By Vince Pietropaolo General Manager, COSTI Family and Mental Health Services; IRMHP Subject Matter Expert

Engaging newcomer clients who do not understand or acknowledge mental health issues is a common and complex challenge in communitybased services. Many refugees, for example, arrive with experiences of displacement, war, loss, systemic oppression, and prolonged stress, yet may not identify these experiences as “mental health” concerns.

Cultural beliefs, stigma, language barriers, and fear of authority or systems can further shape how distress is understood and expressed. Effective engagement requires approaches that are culturally responsive, traumainformed, and grounded in trust. Here are six strategies you can use to reach clients who do not recognize their mental health concerns:

Move away from clinical or diagnostic language

Terms such as “mental illness,” “therapy,” or “counselling” may carry stigma or fear, particularly for individuals who come from contexts where mental health services were inaccessible, punitive, or associated with severe illness. Instead, focus on everyday experiences—stress, sleep difficulties, headaches, worry, family conflict, or challenges adjusting to life in Canada. Framing conversations around “wellbeing,” “coping,” or “support for stress” often feels safer and more relatable.

Trust and safety are foundational

This strategy is especially important for clients who experienced trauma or persecution. Immigrants and refugees may be cautious about sharing personal information, particularly if they fear judgment, child protection involvement, or immigration consequences. Practitioners should clearly explain confidentiality, roles, and limits in plain language and check for understanding. Consistency, patience, and transparency over time are often more effective than early attempts to address mental health directly.

Cultural understanding is essential

In many cultures, emotional distress is expressed physically or relationally rather than psychologically. Clients may describe pain, fatigue, or family tension rather than sadness or anxiety. Cultural humility—asking how clients understand their experiences and what support means to them—helps avoid imposing Western mental health frameworks. Where appropriate, working with interpreters, cultural brokers, or community leaders can strengthen engagement and reduce misunderstandings.

Link support to practical settlement goals

Many immigrants and refugees prioritize housing, employment, immigration processes, language learning, and family stability. Mental health services may feel irrelevant unless clearly connected to these goals. Framing support as a way to improve focus at work, manage parenting stress, strengthen relationships, or cope with migrationrelated challenges can increase willingness to engage.

Psychoeducation should be gradual and relational, rather than formal or instructional.

Practitioners can gently reflect patterns clients already notice, such as how stress affects sleep or how past experiences influence current reactions. Using culturally relevant examples and metaphors can help normalize distress without labeling it as pathology.

Respect client autonomy and readiness

Engagement does not require full acknowledgment of mental health concerns. Small steps—attending appointments, trying grounding techniques, or accepting referrals framed around wellness—are meaningful progress. By honoring clients’ perspectives and pacing, you create space for understanding to develop naturally.

Supporting immigrant and refugee clients begins with listening, respect, and partnership. When services are culturally responsive and aligned with clients’ lived realities, engagement becomes not only possible, but sustainable