How can photography help refugee men talk about mental health?

Talk like a community-based participatory action researcher

Discrimination — unfair treatment due to a person’s race, nationality, religion, gender, disability, age, etc.

Mental health — a state of well-being in which a person realises their own abilities, can cope with the normal stresses of life, can work productively and can contribute to the broader community

Gendered — socially constructed roles based on a person’s gender or sex

Immigrant — a person who has moved to a different country

Integration — the process of ‘fitting in’

Masculinity — societal ideas of what characteristics and behaviours men should have

Peer researcher — a member of a research team who has lived experience of the issue being studied

Photo-elicitation — a research method that uses photos to stimulate discussions

Photovoice — a research method in which participants take photos to translate their experiences into knowledge and to promote action

Refugee — a person who has experienced forced migration as a result of war, climate change, persecution or other factors, and who requires protection

Resettlement — the formal and informal processes of an immigrant’s integration

Social determinants of mental health — social, economic, gender, education or other factors which influence an individual’s mental health

Underemployed — working in a job for which a person is overqualified

Since the Syrian civil war began in 2011, more than half of Syrians have been displaced from their homes, creating one of the largest refugee crises in modern times. While most Syrian refugees live in surrounding countries, including Turkey, Lebanon and Jordan, over 44,000 have settled in Canada. Not only must refugees deal with the trauma of being forced to leave their homes, but they must then overcome the challenges of adapting to life in their adopted country. The process of resettlement has many challenges, such as integrating to a new culture, understanding the language, and finding employment, housing and social support.

At the University of Victoria, Dr Nancy Clark is working with Syrian refugee men to understand their experiences of accessing employment and effects on their mental health and well-being during resettlement in Canada. She is using community-based participatory action research and photovoice methods to uncover how their employment status impacts their mental health.

A key aspect of this project is that Syrian refugee men are active research collaborators, rather than research ‘subjects’. Historically, research has treated marginalised communities as objects for study, rather than working with them to find solutions to problems. Nancy’s research team includes peer researchers (Syrian refugee men who are helping to lead the project), research participants (Syrian refugee men who are sharing their experiences of employment and mental health during resettlement), employment and settlement counsellors from Options Community Services (a not-for-profit organisation that provides support to immigrants in Canada), mental health specialists and academics.

What challenges do Syrian refugee men face in Canada?

“Syrian refugee men face many challenges during resettlement in Canada,” says Nancy. “Our research shows that they experience language barriers, stress, time pressures, isolation at work and difficulties in finding a sense of cultural belonging and identity.” Culturally, the need to provide for their family is a high priority for Syrian men, but finding well-paid work is not easy for newcomers. While many of the men involved in the research project had highly skilled careers in Syria, including in civil engineering, architecture and dentistry, they have been unable to continue working in these roles in Canada. This may be because Canadian employers do not acknowledge their experience, skills and qualifications, or because they are excluded from work opportunities due to discrimination.

“This means many Syrian refugee men cannot work in their occupation of choice,” explains co-investigator Dr Carla Hilario. “Instead, they are forced to take low-skilled minimum wage jobs for which they are often over-qualified, such as driving delivery trucks or working on factory assembly lines.” Among Syrian refugees in Canada, those with higher levels of education report having lower job satisfaction and poorer mental health, as they are more likely to be underemployed.

As the jobs available to them are low paid, many Syrian men are forced to work multiple jobs to make ends meet. This leads to additional challenges as refugee men attempt to adapt to their new life in Canada, and working long hours reduces the time available for integration efforts and activities that promote mental health. “Refugee men are less likely to attend English language classes than refugee women, due to the gendered pressure to earn an income,” says research assistant Muna Zaidalkilani. Without the opportunity to learn the local language, integration into the local culture and community becomes much harder, and better-paid jobs remain out of reach.

“Economic integration is a key social determinant of mental health,” says research assistant Eli Verdugo. “Studies have found clear links between low income, financial insecurity and poorer mental health, highlighting the need for refugees to have access to meaningful work.”

The power of photography

Encouraging people to talk openly about their vulnerabilities is difficult at the best of times. “Cultural ideas of masculinity make it particularly challenging to discuss Syrian men’s mental health issues,” Nancy says. “That was why we turned to photovoice methods.”

To initiate discussions about mental health, the Syrian refugee men involved in the project took photos representing their experiences of employment and mental health in Canada. Many took photos while travelling to or from work, often of sunrises and sunsets, highlighting the long hours they work. Photos of things that help the men relax and relieve stress, such as hikes and picnics with family and friends, were also common. These photos became a starting point to encourage the men to talk about their lived experiences during photo-elicitation interviews, by drawing out what the photos represented and meant to them.

“Photovoice methods give a voice to social justice issues through the power of photography,” explains peer researcher Meer Mahmoud. “Such methods are particularly valuable for helping people express complex concepts, such as mental health.” As a participatory research process, photovoice is a form of storytelling that aims to equalise the power balance between researchers and community members. “Syrian men are the knowledge holders,” says peer researcher Ned Izdden. “We decide how we want our stories to be told.”

What has the team discovered?

Although the men in the project came from different religious backgrounds, ages and educational levels, there were common themes in their photos. These reflected the similar barriers they have all faced when accessing employment and integrating into Canadian society, and the similarities in things that supported their mental health during their resettlement.

“Loneliness was a common theme, both within and outside work environments,” says peer researcher Elias Moses. The men miss friends and family back in Syria, as well as the cultural and social aspects of their lives in Syria before the war. Some feel excluded in their jobs in Canada, as colleagues and employers discriminate against them due to their lack of English or their accent. The greatest sense of connection and support comes from family and social networks, through new friendships, religious communities and connections with family and friends left behind.

“The men wanted to develop a digital storybook that can be given to employers and employment counsellors, to share their voices and experiences in the hope of influencing more inclusive workplaces and better employment opportunities,” says Nancy. The team hopes this research will lead to improved employment for refugee men, who have a gendered responsibility for providing for their families, while integrating into a new culture.

Dr Nancy Clark
Director of Social Justice Studies, School of Nursing, Faculty of Human and Social Development, University of Victoria, Canada

Fields of research: Social justice, refugee mental health, community-based participatory action research, social determinants of mental health, forced migration, intersectionality

Research project: Exploring Syrian men’s mental health and participation in labour employment: A community participatory arts-based project

Funder: This article draws on research supported in part by the Social Sciences and Humanities Research Council of Canada (SSHRC)

About community-based participatory action research

Community-based participatory action research (CBPAR) is a research framework that focuses on equity and social justice, aiming to give a voice to communities and work towards positive social change. “CBPAR involves fostering meaningful participation from all involved,” explains Nancy. “We advocate for an inclusive process that leverages the strengths of all participants, with the end goal of positive social change.” In practice, this involves actively engaging community members in all aspects of the research, from developing research questions and deciding on data collection methods to analysing results and disseminating findings.

Why is it important that people with lived experiences are involved in research about the issues that affect them?

Nancy explains that for research to make a meaningful change, it is important to include people with lived experiences as much as possible. “Our peer researchers were essential for the project!” she says. “They played an integral role in understanding Syrian men and culture, addressing language barriers and building trust.”

As Syrian men who have settled in Canada, Ned, Meer and Elias brought their personal experiences to the project. “We act as a vital link between the research team and our participants, offering essential support and guidance throughout the research process,” says Ned. As Elias explains, “We have shared backgrounds with the participants which helps build trust, which is crucial for collecting authentic and meaningful data.” Ned, Meer and Elias helped recruit research participants from the Syrian community in Canada, conducted the research interviews, provided interpretation and translation services, and supported the men.

“Many researchers forget that community members are knowledge holders,” says Nancy. “They bring unique knowledge and perspectives that can improve both the research process and its impact.” Peer researchers are, therefore, essential for meaningful CBPAR. “Policy interventions often lack the voice of the people affected by the issues they are trying to address,” says Nancy. “We want to ensure that our research respects the voices of the Syrian refugee men involved and provides meaningful outcomes for them.” Through the research process, the men all developed relationships with each other, fostering connection and community.

Why is it important that CBPAR is tailored to the needs of the community?

CBPAR should be culturally tailored to the preferences of the individuals involved to ensure it is inclusive. “For example, our workshops always involved food,” says Nancy. The team purchased food from a nearby Syrian bakery to share with the men, which created a sense of community among the team. “We also had to consider that some men had to pray at the nearby mosque during the day, so we allocated breaks in the workshop schedule to accommodate this.” As reciprocity is a key aspect of CBPAR, all participants were compensated for their involvement in the project, with the team paying for their travel and childcare support during the workshops and interviews.

Meet the team

Dr Nancy Clark
Project leader

When I came to Canada as a young child, I experienced severe racism and discrimination. As a Palestinian immigrant, my father struggled to continue his degree in political science when he arrived in Canada, and instead spent most of his life working as a labourer, painting houses. Both my parents were unable to work in their chosen fields, and I saw the toll this had on their mental health and well-being. As a result, I have devoted my professional career to supporting those who do not ‘fit in’, specifically people who experience forced migration and are affected by social determinants of mental health.

I studied nursing because I was interested in health and helping people who are marginalised. After years of working as a community mental health nurse, I am passionate about getting to the root causes of mental health issues and uncovering the factors that support mental health.

I was inspired to investigate the gendered experiences of migration because most refugee research focuses on women. While working with Karen refugee women from Myanmar and Thailand, I realised that men’s experiences of immigration were very different. Having access to meaningful employment is especially important for men’s mental health due to masculine ideals and pressures of providing for their families. Resources and support should be equally accessible to the whole family.

I hope to make a significant contribution to advancing health equity for refugees. I intend to advance my research in addressing the social determinants of refugee mental health and, importantly, I aim to improve health systems and services.

Dr Carla Hilario
Co-investigator