Mental health among Muslims is deteriorating as the community increasingly feels under siege. But, as Jeremy Dunning reports, services need to understand the importance of faith when treating the patient
Dr Rabia Malik (pic: Tom Parkes)
“There’s tremendous pressure. A sense of always being under attack, hostility and lack of understanding, creating high levels of depression and stress.” These are the words of community worker Khalida Khan, describing increasing anxiety and mental ill-health, including incidences of depression, among Muslims.
Khan, director of the Muslim women’s welfare organisation the An-Nisa Society, believes the causes are manifold. She highlights decades of social exclusion and poor engagement with services, anecdotal evidence of increasing family dysfunction and criminal behaviour, as well as the impact on Muslims of the government’s policies to combat Islamic extremism and terrorism, and regular critiques of multiculturalism, most recently by prime minister David Cameron.
She is not the only person concerned.
“Any suspect community will be living with anxiety, fear, stigma and discrimination,” says Kamaldeep Bhui, professor of cultural psychiatry and epidemiology at the Wolfson Institute of Preventive Medicine. “These factors have been linked to poorer mental health irrespective of the ethnic or religious group involved.”
Statistical evidence for this phenomenon is scarce, and clouded by poor engagement of minority groups in services.
The 2009 Count Me In census of mental health patients in England and Wales found 3.9% were Muslim, just above the group’s representation in the population.
However, Bhui points to growing reports of stress within the Bangladeshi, Pakistani and Somali communities driven by deprivation and concerns over the media and politicians’ characterisation of some Muslims as radicalised.
Khan adds that the Prevent agenda, set up in 2008 to enlist local authorities and their partners in tackling Islamic extremism, created a fear and suspicion of public services among Muslims. They began to be seen as an arm of the intelligence services, she says.
This lack of engagement with public services is also in part due to mainstream services not fully acknowledging the importance of faith, it is argued.
Professor Dinesh Bhugra, president of the Royal College of Psychiatrists, says it is a matter of good practice for psychiatrists to have an understanding of patients’ cultural backgrounds.
This is made clear in the core module of the college’s curriculum for specialist training in psychiatry, in which it is stated that practitioners should be able to perform assessments on patients from diverse cultural backgrounds. This should include taking a socio-cultural history.
However, many counselling services still have a one-size-fits-all approach, with little understanding of an individual’s cultural and family pressures, according to recent research on mental health services in Waltham Forest, London.
Dr Qadir Bakhsh, who led the research by mental health provider the Qalb Centre, says it is crucial to gain trust: “Asian patients may need encouragement to express their emotional problems in psychological terms and doctors need to develop a greater sensitivity in recognising them.”
This situation has bred a desire among some Muslims for more culturally-specific or faith-based services within the NHS.
The Central and North West London NHS Foundation Trust has been running an Asian family counselling service at the Marlborough Cultural Therapy Centre in St John’s Wood since 1995 and this has proved popular. However it is a rare example.
Reluctance to engage
“The community is becoming more and more harassed so there’s lack of trust and a reluctance to engage with mainstream services,” says service co-leader Dr Rabia Malik.
In service terms, many trusts had not put enough resources into fully developing cultural and faith aware programmes nor was diversity training for psychiatrists meeting the challenge, she says.
“Most people’s training does not address issues around faith,” she says, “I do a lot of work with people from different Muslim backgrounds. For many, faith is an important part of their life. It plays an important part in resolving difficulties and not drawing on that limits the effectiveness of your work.”
Although culturally-based services may be lacking in the NHS, several voluntary sector services have developed within Muslim communities, but they lack funding and capacity.
Among these is the Muslim Youth Help-line, which aims to provide help for young British Muslims and can act as a bridge to other services. It receives 5,000 calls a year.
Josie Hinton, a migrant and faith access worker at Mind, in Harrow, London, has been working to bridge the gap between mainstream services and faith groups to encourage better understanding among communities of mental health and the services that can be accessed.
“Mental health services and faith leaders need to be working closely together,” she says. But she finds there is still a chasm separating them, leaving the Muslim voluntary sector services working in parallel, rather than in partnership, with the NHS.
Tackling social exclusion
Bridging this gap will be a key element in ensuring that Muslim people who have mental ill-health receive the right support at the right time, and in a way that is culturally appropriate, be it in the NHS or the voluntary sector.
However, tackling social exclusion among some Muslim communities will also be key, while some argue that a change in government and media perceptions of Islam and Muslim people is also required.
“You need to address people’s needs holistically and not stigmatise a whole community,” says Khan.
Case study: ‘I would never be an inpatient again after the way i was treated’
Nazish* had just one experience of inpatient services. This was in 2004 when she suffered a psychotic episode brought on by a combination of things – though not racism or discrimination.
Nazish, an Asian Muslim, was sectioned for a month and to this day remembers it as one of the most unpleasant experiences of her life.
The 34-year-old says it felt that some of the members of staff were “nasty” towards her and picked on her, though none was overtly racist. She says she would have expected more compassion.
Nazish, who comes from London, emphasises this has not deterred her accessing outpatient services and that she saw a psychologist for six weeks after leaving inpatient services.
“It’s not put me off seeing a psychologist as an outpatient, but if someone said I had to stay in hospital for a month I wouldn’t go under the care of staff. I would say ‘no, I don’t want that’,” she says.
Since then she has not suffered a relapse.
Nazish is a practising Muslim and attends the mosque every week.
Unlike many Muslims, it would never have occurred to her to have asked her imam for help, nor does she intend using him now as a support mechanism, preferring instead to support herself.
She says: “The imams don’t have much time. Even if you asked them for a fixed time it’s unlikely they would be able to see you. Also, an imam wouldn’t give you more specialist advice or care.”
She adds that the Muslim community as a whole appears unhappy due to job insecurities and targeting by the authorities and the media on the lookout for extremists.
*Not her real name.
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