“Without Them I Wouldn’t Be Here”: Parenting Practices and Access to Mental Health and Substance Use Care Among Immigrant and Refugee Youth of African Descent in Nova Scotia

Abstract

This study explores how parenting practices influence access to mental health and substance use (MHSU) care among African immigrant and refugee youth in Nova Scotia. Based on qualitative interviews and focus groups with youth aged 18–25 who had accessed or attempted to access MHSU services, this study centers youth narratives on parental roles in navigating culturally unfamiliar health systems. Data were analyzed thematically by the research team, with input from advisory committee members of African descent, using a collaborative and manual approach grounded in Afrocentric and Ubuntu principles of relationality, collective meaning-making, and respect for participant voice. Despite stigma, and acculturative stress, findings reveal that African parents often act as vigilant protectors, cultural anchors, and decisive actors in recognizing and responding to youth substance use. Participants described their parents as watchful, strict, and deeply invested in their well-being, sometimes even “saving” them by initiating care when peers or institutions failed to do so. Parental nudging, family-based intervention, and cultural values of collective responsibility were central to accessing MHSU services. This study emphasizes the need for culturally responsive and family-inclusive healthcare delivery by highlighting gaps in care systems where parental involvement was excluded or where African family dynamics that shape help-seeking and support were misunderstood.

1. Introduction

Canada is contending with high rates of mental health and substance use (MSHU), with the number of affected persons increasing during and after the COVID-19 pandemic (Canadian Institute for Health Information (CIHI), 2021; Statistics Canada, 2021). Canada is also one of the first countries to legitimize the use of marijuana for non-medical purposes and is considered one of the countries with the highest substance use problems (Canadian Centre on Substance Use and Addiction (CCSA), 2020; Belzak & Halverson, 2018), with increased exposure and normalization of drug use among youth between 15 and 24 years in social and recreational settings (Burlew et al., 2009; Chan et al., 2008; Statistics Canada, 2020). The high use of illicit substances among this demographic (Canadian Institute for Health Information (CIHI), 2019; Government of Canada, 2019) and the unmet needs to access MHSU sometimes due to stigma, long wait times (Government of Canada, 2019), and geographic access to services (Government of Canada, 2019), can interfere with youth development or the ability to make positive transitions in their lives, relationships, and aspirations (Schulenberg et al., 2005) reportedly leading to low school outcomes (Masten et al., 2005), poor academic performance (Goodman et al., 2015; Government of Canada, 2019; MacLeod & Brownlie, 2014), dropping out of school (Hussong & Chassin, 2004), and high rates of hospitalization and car accidents due to overdose or misuse (Canadian Institute for Health Information (CIHI), 2019; Government of Canada, 2019). These outcomes highlight the importance of incorporating developmental approaches when planning support, prevention, or intervention strategies and services for adolescents as they manage their MHSU issues. This includes the struggle young people have with managing their MHSU problems and the likely effects this has on social, economic, and cultural functioning, their educational abilities, and family or community relationships (Farrell et al., 2006).

There is limited research on the experiences of youth of African descent with MHSU care, making it critical for youth to project parenting voices in the design of culturally responsive service delivery. Therefore, this paper aims to address these questions:

• How do youth of African descent perceive the parenting styles of their parents?
• What is known about the role of these parenting styles in the likelihood of youth of African descent receiving mental health and substance use care in Canada?
• Are there lessons to be learned from the projected parenting styles in the design of culturally appropriate mental health and substance use services for youth of African descent in Canada?

MHSU services may take different forms, some without the inclusion of parents in the treatment plan, especially when it is considered that affected persons are aged 18 years or older. However, in African cultures, being 18 years old does not necessarily mark independence. Yet, in Canadian health systems, age 18 can limit parental inclusion in care decisions. This mismatch complicates culturally responsive treatment and highlights the need for family-oriented models that respect both youth autonomy and cultural expectations.

1.1. Youth of African Descent, Their Parents, and Mental Health and Substance Use (MHSU)

Canada is also one of the leading countries for receiving immigrants and refugees. However, upon arriving in Canada, family members must contend with the realities and expectations of living in a new environment or homeland. Children and youth, especially, are often forced to adjust to a new country, new social norms, a new language, and changing cultural expectations (Hamilton et al., 2014), as well as changes in their socioeconomic status (Shields et al., 2011). Although youth often adapt to Canadian social norms and linguistic practices faster than their parents (Berry & Hou, 2019; Schwartz et al., 2010), these adjustments or transformations, which are performed within a short time frame, can cause significant stress (d’Abreu et al., 2019). This stress can make young persons susceptible to heightened peer pressure (Burlew et al., 2009; Mundt, 2011) and an urge to experiment with drugs, especially when coupled with the trauma of migration and the burden of meeting new educational and social expectations (Burlew et al., 2009; Fazel & Betancourt, 2018; Moloney et al., 2008). With the involvement of youth of African descent in drug use, the strain on family and personal relationships compounds their mental health problems (Djiometio et al., 2020; Planey et al., 2019). Youth of African descent also face disadvantaged treatment in educational settings (Arday, 2018; Planey et al., 2019), leading to poor school attendance and high school dropout rates, occupational difficulties, and challenges in life or career advancement (Mundt, 2011; Wen & Shenassa, 2012). Furthermore, the highest rates of vehicular accidents in Canada are attributed to drug use, which may lead to the death of affected youth and, in some cases, their victims (Government of Canada, 2019).

Immigrant and refugee youth of African descent have also been shown to adopt new cultures and the dominant language much faster than their parents (Weisskirch, 2007; Wunseh & Nomlomo, 2023), with the new social and cultural environment becoming both exciting and overwhelming for youth at the same time. Young persons often find that they must adopt certain cultural, social, and behavioral practices that differ from their home environment to survive. With the absence of their parents, who are often busy taking on multiple jobs a day to survive (Salami et al., 2022), some of the risky practices that children explore may not be noticed until it is too late. Some studies have indicated that youth engagement in drug use may be due to its ready availability (Li et al., 2024), acceptance of some drugs such as marijuana use in social and recreational settings (Burlew et al., 2009), the need to mitigate the trauma of their migratory journeys (Moloney et al., 2008), and the pressure to cope with presenting mental health situations aggravated by expectations in their new environment.

African youth have been nurtured to look up to and emulate their parents. However, immigrant parents are not exempt from the acculturation process (Bevelander & Pendakur, 2014), as they often devise creative coping mechanisms to maintain family cohesion while providing their children with the basic needs of housing, food, clothing, and educational support. Parents are silently preoccupied with the absence of their normally taken-for-granted support mechanisms (such as extended family members, neighbors, and friends), rebuilding these lost support systems (Stewart et al., 2015), navigating unemployment or low-paying jobs, and non-acceptance of their academic credentials (Galabuzzi, 2005), which affect their mental health (Beiser et al., 2002), with some coping by resorting to substance use themselves (Salami et al., 2022). Parents may also face the absence or lack of access to culturally appropriate, family-oriented support programs, and a lack of early training on the impact of adaptive modes in the likelihood of their children leaning towards drug use (Beiser et al., 2002; Williams et al., 2016). With the diverse problems that immigrant parents face while settling into Canada, they may not recognize early signs of MHSU problems among their children (Salami et al., 2022). However, when parents eventually become aware of their children’s MHSU problem, some are unable to know how and where to access services (McCann et al., 2016), and may be hesitant due to the stigma associated with MHSU in their communities (McCann et al., 2016; Salami et al., 2022). Other MHSU service deterrents are, stigma experienced from some healthcare providers around seeking MHSU services (Campbell et al., 2020), long wait times attributed to funding and shortage of MHSU care professionals, financial costs of healthcare services (Fante-Coleman & Jackson-Best, 2020; McCann et al., 2016; Santiago et al., 2013; Tinghög et al., 2007), distrust of mainstream healthcare systems (Cénat et al., 2024; Yohani et al., 2020), and a lack of follow-ups to ensure adequate recovery (Isiwele et al., 2025). These delays in accessing mental health services also lead to delays in identifying the problems and needs of affected youth, which manifest in poorer outcomes (McCann et al., 2016); resulting in visits to emergency departments (Campbell et al., 2020; Saunders et al., 2018) before care can be accessed, or in coercive, forced or mandated access to care. Parents must contend with the reality that illicit substances are more readily available to youth in Canada than in their home countries (Li et al., 2024).

Furthermore, there is the added complication of how to moderate their children’s drug use problem within culturally appropriate healthcare modalities in their new country. There are diverse views on parenting styles and their impact on the identification of MHSU problems faced by youth (Wen & Shenassa, 2012) and their readiness to access healthcare services. There is the view that parenting practices, particularly those rooted in traditional norms (as with African parenting styles), can both protect and complicate youth access to care. Others contend that strict or authoritarian parenting, shared in some African cultures, may deter open conversations about mental or emotional well-being or drug use, thereby increasing the likelihood of problems remaining hidden until a crisis occurs (Olawo et al., 2021). Essentially, the way youth perceive their parents, evident in their relationships or conversations with them, indicates whether they feel supported, heard, or constrained, and can significantly influence whether they seek or accept help (McCann et al., 2016) for their MHSU problem.

1.2. Coping Strategies for Immigration and Resettlement Stress

Substance use among immigrant and refugee youth is increasingly recognized as an unhealthy coping strategy, often triggered by acculturative stress. This form of stress is triggered by the silent and unaddressed issues of moving away from familiar places, people and activities, sometimes in a hasty or ill-prepared manner (Evans, 1987). Refugee youth, especially those who have endured multiple exits from their home countries, into camps, before settling in Canada, are likely to report poorer medical health (Evans, 1987) and be exposed to harmful or troubling migratory experiences than other immigrants of African descent. The resulting disorientation and demands of adjusting to the new cultural environment have been shown to increase the likelihood of affected youth engaging in drug or alcohol use to regulate emotional discomfort (Sirin et al., 2013), reduce memories of absent but desired places or people, and mask their sadness. An Ontario-based study by Hamilton et al. (2014) showed that lower levels of substance consumption were evident among immigrant youth than Canadian-born youth. They reported that acculturation or trying to foster a sense of belonging in their new community was a significant driver of initiation into drug use for immigrant youth. The findings should not come as a surprise because in African immigrant communities, parental authority and community belonging are often deeply intertwined. However, immigration interrupts traditional family structures, often isolating youth from the extended familial networks that typically serve as nurturing and conversational units and buffers against risky behavior. The resulting void may drive youth to seek belonging through peer relationships, including those where drug use is normalized (Brody et al., 2012).

Moreover, the new country is not without negative triggers within educational (Baak, 2019; Wang & Palacios, 2017; Goings & Bianco, 2016), social, and work settings, where racism and discrimination (Abada et al., 2008; Salami et al., 2022) undermine their potential and aspirations. The negative attitudes of teachers, students, co-workers, and other persons within these spaces may be complex for youth to handle, leading them to cope by using substances (Tran et al., 2010). These outcomes of their socio-cultural dislocation and likely conflict contribute to the development of anxiety and depression, which, in turn, increase reliance on substances to cope (Sandberg et al., 2023). In essence, although studies indicate that several immigrants, including accompanying youth, arrive in Canada in good physical health, a phenomenon referred to as the “healthy immigrant effect,” (Feliciano, 2005; Vang et al., 2017), which could be linked to Canada immigration’s screening for immigrants with higher education, high proficiency on Canada’s two languages, English and French, and the work experience to compete in the labor market with the belief that higher skills correlate with good health (Jasso et al., 2004; Knowles, 2007). However, this advantage often deteriorates quickly due to racism, employment or underemployment stress, absence of culturally responsive care, and housing instability (Alamgir et al., 2025), culture shock, and adoption of risky behaviors and practices from the host country (Berry & Hou, 2019; Hochhausen et al., 2010), as well as inequitable access to health services (Beiser, 2005; Fung & Guzder, 2018; Newbold & Danforth, 2003). Ultimately, some youth benefit from informal support networks (Jacob et al., 2023), or resilience-building and adaptive coping activities such as sports, or participation in faith-based, religious, or spiritual communities (Alaazi et al., 2022; Bilkins et al., 2016), or craft groups. Others without such support may gravitate toward maladaptive pathways, especially when parents lack awareness or tools for early detection and prevention (St-Pierre et al., 2024) of the MHSU problem; and there is an absence of clinicians capable of integrating culturally responsive strategies into the MHSU care plans (Cénat et al., 2024; Isiwele et al., 2025).

This study foregrounds the voices of youth of African descent aged 18–25 in Nova Scotia. Their perspectives help to: illuminate how they processed their mental health and substance use experiences; identify the actors or support structures central to their recovery; explore whether individualistic or collective interventions were more effective; reveal how youth envision culturally congruent recovery pathways; and consider whether youth can navigate healing independently of parental involvement.

2. Materials and Methods

This qualitative study draws on interviews and focus group discussions with youth aged 18–25 of African descent living in Nova Scotia, Canada. The study is part of a broader project that explores access to mental health and substance use (MHSU) care among youth of African descent who reside in the province. This paper focuses specifically on youth who self-identified as immigrants or refugees and had personal experiences with MHSU services or were planning to access them.

The research team shared recruitment notices through community organizations, outreach networks, social media platforms (e.g., LinkedIn), and word-of-mouth. Youth interested in participating contacted the research team directly and were invited to complete an eligibility form. The eligibility criteria required that participating youth (1) be of African descent; (2) reside in Nova Scotia; (3) be between 18 and 25 years of age; and (4) have accessed, attempted to access, be currently accessing, or plan to access MHSU services in Nova Scotia. Individuals who did not meet these criteria were not included in the study.

Ethics for the study was obtained from the Nova Scotia Health Research Ethics Board (REB File #: 1029346), and research participants were required to provide consent before data collection commenced for each stage of the research process. Participation was voluntary, and youth received an honorarium of $50 for each completed stage of the study.

All participants took part in an individual interview, which served as the initial and mandatory point of engagement. Focus groups, typically comprising 6–8 participants, were offered as an optional second stage. While the broader study included arts-based components, this paper draws exclusively on the narratives generated through interviews and focus group discussions.

In total, this ongoing study has engaged 60 participants (35 male and 25 female) to date, with plans to reach between 60 and 80 youth. All 60 youth participated in personal interviews with the researcher, while seven focus group discussions were conducted with 6–8 participants in each group. In keeping with the Afrocentric and Ubuntu principles guiding this study, youth participants were not required to disclose demographic details that felt intrusive, particularly for those with precarious status, stigma-related experiences, or previous distrust of institutional and health related research or encounters. Nonetheless, many participants voluntarily shared information about their educational and employment pathways. These youth represented a broad spectrum of life experiences. Eleven participants were university students, including international students; five were recent graduates or professionals; nineteen were employed full-time; ten combined part-time work and schooling; and four worked part-time. One participant was taking a break from school to focus on recovery; two were actively job-hunting; and three were self-employed. Two participants were still in high school, one in vocational training, one had left school altogether, and one was unemployed. These patterns reflect the diversity of contexts that shape how youth of African descent navigate MHSU care in their everyday lives in Nova Scotia.

In summary, participants reflected a range of educational and employment statuses. Some had completed high school; others were enrolled in or attempting to gain admission to postsecondary institutions or trade programs. Some participants were international students, others were employed full-time, and a few were temporarily out of school due to MHSU challenges. Although demographic information is aggregated here to preserve participant anonymity, the youth identified origins from across the African continent, including Kenya, Uganda, Sudan, Eritrea, South Africa, Rwanda, Congo, Djibouti, and Ethiopia.

Data were analyzed manually using a thematic approach. The analysis was conducted collaboratively by the research team and an advisory committee comprising individuals of African descent. The advisory committee included team members from the project (including those affiliated with Nova Scotia Health Authority) and additional community members of African descent not formally on the grant. These community members played a critical role in supporting the interpretation of narratives. The analytic process involved multiple readings of transcripts, open coding, and theme development. Advisory committee members provided insights into culturally specific meanings, language, and recurring patterns across transcripts. The interpretation of findings prioritized participants’ language, tone, and cultural expressions, in alignment with Afrocentric and Ubuntu principles of mutual respect, relationality, and collective wellbeing. Ubuntu, as applied in this study, reflects a communal worldview that emphasizes interdependence, shared responsibility, and the understanding that individual wellbeing is intrinsically tied to collective wellbeing and dignity (Mbakogu & Odiyi, 2021; Fante-Coleman et al., 2024; Mbakogu et al., 2025). Pseudonyms and participant numbers (as chosen by participating youth themselves) are used to preserve confidentiality, respect, and agency while maintaining participant voice.

3. Findings and Discussion

This paper contributes to the literature on alternative approaches for building and supporting family cohesion in providing culturally appropriate mental health and substance use (MHSU) services to youth of African descent. The narratives shared by participants highlight culturally grounded parenting strategies and underscore the essential role of family in access to care and impact on recovery. The themes discussed below emerged from youth reflections on their lived experiences navigating MHSU challenges, parental involvement, and interactions with health systems. The six themes—Curious, watchful, and action-oriented parenting; Self-instigated decisions and change; Parental nudging as a driver for accessing MHSU services; Collective problem, collective care, and collective solutions; Strict but impactful parenting; and Parents as the embodiment of courage and capability—are interwoven and reflect the multiple dimensions of how family, culture, and systemic pressures interact in shaping youth access to care. These themes are not presented in isolation, but as overlapping expressions of youth realities in a context shaped by both collective traditions and institutional barriers.

3.1. Curious, Watchful, and Action-Oriented Parenting

A standard narrative with youth who live with their parents is the busy lifestyle of parents, who may be single parents or those juggling between several jobs, their household responsibilities, and parenting duties. The children recognize the multiple roles that these parents play, and on occasion, this has led to opportunities for them to stay away from home and engage in suspicious activities. However, once the parents notice a pattern and their questions are not answered, they devise their own methods for seeking answers. This is supported by Fang et al. (2011) and Van Ryzin et al. (2016), who affirm that vigilant, family-based interventions are practical tools in identifying early substance use. While initial parental reactions involved anger and surveillance, many participating youth expressed that their parents eventually allowed them the autonomy to initiate recovery. This is a situation shared by No. 400, an 18-year-old male who narrated how his mother almost became a detective while seeking to understand what was going on with her child:

I used to borrow some cash from Mommy... at some point, she got nervous, she got curious and asked... where I was taking the cash to, because every now and then...something was missing at home. So, she got curious. Until she followed me one day, I didn’t know she followed me. We had somewhere we were meeting with my boys, so we went, and she was watching in her car…Later in the evening, she asked me where I went and then I started using the same lies again, but then she realized I was into drugs... She was angry at me for some days... [she] couldn’t even stare at me for even a minute she was so furious about it.

(No. 400, 18-year-old male)

Youth participants shared that when their parents understood the problem and its triggers, they encouraged reflective conversations and supported the youth in self-identifying their needs and how to meet those needs in flexible or manageable ways that aid recovery. Relatedly, Fante-Coleman and Jackson-Best (2020) emphasize the importance of emotional safety and autonomy in culturally responsive care. This narrative was shared by No. 400 during the personal interview. Also note that this participant preferred to be identified with a number

3.2. Self-Instigated Decisions and Change

Although No. 400 shared that his mother was upset upon learning that he was lying about his activities within and outside the home, and engaging in drug use, she allowed a gradual process for discussions. She ensured that he took the lead in making decisions about the process of addressing his problem. Some other research participants also maintained this self-instigated approach to wellness decisions.

After that incident, she became so hard on me. She wanted the turnaround to be self-instigated. So... we’d have some sitting-down; she would even take me out sometimes to go and just have a real talk with me so I could turn things around. After three to four attempts, I came to my senses that...there was a need to change.

(No. 400, 18-year-old male, personal interview)

Regardless of their annoyance with youth drug use and its effects, the family members realized that actions towards self-care require that the youth understand that there is a problem, with a need to isolate the triggers and contributing factors of that problem. The youth also have to be assured of parental support as they engaged in the help-seeking journey.

3.3. Parental Nudging as a Driver for Accessing MHSU Services

Several participants indicated that they would not have accessed MHSU services had their parents not noticed that they were taking substances and insisted that they receive help, often accompanying them to the facilities. For instance, No. 11 credited her parents for recognizing her alcohol addiction and taking her to a rehabilitation facility:

When they realized, they took me to this mental health service…they (parents) had to force me to go into this rehabilitation center because if it were with my friends alone, I would be taking alcohol even right now. My parents believe that they have a kid that they have to take care of. They believed in me, so they had to take me to a rehabilitation center for a little reform. Without them, I don’t think I would be here because no one else cares…because the rest want you to join them and be like them. I don’t think that I would be here without them.

(No. 11, 21-year-old female, personal interview)

According to No. 11, her parents saved her from more years of drug use because they loved and believed in their child and her future aspirations. To her, the support and dedication residing in the African parent stands in contrast to the indifference of peers, who would want to retain their company as they shared or experimented with substances, rather than encouraging them to seek help for the problem. The youth’s experience supports the findings by Alaazi et al. (2022), who argue that in many African families, addressing youth mental health is viewed as a collective rather than an individual responsibility. Therefore, MHSU care providers should understand that the journey toward accessing mental health services is rarely undertaken solely by the youth of African descent, considered a “client,” but also by close, immediate, and extended family members who are affected by their MHSU problem.

These narratives highlight the decisive role parents play in identifying the warning signs of substance use and intervening when necessary. Their actions were not merely reactive but grounded in love, duty, and belief in their children’s capacity for change. These forms of parental nudging, while sometimes forceful, were ultimately described by youth as lifesaving and rooted in care. In the next theme, we explore how these same family dynamics intersect with disciplinary practices and collective parenting strategies, offering additional insight into the culturally embedded ways families navigate MHSU support.

3.4. Collective Problem, Collective Care, and Collective Solutions

Also, linked to the discussion on parental nudging on the need to receive care for identified problems, focus group participants described family issues as shared concerns that required unified or collective responses. As 24-year-old Charlie emphasized:

The support we Africans get from our families is huge and something to show to the world and to integrate into the healthcare system because we Africans, take our family to the highest level that we can. We feel a problem with either your sibling or your parent is a problem for you too and all that.

(Charlie, 24-year-old, focus group)

“We feel a problem with either your sibling or your parent is a problem for you too.” This ethos mirrors community-based care models that embed collective care into MHSU treatment for youth of African descent. The role of immediate and extended family members in the wellness paths of affected individuals should be understood and incorporated into decisions about interventions, contexts, and approaches for care, ensuring that they align with the short- and long-term goals of affected youth.

The assessment and treatment plan for MHSU recovery among youth of African descent should not be treated as a static, individualized, one-size-fits-all process moderated by the medical model. Instead, it should reflect a holistic approach that considers the context of their problems, their personal and familial histories, the effects of larger structural and systemic issues, and the weight of those who will lift them and remain with them as they access healthcare. When some of these pieces are missing, affected youth may be hesitant about accessing care and remaining in care. The next theme examines how culturally grounded practices, such as strictness and discipline were described by participants not as punitive, but as expressions of protection and care.

3.5. Strict but Impactful Parenting

Regardless of the role parents play in ensuring the collective well-being of every family member, the practices for achieving this may conflict with those seemingly advocated by the dominant group. Youth such as 22-year-old Ryan highlighted the cultural strength of strict African parenting, contrasting it with the perceived leniency of dominant Canadian parenting styles:

I agree with Charlie, and I can say this: we Africans are a more advantageous group. I can say we have more strict parents. You know, African parents are not a joke. Maybe they can even kick you out any time. They don’t joke around. If they (African parents) say they don’t want this, they are not joking. You know, they are strict.

(Ryan, 22-year-old male, focus group)

While Ryan described his parents as adopting a strict and no-nonsense approach to parenting, he commends their approach as effective in ensuring that, when they stray from the right path, their parents apply strict rules for identifying and addressing their problems. They considered this type of parenting to be both protective and empowering within their new society. African parenting styles are often scrutinized and questioned, sometimes categorized as archaic, primitive, or harsh, while forcing African immigrants to adopt parenting practices that are acceptable within their new country (Mbakogu, 2013). Some parents see the adoption of the dominant parenting practices as contributing to losing grip on their children (Mbakogu, 2013), their children falling through the cracks, and on their part, losing their identity as parents of African descent.

Parenting is culturally situated and shaped by both traditional values and the adaptations required by migration (Alaazi et al., 2022). Youth in this study, often positioned strictness as a form of care and accountability, a way of expressing love and investment in their wellbeing. However, these perspectives should be read not as a universal endorsement of a singular “African” parenting style, but as reflections of individual lived experiences, filtered through complex and intersecting cultural, structural, and personal realities.

3.6. Parents as the Embodiment of Courage and Capability

A crucial aspect of healthcare delivery is understanding the differences between various clients, their needs, experiences, approaches for enabling them to share their stories, and their preferred ways of navigating care. Regardless of similarities in MHSU problems, race, histories, or socio-economic status, no two clients are the same. Therefore, modalities for care that work for one patient should not be replicated for another patient based on identified similarities or successes (Mbakogu, 2020). Parental presence was also described as a buffer against stigma and emotional withdrawal in therapy settings. In an individual interview, No. 512 shared how his parents’ presence gave him the courage to speak honestly about his experience:

So, in the first two sessions, we used to go with my parents and our personal therapist, who will talk to me, who will educate me on the side effects of using drugs and substances. So, my parents were just there to try… to eliminate the stigma [and] to give out my story to the therapists. I was kind of happy because I was afraid to give all my story to the therapist. Someone who you haven’t interacted with... So, I was afraid but with my parents I found the courage to tell the whole story. It was a white person [therapist].

(No. 512, 23-year-old male, personal interview)

The youth, No. 512, narrates that, while parents oppose substance use, their support, vigilance, and cultural values are pivotal to wellness. These findings emphasize the importance of MHSU services being culturally grounded, inclusive of family participation, and responsive to collective pathways to recovery. No. 512, amplifies the thoughts shared by some other youth about the need to obtain their input on who should be present at the beginning, middle, and end of the MHSU treatment plan. This reflects broader calls for culturally safe practices (Fante-Coleman & Jackson-Best, 2020) that involve family presence if expressly desired by the patient, especially during early intervention stages. No. 512 shared that the ability of himself and other participating youth to be open about their problems and withstand the stigma associated with their MHSU problem by opting to visit healthcare facilities was because their parents were supportive by creating time to be present at the beginning stages of their journey. The research participants were emphatic that their parents have zero tolerance for substance use; however, their association with multiple persons and associations within their neighborhood predisposed them to substance use and exploring ingenious ways to hide their addiction from their parents.

4. Limitations

This paper draws on a specific subset of data from a larger qualitative study to examine how parenting practices shape access to mental health and substance use (MHSU) care among African immigrant and refugee youth in Nova Scotia. While the narratives offer rich insight into the cultural meanings of parenting and family-based intervention, the paper presents findings only from youth who self-identified as immigrants or refugees and were willing to speak to their MHSU journeys.

Thematic analysis was conducted manually through a collaborative process involving the research team and members of the advisory committee. This team was composed of individuals of African descent as well as others, offering a range of perspectives. As with all qualitative research, the cultural positions and lived experiences of both participants and analysts shaped the interpretation of available data. This co-construction of meaning reflects the study’s commitment to reflexivity and contextual integrity.

5. Mapping Themes to Research Questions

This study set out to explore how youth of African descent in Canada experience and interpret the parenting styles of their caregivers, the influence of those styles on their access to mental health and substance use (MHSU) services, and the implications for developing culturally appropriate care models. The reflective narratives of participating youth addressed these inquiries within six themes.

• Research Question 1: How do youth of African descent perceive the parenting styles of their parents?

This question is reflected most clearly in the themes Curious, watchful, and action-oriented parenting, and Strict but impactful parenting. These themes capture how participants viewed their caregivers as present and observant, not distant or disengaged, even when parental approaches were firm. These parenting styles were described as rooted in protection, responsibility, and discipline, though sometimes lacking in open dialogue. The theme Parents as the embodiment of courage and capability further adds nuance, revealing that many youth viewed their parents as resilient figures who modeled perseverance, often despite structural barriers or unfamiliarity with Canadian MHSU systems.

• Research Question 2: What is known about the role of these parenting styles in the likelihood of youth of African descent receiving mental health and substance use care in Canada?

This question is most directly addressed in the themes Parental nudging as a driver for accessing MHSU services and Self-instigated decisions and change. Participants’ experiences suggest that although parental influence played a role in early perceptions of care, it was often subtle or indirect. Some parents offered encouragement or “nudges” rather than mandates, while others withheld direct engagement due to stigma or unfamiliarity. In these situations, young people often took initiative to pursue care themselves, illustrating how parenting styles shaped, but did not always determine pathways to support.

• Research Question 3: Are there lessons to be learned from the projected parenting styles in the design of culturally appropriate mental health and substance use services for youth of African descent in Canada?

The themes Collective problem, collective care, and collective solutions and again Parents as the embodiment of courage and capability, point to important takeaways for service design. Participants emphasized that culturally grounded support systems, those that reflect shared community responsibility and intergenerational wisdom, would better align with their lived experiences. Participants also suggested that healthcare providers who understand the strength that many youth repose in their parents are more likely to offer services that feel respectful, trustworthy, and relevant. These insights stress the value of applying family-informed, culturally attuned care models in MHSU care delivery to youth of African descent in Canada.

6. Conclusions

This paper contributes to the limited literature on the MHSU care-seeking experiences and behavior of youth of African descent, this time from Nova Scotia. The narratives of participating African immigrant and refugee youth report their experiences of MHSU challenges within a complex and interrelated trend of cultural expectations, systemic barriers, and family dynamics. Their narratives also highlight the pivotal role of parents, not only as disciplinarians but also as advocates, confidants, mentors, role models, caregivers, and cultural anchors in accessing care, remaining in care, and their recovery process. This is evident in their narratives of vigilant monitoring, which they attribute to saving them from self-destruction and to supportive interventions. In essence, African parenting approaches emerge as essential, though often overlooked, elements in accessing and sustaining MHSU care.

These insights should drive policymakers, service providers, and mental health systems to move beyond Euro-American-centric models of care to models of care that are flexible enough to inform healthcare structures and practices that validate cultural understandings of family, collective notions of receiving care, and their impact on patient wellness. Culturally grounded interventions that recognize intergenerational trust, foster safe spaces for respect, mutual learning, engaging with professionals to voice problems, are not optional but necessary for effective and equitable outcomes. The findings should drive the need for MHSU service delivery that is willing to invest in family-inclusive approaches, develop anti-racist mental health frameworks, and integrate youth perspectives to co-create spaces of care that reflect the lived realities of youth of African descent, thereby heightening the resolve of this population to seek care.