5) Playing video games 6) Working for money 7) Watching movies 8) Hanging out with my girlfriend/boyfriend 9) Thrill-seeking 10) None of the above 72. Have you ever been worried that you (or your girlfriend) was pregnant? 1) Yes 2) No 73. Have you ever been worried that you may have contracted a sexually-transmitted disease? 1) Yes 2) No

64. In the LAST 12 MONTHS, how many times has someone verbally attacked you because of your racial or ethnic identity? 1) None 2) Very few times 3) Sometimes 4) Often 5) I face direct racism everyday 65. How much impact do you think racism has on your success in life? 1) no impact 2) very little impact 3) some impact 4) major impact 66. Have you ever got in a physical fight because of your race or ethnic background? 1) Yes 2) No 67. If you could change your colour, would you? 1) Yes 2) No 3) Not sure 68. If you could change your gender (i.e female to male), would you? 1) Yes 2) No 3) Not sure

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74. During the LAST 12 MONTHS, how many times were you in a physical fight with someone other than a brother or sister? 1) Never 2) Once 3) 2 to 5 times 4) 6 to 12 times 5) More than 12 times 75. Please mark off any of the following things that you have done (if ever) in the LAST 12 MONTHS? (Write 0 if you have not done it.) 1) Taken a car for a ride without the owners permission? 2) Banged up or damaged something (on purpose) that did not belong to you? 3) Beat someone 4) Sold marijuana or hashish 5) Taken things worth $50 or less that did not belong to you? 6) Taken things worth more than $50 that did not belong to you 7) Beat up or hurt anyone, not counting fights you may have had with a brother or sister 8) Broken into a locked building other your own home 9) Carried a weapon, such as a gun or knife 10) Sold drugs other than marijuana or hashish 11) Taken part in gang fights 12) Were thrown out of your home (that is, you were told to leave your home when you did not want to leave) 13) Run away from home (that is, left home without the permission of one or both of your parents) 14) Carried a handgun for your safety 76. In the LAST 12 MONTHS, have you ever gambled more than you had planned to? 1) Yes 2) No 3) Never gambled in the last 12 months 4) Never gambled in my life

77. What is the largest amount of money you gambled AT ONE TIME in the LAST 12 MONTHS? 1) Less than $10 2) $11 to $49 3) $50 to $99 4) $100 to $199 5) $200 or more 6) Never gambled in my lifetime 78. How do you gamble? 1) Playing cards 2) Playing dominoes 3) Buying sport lottery tickets (i.e. PROLINE) 4) Buying lottery ticket (draw-based) 5) Playing mahjong 6) Playing dice 7) Playing video gambling machines 8) Internet gambling/internet poker 9) Casino games (blackjack) 10) I dont gamble 11) Other. Please specify: __________________ 79. Which of the following statements do you agree with? 1) Where I come from, you have to carry a weapon to be safe 2) Violence is a danger for me that I cannot control 3) In the recent past, someone threatened to kill meand it was a serious threat 4) I am cautious where I travel because of rival gangs, and people I have a dispute with 5) Cash rules everything around me (but it doesnt rule me) 6) None of the above are true for me 80. In your area do you think that the risk of sexually-transmitted diseases is higher, lower, or about the same as it was a few years ago? 1) Higher 2) Lower 3) About the same

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81. In your neighbourhood, how many youth do you think carry a weapon every day? Only a few people More than a few Lots of people (about 50%) Almost everyone 82. During the LAST 12 MONTHS, how many times has someone threatened or injured you with a weapon, such as a gun, knife, or club on school property? 1) Never 2) Once 3) 2 to 5 times 4) 6 to 12 times 5) More than 12 times 83. Which of your parents/guardians currently smoke(s) cigarettes? 1) 2) 3) 4) Both parents smoke Only my mother smokes Only my father smokes My parent(s) do not smoke

86. Do you smoke cigarettes? 1) Yes 2) No 3) Sometimes, but I am not a regular smoker 87. On average, how much hard liquor do you usually drink at any one time? 1) Less than 1 drink 2) 1 drink 3) 2 drinks 4) 3 drinks 5) 4 drinks 6) 5 drinks or more 7) Dont drink hard liquor 88. In the LAST 12 MONTHS, how often did you use MARIJUANA (also known as cannabis, weed, grass, pot, hashish, hash, hash oil, etc.)? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

84. In the LAST 12 MONTHS, how often did you drink ALCOHOL liquor (rum, whiskey, etc.), wine, beer, coolers? 1) Drank only at special events (for example, at a wedding) 2) 3) 4) 5) 6) 7) 8) Had a sip of alcohol to see what it is like Once a month or less often 2 or 3 times a month 4 or 5 times a week Almost every day 6 or 7 times a week Drank, but not in the last 12 months Never drunk alcohol in lifetime

89. In the LAST 12 MONTHS, how often did you use the drug KAAT/QAAT? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

85. On average, how much beer (or coolers) do you usually drink at any one time? 1) Less than 1 bottle 2) 1 bottle 3) 2 bottles 4) 3 bottles 5) 4 bottles 6) 5 bottles 7) 6 bottles or more 8) Dont drink beer

9) Dont know what Kaat is

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90. In the LAST 12 MONTHS, how often did you use ECSTASY OR MDMA? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

8)

Never used in lifetime

9) Dont know what LSD is 94. In the LAST 12 MONTHS, how often did you use HALLUCINOGENS, OTHER THAN LSD OR PCP (such as Mescalin and Psilocybin, also known as magic mushrooms, shrooms, mesc, etc.)? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

9) Dont know what Ecstasy is 91. In the LAST 12 MONTHS, how often did you use COCAINE (also known as coke, snow, snort, blow, etc.)? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

9) Dont know what hallucinogens are 95. In the LAST 12 MONTHS, how often did you use METHAMPHETAMINES or speed? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

92. In the LAST 12 MONTHS, how often did you smoke cocaine in the form of CRACK? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

9) Dont know what Speed is 96. In the LAST 12 MONTHS, how often did you use the drug PCP (also known as angel dust, dust, horse tranquilizer, etc.)? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

9) Dont know what Crack is 93. In the LAST 12 MONTHS, how often did you use LSD or acid? 1) 2) 3) 4) 5) 6) 7) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months

9) Dont know what angel dust is

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97. In the LAST 12 MONTHS, how often did you use TRANQUILLIZERS (such as Valium, Librium, also known as tranqs, downers, etc.) WITHOUT A PRESCRIPTION or without a doctor telling you to take them? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

100. In the LAST 12 MONTHS, how often did you use HEROIN (also known as H, junk, smack, etc.)? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

9) Dont know what heroin is 101. In the LAST 12 MONTHS, how often did you use STIMULANTS other than cocaine (such as diet pills, also known as uppers, bennies, dexies, etc.) WITHOUT A PRESCRIPTION or without a doctor telling you to take them? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

9) Dont know what Tranquillizers are 98. In the LAST 12 MONTHS, how often did you use methamphetamine in the form of ICE? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

9) Dont know what ice is 99. In the LAST 12 MONTHS, how often did you use BARBITUATES (such as Seconal, also known as barbs, rainbows, etc.) WITHOUT A PRESCRIPTION or without a doctor telling you to take them? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

9) Dont know what stimulants are 102. In the LAST 12 MONTHS, how often did you use ROHYPNOL (also known as roach, roofies)? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

9) Dont know what Rohypnol is

9) Dont know what Barbituates is

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103. In the LAST 12 MONTHS, how often did you use the drug KETAMINE (also known as special K)? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

108. Are you sexually active? 1) Yes 2) No 3) Unsure 109. In your opinion, what are the most used drugs among youth? Number the top five with 1 being the most used. 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) Alcohol Marijuana Cocaine Crack Ecstasy LSD Methamphetamines Heroin Kaat Glue Ketamine Tranquillizers Barbituates Rohypnol Other: _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______ _______

9) Dont know what Ketamine is 104. In the LAST 12 MONTHS, how often did you sniff GLUE (for example, airplane glue, contact cement, etc.) in order to get high? 1) 2) 3) 4) 5) 6) 7) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months

Specify_________________ JUST A FEW MORE QUESTIONS. 110. Overall, how easy did you find the questionnaire to understand? 1) Not at all easy 2) Not very easy 3) Fairly easy 4) Very easy 111. What about the length of the questionnaire, did you find it 1) Much too long 2) A bit too long 3) About right 112. Would you do this survey again, if you didnt get paid for it? 1) No way 2) Probably not 3) I might do it if I had spare time 4) I would have done it for no money

105. In the LAST 12 MONTHS, how often did you sniff SOLVENTS (such as nail polish remover, paint thinner, gasoline, etc.) in order to get high? 1) 2) 3) 4) 5) 6) 7) 8) 1 or 2 times 3 to 5 times 6 to 9 times About once a month More than twice per month More than once a week Used, but not in the last 12 months Never used in lifetime

106. In the LAST 12 MONTHS, have you used any illicit drug by injection or needle? 1) Yes 2) No 107. In your area, do you think that drug use is higher, lower, or about the same as it was a few years ago? Leave blank if nothing has changed. 1) Higher 2) Lower

THANK YOU FOR YOUR HELP WITH OUR STUDY

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Appendix D: Key Informant Interview Guide Main purpose: to explore the current and/or prospective best practices in mental health and addictions with racialized populations generally and specifically with racialized youth from the Jane & Finch community through the insights, expertise, experiences, and viewpoints of current community-based service providers. To identify particularly the mental health and addictions needs of this population according to service providers. Opening Introduce facilitators/any other members of research team Introduce project & use of information from respondents (inlc. dissemination) Mention the catchment area (i.e.: beyond J/F) Length of interview Review confidentiality procedures including consent forms Respond to any questions Community What would you say are the strengths of your catchment area? What would you say are the greatest needs of youth and their families in this community? What resources are available for youth and their families in this neighbourhood? In your opinion, are they adequate? Probe: Are there recreational facilities, youth drop-in centres, etc. available? Probe: Broadly, what are the community issues in terms of drug use/addiction and mental health currently? Probe: What are the most prevalent types of drug use and issues of mental health? Probe: Which residents tend to be most in need of your services? Probe: What would you say are the major mental health-related issues or concerns among the youth you serve? Probe: What do you hope to see happen in this community in the next year/five years/ten years? Service Provision What groups usually use your services in terms of ethnoracial and/or cultural background? In which way are your clients diverse? How well is the community you serve actually represented among your clients? From your experience, what groups would you say is under-served? Who has not been engaged effectively (and why)? Which residents tend to be the most difficult for your agency to reach? Why? Would you say there are specific groups who are being well reached with mental health services in this community? Probe: If so, who? Probe: What services are they (the clients) mostly coming to you for? Probe: What services or community functions do the people you serve want, but arent receiving? What are the unmet needs?

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Probe: On average, how do your clients find out about your programs? How do youth in particular come to use your services? Probe: Do you see any gender differences among your clientele? Probe: In terms of need, in terms of service-seeking behaviour, in terms of Probe: Is there a gap between services in your area of expertise and the needs of service users in your area? Probe: Can you identify the most critical service gaps facing youth in particular? Probe: Among the service gaps identified, which ones are the two most urgent to address? Why are they most important? Probe: What are the conditions of use among this diverse population? Probe: Times per day needed by various populations Probe: Identities of workers and language Probe: Differences of health promotion and outreach, and materials Re: the closing of Youth Clinical Services: What impact, if any at all, has the discontinuation of Youth Link had on the community and the youth from what you can tell? Probe: What impact, if at all, has it had on your organization? On your practice/work? Mental Health Practice What challenges/issues do you face in providing services to youth? How can these issues be addressed? What language skills do you and your staff/colleagues currently have? Which ones are missing? What languages are needed (spoken, written)? What does cultural competence mean to you and how important is it in terms of the work you do? Can you relate any experiences where cultural competency was lacking, and comment on how it affected the program/service? Based on your experience and knowledge, what are the best practices for reaching out to youth? What has worked and not worked in the past? What are the best practices for culturally-competent approaches to drug use/addictions and mental health? From your viewpoint, what are some of the gaps in terms of the knowledge base of some mental health service providers who work with youth out there right now? Is there anything else that you think we should know?

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Appendix E: Focus Group Interview Guide Main purpose: To identify the needs (particularly as pertaining to mental health and addictions) of youth based on their experiences, perspectives, insights, and opinions. This might include exploring their views about the needs of their community, how well current services correspond to needs, service gaps and unmet needs, mental health issues and/or addictions trends among youth in their community, what the most common mental health issues/problems are, coping mechanisms in lieu of accessible/appropriate services, and alternative systems of mental health care. Opening Introduce facilitators/any other members of research team Introduce project & use of information from respondents (inlc. dissemination) Mention the catchment area (i.e.: beyond Jane and Finch) Length of interview Review confidentiality procedures including consent forms Respond to any questions Community First off we would like to know a bit about your experience in Canada. Where was everyone here born? For those that moved to Canada, how long have you been in the country? What are some of the issues that you see your peers (that is, other members of your cultural group and age-group) facing? Probe: So x is a major issue in your community? Probe: How do you notice people reacting to this issue? Probe: Do you think depression, anger, and loneliness are caused by this issue? Probe: What do you think someone should do if they suffer from these depression, anger, or loneliness? Probe: What do you think people are doing when they suffer from these problems? How do people in your youth group deal with their problems (such as x but also y)? Probe: Do you notice that some people have a difficult time dealing with problems? Probe: How is this apparent? Probe: Do you think this reaction has an impact on the family, or other social relationships? Probe: How? Probe: The main value that Y-CONNECT promotes is to offer a welcoming space for people that who may experience racism or other discriminations because of their gender, faith and place of birth. Can you remember any experiences of racism or other hateful attacks that have affected you or other people from your community? Probe: How did you or this other person react to this experience Probe: Do these sort of experiences discourage or damage your self-confidence?

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Service Use and Access Y-CONNECT will have many workers from different backgrounds, and we will have several who speak x language. Does anyone here prefer speaking in x language, or is English ok? Probe: What about pamphlets and others written materials, do these work? Probe: Is x being properly translated in pamphlets you have seen in the past? Probe: Maybe this is just part of the areas reputation, but it is often said that drugs are easily available around here. Do you think drugs or alcohol are a major issue among youth in your community? Probe: What are some other drugs that some people may be using in your community? Probe: Why do you think people use these sorts of drugs? Probe: Could it be that they feel using x drugs will relax them? Probe: Do you think drug use is increasing or decreasing in the area? Probe: And for your group? Although there are some youth-based programs in the area, many youth are not using them. Can you think of any reasons why is this happening? Probe: Do you think it is because they are not well promoted? Probe: What is the best medium (that is posters, pamplets, referrals) for promoting these services Probe: Do you think people avoid these services because they are scared or nervous? Probe: Would you prefer speaking with a person from your background about personal issues such as depression or sadness? Probe: How about sexuality or drugs? What does mental health mean to you? Probe: What do you consider to be common mental issues that affect youth or others in your community? Probe: Do you ever notice unusual behaviours or attitudes (such as depression or uncontrolled anger, carelessness) among youth? Probe: What are some of these behaviours or attitudes? Do you think some peoples depression puts them at risk of suicidal thoughts or attempts? Do you or anyone you know ever fear for your safety in your community? Probe: How do you or them react to this risk? Probe: Do you know of people who carry weapons just in case of an attack? Probe: Do you know of people who avoid certain places or groups because of their safety? Would you approach your parents about violence or drug issues? Probe: Why, or why not? Recommendations Can you think of a way to encourage youth from your background to use community services? Probe: What about employment? Probe: What about transportation tickets, honoraria?

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