title: Understanding immigrants' reluctance to use mental health services: a qualitative study from Montreal.
abstract: OBJECTIVE
  Studies suggest that non-European immigrants to Canada tend to under use mental health services, compared with Canadian-born people. Social, cultural, religious, linguistic, geographic, and economic variables may contribute to this underuse. This paper explores the reasons for underuse of conventional mental health services in a community sample of immigrants with identified emotional and somatic symptoms.
  
  
  METHODS
  Fifteen West Indian immigrants in Montreal with somatic symptoms and (or) emotional distress, not currently using mental health services, participated in a face-to-face in-depth interview exploring health care use. Interviews were analyzed thematically to discern common factors explaining reluctance to use services.
  
  
  RESULTS
  Across participants' narratives, we identified 3 significant factors explaining their reluctance to use mental health services. First, there was a perceived overwillingness of doctors to rely on pharmaceutical medications as interventions. Second, participants perceived a dismissive attitude and lack of time from physicians in previous encounters that deterred their use of current health service. Third, many participants reported a belief in the curative power of nonmedical interventions, most notably God and to a lesser extent, traditional folk medicine.
  
  
  CONCLUSIONS
  The above factors may highlight important areas for intervention to reduce disparities in immigrant use of mental health care. We present our framework as a model, grounded in empirical data, that further research can explore.
authors.affiliation: New Hampshire-Dartmouth Psychiatric Research Center, Lebanon 03766, USA. rob.whitley@dartmouth.edu
authors.forename: Rob
authors.initials: R
authors.lastname: Whitley
authors.forename: Laurence J
authors.initials: LJ
authors.lastname: Kirmayer
authors.forename: Danielle
authors.initials: D
authors.lastname: Groleau
mesh_terms: D017691:Caribbean Region / Q000208:ethnology; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology* / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011792:Quebec / Q000453:epidemiology; D011795:Surveys and Questionnaires