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“They can say someone experiencing mental-health issues is due to karma, or it’s black magic. There’s a lot of denial, shame, guilt,” Mandeep (Mandy) Grewal of Punjabi Community Health Services says.

Kevin Van Paassen/The Globe and Mail

This is the third in a four-part series examining support programs and services for lower-income residents in Mississauga, Brampton and Caledon – the cities and towns of Peel Region more known for their affluent middle and upper classes than a growing population who live in poverty.

In the still-growing Region of Peel, social-service advocates say the support network for the diverse array of residents in Brampton, Mississauga and Caledon is not keeping up.

And in the push to bolster poverty-reduction initiatives with better mental-health care, finding ways to connect people with services can be a battle against systemic shortfalls and a lack of culturally appropriate options.

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Stigma is often a roadblock to seeking help for mental illness, but Mandeep Grewal, the mental-health case manager at Punjabi Community Health Services, says it can be an even more significant barrier for people from South Asian communities, which make up almost half of Peel's population.

"There's lots of labelling: They can say someone experiencing mental-health issues is due to karma, or it's black magic. There's a lot of denial, shame, guilt," she says.

And for those who do reach out for help, finding culturally appropriate services is a challenge. Mental-health services are often based on an individual, client-centred approach, but Ms. Grewal says the "close-knit" nature of South Asian families means that involving all the family members in a care plan can be much more effective.

"From my experience, family support really helps for the recovery of the client," she says. "And they want their parents involved; they want their spouse involved. Even seniors that come here, they want their kids involved."

Outreach workers from the Peel branch of the Canadian Mental Health Association work out of hospital emergency rooms to identify people who might need mental-health care. New immigrants often end up at the hospital if they are in crisis, because they do not know about other options, or they find navigating the mental-health system too overwhelming, CMHA Peel CEO David Smith says.

"Many people only know their family doctor or the hospital, so that's where they're more likely to start," he says. "That's where we're trying very hard now to make those connections."

The Fair Share Task Force for Peel estimates that services in Peel receive one-third to one-half of the provincial per capita average for funding in various areas. The coalition of organizations that makes up the task force has been advocating for more than two decades for changes in the way provincial funding is distributed to correct what they say is historical underfunding of services in Peel.

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Darryl Wolk, a strategist for the task force, says funding for mental-health services is a key issue in the push for more equitable support for Peel. He points to a victory in 2012, when the province changed the way child-care funds are distributed, resulting in a 53-per-cent funding increase in Peel, but he says adult services related to poverty reduction, addictions and mental health still do not have the support they need, especially as Peel's population has reached 1.35 million people, making it the second-largest municipality in Ontario.

"The general thought process in the past was Peel, York and Halton are more or less suburbs of Toronto," Mr. Wolk says. "A lot of times, resources were placed in Toronto with the expectation that they would serve the GTA."

That is no longer the case, according to Shelley White, chief executive officer of the United Way of Peel Region, which advocates for social services. She says the cities in Peel have grown into true urban centres, and the rapid population growth the region has seen – nearly tripling over 30 years – has compounded the problem of getting timely access to services such as mental-health care.

The prevalence of poverty, which Ms. White says is often linked to mental-health issues, is also a concern: University of Toronto research shows that the proportion of Peel residents who live in a neighbourhood classified as low-income increased to 50 per cent in 2010 from 2 per cent in 1980.

"It would be very advantageous for Peel if public policy-makers, funders, decision-makers thought of Mississauga and Brampton as the sixth- and [ninth]-largest cities in Canada and invested in them accordingly," she says. "Peel doesn't have the human services network that it needs."

In January, 2014, the United Way of Peel Region commissioned a report on Peel's mental-health system, which resulted in several recommendations for expanding and improving services. Anita Stellinga, the organization's vice-president of community investment, says a lack of access to mental-health services in the region is a barrier across the board. She says the United Way was surprised at the shortfalls the report revealed, and notes that Caledon is particularly underserved.

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Ms. Stellinga says Peel residents need to be able to gain access to supports in their own neighbourhoods so that long wait times or referrals to services outside the region do not isolate them further. The CMHA's Mr. Smith says it sometimes makes sense for some complex, intensive cases to be referred to experts outside the community, but Peel still needs more basic resources.

The United Way report also identified "cultural and linguistic competence" as a barrier to access, reflecting the needs of Peel's highly diverse population. As of 2011, the National Household Survey showed that Peel had the highest percentage of members of visible minorities in the Greater Toronto Area, at nearly 57 per cent of the population. In Mississauga, about 40 per cent of residents are of South Asian origin, and in Brampton the proportion is almost 60 per cent.

In 2011, Peel also had the highest proportion of immigrants in the GTA, at 50.5 per cent of the overall population.

Punjabi Community Health Services provides health and settlement programs for thousands of people in Peel's South Asian community, and Ms. Grewal says the community's needs are quickly outpacing the centre's capacity. They have two offices in Mississauga and one in Brampton, but there's a wait list for every one of their programs, and for counselling, clients might have to wait for up to six months.

However, she says they never turn clients away, and will take extra steps to accommodate their needs, whether that means making time for people outside regular office hours or meeting them for counselling sessions in their homes. They also offer services in Hindi, Punjabi, Urdu, Tamil and English, and they recently hired staff who can speak Malayalam.

"Peel Region is so diverse. It's necessary," Ms. Grewal says.

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At the CMHA, Mr. Smith says cultural competency training among the staff is key, and the association offers services in nearly 20 languages. It is also currently working on a research project about how to engage young people in Peel's South Asian communities.

Punjabi Community Health Services has also been involved with United Way in an initiative to engage faith leaders in discussions to raise awareness about what mental illness looks like and where people can get help. Ms. White, from United Way, says it's an important step toward breaking the stigma of mental illness, and Ms. Grewal says it's an effective way of getting the word out about her organization's services. "When stigma is out of the picture, only then are people going to be willing to come in for help," she says. "Faith leaders hold a very important stand with the South Asian community, so if they hear from the faith leaders, it must be okay."

There is also a push to make Peel's mental-health system more accessible: Mr. Smith says work is under way to create a single access point for services, so it is up to the agencies, not those seeking help, to find the correct supports. But he says he has seen a change in the way people talk about the issue in his 25 years working in mental health – there is more willingness than ever to take the problem seriously and get behind initiatives tackling mental illness.

In Peel, while there is still more work to be done, that sentiment is taking hold too. "I know that everyone understands what the barriers are," Ms. Grewal says. "Everyone has acknowledged the problem, and it's basically just trying to make that change, little by little."

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