M3 Toronto – The Research

Aims of M3 Toronto

The aims of this first phase of research in Toronto are as follows:

  • How mental disorder is patterned in Toronto and especially how that pattern is affected by recent dynamics of migration, and compare these results to other cities that have grown through inward migration (eg. Shanghai, São Paulo and Mumbai) and to the experience of migrants in comparable urban environments which have experience both rural-to-urban and transnational migration (South-East London);
  • The first-hand experience of migrants and the establishment of new forms of community, and patterns of daily life across time and, in some cases, across generations;
  • Governance mechanisms that intersect with the experience of mental disorder in the city, and policies or services to reduce the burden of mental health among migrants;
  • The impact, if any, of legal and policy changes in Toronto, including the Convention of the Rights of Persons with Disabilities (ratified by Canada) and the extent that these can be leveraged to reduce that burden;
  • How these experience can inform mental health policy interventions cities elsewhere in the world in relation to their growing slum and migrant populations.

Research Questions

  1. How (spatially, culturally, institutionally) have migrants been absorbed into Toronto and what are the likely consequences for the distribution of mental health – both for migrants as a distinct population, and for the city of Toronto as such?
  2. What formal and informal resources are currently available to meet the mental health needs of Toronto’s migrant population, and how might these be improved in the light of a better understanding of the factors exacerbating mental ill health and impeding access to services?
  3. Can an interdisciplinary account of mental health be used to devise a novel deep surveying instrument for wider use on the (global) social epidemiology of urban mental health, to inform strategies to address development priorities?

Study Design

The eighteen month project is composed of three workpackages

WP1: Understanding migrants’ mental health in Toronto through a systematic review and synthesis of literature;

WP2: Developing a nuanced understanding of Toronto’s migrants, by undertaking a pilot study of ethnographic field work based on methods developed in research on other cities;

WP3: Promoting group meetings between researchers from Toronto and London, including a site visit to Toronto locations of London researchers from the King’s College Urban Brain Programme.

WP1: Literature review and Synthesis

WP1 is a thorough review and synthesis of the existing social scientific literature, debates and data on migrant mental health in Toronto, located within international and historical literatures. The goal of this review is to synthesize and identify the gaps within literature on mental health, migration and urbanization in Toronto, noting continuities and differences with other regions. Special attention will be paid to three aspects: people, space and place, and mental health. First, people refers to migrants as a dynamic and diversified social group, focusing on their daily life experiences within Toronto. Second, space and place are not examined alone, but through the way that migrants interact with the city’s built environment, and how spaces shape and are shaped by migrants’ daily activities. Examples include spaces where people meet, interact, and develop mutual support, and in turn migrants’ activities reshaping of urban physical and social spaces. Third, the theme mental health will focus on the nature, level and distribution of mental disorder in the city, mental health services accessibility and utilization, as well as mental health governance.

The search phase will primarily consist of searching electronic databases and journal websites to identify empirical papers published in peer-reviewed journals. The following database will be searched: Ovid MEDLINE, Journals@Ovid, SCOPUS (Elsevier), Web of Science, Pubmed and Scielo. Key journals include Community Mental Health Journal, International Journal of Social Psychiatry, Social Science & Medicine, Social Psychiatry & Psychiatric Epidemiology, Health & Place, as well as Urban Studies and Habitat International, and any other relevant journals. Results will be stored in Endnote for screening and later retrieval. The following English words will be used alone or in combination for searching the English database: migrants, floating population, peasant workers, mental health, stress, big cities, Toronto..

Following the literature search, we wil undertake a narrative’ synthesis’  – an approach to the systematic review and synthesis of findings from multiple studies that relies primarily on the use of words and text to summarise and explain the findings of the synthesis. (Popay et al., 2006).  Whilst narrative synthesis can involve the manipulation of statistical data, the defining characteristic is that it adopts a textual approach to the process of synthesis to ‘tell the story’ of the findings from the included studies.” A general framework for narrative synthesis includes four main elements: 1. Developing a theory of how the intervention works, why and for whom; 2. Developing a preliminary synthesis of findings of included studies; 3. Exploring relationships in the data; 4. Assessing the robustness of the synthesis. However, this guideline for narrative synthesis is produced for systematic reviews of research-based evidence on the effects of interventions and/or the factors shaping the implementation of interventions. Since this research is not about interventions, the four elements suggested by Popay may not be all relevant.

WP2: Ethnography

The challenge of emerging mental health problems within the forms of urbanisation specific to the twenty-first century exceeds the capacities of single disciplines, whether social-scientific, biological, or psychological.  If mental health in mega-cities is produced by complex, multi-layered interactions of social, historical, biological, and psychological factors, then measurement and analysis requires not only a horizontal, epidemiological account of maps and patterns, but also a vertical, ethnographic analysis of how migrant life is actually lived in contemporary Toronto

In this work package, through collaboration with the study already being conducted by King’s College in Shanghai and São Paulo, we will develop a pilot ethnographic study to deepen our understanding of urban experience and mental health. This will enable us to expand the research field to examine who are migrants, their habits, their health management strategies, their identity references and understand to what extent urbanicity, social deprivation and migration is a factor of risk or protection for people living in Toronto.

A researcher trained in ethnographic methods will study the lived experiences of migrants, migrant households and migrant neighborhoods through a brief apprenticeship with the King’s research team in Shanghai. This method will draw out smaller-scale, less-visible aspects that comprise the physical and technical elements of city life, as well as the culture, economy and family/personal circumstances which create or mitigate mental distress. Our aim is to look at how migrants negotiate the stresses of city life and observe how these stresses affect mental health.  The methodology will involve a mixture of ethnographic techniques including interviews, participant observation, group discussions, and, potentially, the use of standardized measures to assess mental health and perceived stress.  This is not only a focus on people, but also on the situations through which people move and create their urban lives: our sampling frame therefore includes both people and their situations, such as their domestic places, work settings, service consumption (healthcare, education, and housing) and locations for friendship and conviviality. We will share this pilot experience with the other researchers in Shanghai and São Paulo, and draw up plans for a major funded research project in Toronto.

WP3: Meetings in Toronto and London

WP3 creates research capacity and coordination through three interdisciplinary meetings of the research teams in different sites. The first, in Toronto, with participation of key Brazilian researchers from CEBRAP and CEM (Center of Metropolis Study – Brazil) and researchers from King’s College, will discuss the empirical and theoretical analyses that are the basis for the study, combined with detailed arrangements for this project. The second, in Toronto,  will enable a site visit from the London team to key research sites in Toronto, and work to develop a comparative analysis of the findings from the Toronto review with those made by King’s College from Shanghai, São Paulo and Mumbai. The third, either in Toronto or London, will focus on development of a larger research project on migrant mental life and mental health in Toronto, and the development of policies and interventions.

References

Adli, M., Berger, M., Brakemeier, E.-L., Engel, L., Fingerhut, J., Gomez-Carrillo, A., Hehl, R., Heinz, A., Mayer, J. and Mehran, N. (2017) ‘Neurourbanism: Towards a New Discipline’, The Lancet Psychiatry, 4(3), pp. 183-185.

Cantor-Graae, E. and Selten, J.-P. (2005) ‘Schizophrenia and Migration: A Meta-Analysis and Review’, American Journal of Psychiatry, 162(1), pp. 12-24.

De Silva, M. J., McKenzie, K., Harpham, T. and Huttly, S. R. (2005) ‘Social Capital and Mental Illness: A Systematic Review’, Journal of epidemiology and community health, 59(8), pp. 619-627.

Galea, S., Uddin, M. and Koenen, K. (2011) ‘The Urban Environment and Mental Disorders: Epigenetic Links’, Epigenetics, 6(4), pp. 400-404.

Gill, P. S., Bhopal, R. S., McKenzie, K. and Kaul, R. (2003) ‘Racism and Health ‘, BMJ, 326(7394), pp. 880-.

Harper, M. (ed.) (2016) Migration and Mental Health : Past and Present. London: Palgrave.

Hatch, S. L., Frissa, S., Verdecchia, M., Stewart, R., Fear, N. T., Reichenberg, A., Morgan, C., Kankulu, B., Clark, J. and Gazard, B. (2011) ‘Identifying Socio-Demographic and Socioeconomic Determinants of Health Inequalities in a Diverse London Community: The South East London Community Health (Selcoh) Study’, BMC Public Health, 11(1), pp. 861.

McKenzie, K., Fearon, P. and Hutchinson, G. (2008) ‘Migration, Ethnicity and Psychosis’, Society and psychosis, pp. 143-160.

McKenzie, K., Whitley, R. and Weich, S. 2002. Social Capital and Mental Health. RCP.

Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., Britten, N., Roen, K. and Duffy, S. (2006) ‘Guidance on the Conduct of Narrative Synthesis in Systematic Reviews’, A product from the ESRC methods programme Version, 1, pp. b92.

Toyokawa, S., Uddin, M., Koenen, K. C. and Galea, S. (2012) ‘How Does the Social Environment ‘Get into the Mind’? Epigenetics at the Intersection of Social and Psychiatric Epidemiology’, Social Science & Medicine, 74(1), pp. 67-74.