Paper short abstract:

Access to health care is often difficult for illegal immigrants in Canada to obtain. The clinical setting is a place in which understandings of citizenship and care are negotiated and contended. Through use of strategies, networks and discursive practices, illegal immigrants and clinical practitioners navigate this tenuous terrain of health/care.

Paper long abstract:

Modern multicultural societies are confronted with the challenge of providing health care for their diverse populations. Taking on this social and political challenge means examining how access is granted, how political decisions shape services, and weighing different ideological claims about patients. These can range from a universalistic vision of the patient as a citizen, as an immigrant, as a specific "minority" other, as refugee in need of legal protection, and as an "illegal" to question. In Canada, the illegal immigrant population is comprised mainly of non-status immigrants who enter legally but stay after their legal status expires. Because of their "non-status," they avoid institutional encounters and have no rights to the health care system. What happens, then, if they get sick?

Drawing on current research among medical institutions in Montreal, this paper looks at

how non-status immigrants and health practitioners construct and negotiate, through use of strategies, networks, and discursive practices, a tenuous field of health/care. In particular, it examines how the discourses and regimes of the hospital and of citizenship intersect at a particular mental health facility offering cultural consultations in the treatment of immigrant and refugee patients. The case of a patient referred for consultation in virtue of her being a "cultural other" offers a starting point from which to explore the dissonances between policy and practice. Such an investigation brings to the forefront illegal immigrants' resilience in negotiating their visibility and invisibility, and the political, institutional, and ethical roles of psychiatrists in treating politically vulnerable patients.