Table 2.

Theme overview.

Themes	Subthemes	Quotes
Concerns regarding social isolation, stigma, and silence around mental health	Suffering in silence and dealing with social isolation	“When you come here, you feel isolated … that has an effect. You don’t have enough people to talk to, or other people that you know, that you recognize, that is a problem. Definitely, isolation has an effect on mental health. I think that isolation for such a long period, I feel like, is one of the big things.” “People cannot cope with the society in this country, especially the migrants who come at a later age and then they see that their environment here is totally different and they don’t have the same family support like people do in the Islamic countries … or in their home country.”
	Cultural barriers to voicing mental health concerns	“Mental health is really what I think is very not well understood in our community … Our community doesn’t want to acknowledge it. It’s not that they are not aware of it. They’re aware of it, but at the same time they don’t want to acknowledge it out of fear, stigma, and other socioeconomic factors.” “I saw this a lot amongst the older male adults where they would say, ‘We don’t talk about things that were distressful. We don’t talk about the past’.” “They come to us, Imams, when it’s really bad. Because until then, they just kind of, they keep overlooking and denying it themselves, really.”
Challenges with referrals and fragmented pathways to community-based mental health services	Needing more practical mental health training	“We were dealing with a lot of Muslim [immigrants and refugees]. Our role was to help them gain self-sufficiency, so we would create a plan for them, short-term and long-term goals, and get them back on their feet, hopefully. That was the goal … We realized that wasn’t enough for them … they needed more attention. They just didn’t have access to a lot of things. A lot of them had language barriers. A lot of them were educated in their country … You’re dealing with a lot of emotions, a lot of anger, a lot of sadness. It is extremely difficult.”
	Limited capacity to address basic needs and practical barriers	“I think institutions that deal with refugee populations need to collaborate. They need to work together because you’re talking about people who have needs on every single level, financial, housing, educational … So on every level, they’re in need. And the refugee resettlement agencies, they have limited capacity.” “I don’t think Imams should be tasked with addressing the mental health issues, this is for the professionals, [Imams] are already overwhelmed with the community needs already”
	Limited awareness of local resources	“A lot of them [older adults] don’t know we have mental health services. I get referrals from case managers because our staff will let them know we have a mental health program. They notice they might be struggling or having challenges with mental health, and they will call me in, and then I do a quick assessment; it happens all the time.”
Leveraging and de-stigmatizing community-based mental health services for older adult refugees		“A lot of this is building on trust and rapport until you feel that you can make that recommendation [to mental health care], put him in that place where you think they could follow through with your suggestions.” “I think bringing it [mental health outreach] more to the mosque because that’s where most people congregate. That’s the one thing I think about having the tables set up where people know about it. And social media, I think, plays an essential aspect now … Yeah, that would be the best way to reach out to them, but I think the older generation [prefers] tabling.” “So having that sort of a connection. There’s a lot of elderly folks that have come over from Syria and so providing needs specific to them. So refugee agencies that work with refugees on any level need to be well connected.”