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Main barriers to accessing mental health support for Muslims

Dr Ahmed Hankir responds to a question we put to him about what he considers to be the main barriers to accessing mental health support for Muslims
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The main problems I have come across are as follows. Number one, mental health literacy. Muslims tend to have low mental health literacy which has been defined as knowledge and beliefs about mental disorders, which aid the recognition, management or prevention. Many Muslims attribute mental health problems such as perceptual, behavioural, psychological, or cognitive disturbances to supernatural causes such as jinn, spirit possession, and or being cursed by the evil eye of envy. The explanatory framework that many Muslims formulate can influence help seeking behaviours. Muslims tend to avoid mainstream mental health services because they do not accept or believe that they have any problems with their mental health that need treatment.
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But they have been possessed or cursed by a malevolent entity, and thus they consult raqis or faith healers. Unfortunately, the raqi industry is unregulated, and there are many self-proclaimed raqis who have taken advantage of Muslims with mental health problems, who are often at their most vulnerable and have exploited them financially and have even abused them emotionally, physically and sexually.
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Problem Number Two. Mental health stigma. Mental health related stigma is rampant in the Muslim community. There is a tremendous amount of shame attached to mental health problems. If, for example, a young Muslim lady has a mental health problem and members of the community discover this it will likely reduce her chances of getting married. Stigma and a culture of shame are formidable barriers to mental health services, and consequently, many Muslims with mental health problems continue to suffer in silence. Despite the availability of effective treatments, I repeat, many Muslims with mental health problems continue to suffer in silence despite the availability of effective treatment. Problem Number Three.
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The social determinants of mental health problems are a huge issue in the Muslim community that are shockingly overlooked. 46% of Muslims live in the 10% most deprived local authority districts in Britain today. Poverty impacts access to resources, school attainment, employment opportunities, and the likelihood of involvement in crime and therefore incarceration. Muslims are often ethnic minorities and are consistently stereotyped as criminals and terrorists, such realities create inter generational cycles whereby Muslim people cannot accumulate enough economic or social capital to break out of poverty. Poverty and unemployment are some of the main social determinants and drivers of mental health problems and criminal behaviours. Muslims account for 15% of the prison inmates, yet represent less than 5% of the population.
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So Muslims are both overrepresented in criminal justice system and mental health services. Disaffected Muslim youth do not have any role models who they can identify with, who they can emulate. A Muslim professional from a disadvantaged background who they feel understands them.
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Problem Number Four. Identity crisis. Many Muslims are immigrants, and this can be first generation, second generation, third generation. And this is a risk factor for developing mental health problems. Muslims, especially our youth, are prone to experiencing an identity crisis. They will say to themselves, I’m too Eastern to be Western, too Western to be Eastern, to where do I belong? Who am I? Which in and of itself is associated with emotional turmoil Muslims who enroll in university often become intimate with the Western culture for the first time in their lives.
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They will move out of their family homes and meet other non-Muslim students in halls of residence who consume alcohol and take illicit substances, have pre-marital relationships and who go out clubbing. All haram, prohibited in Islam. Both resisting temptation and remorse they often experience if they succumb to it can precipitate psychological distress and shame. Current mainstream mental health services, by and large, operates from a secular framework which excludes religiosity and spirituality. Not only this, in my capacity as a Muslim psychiatrist working for the NHS I have seen first-hand how many mental health care professionals ridicule people who believe that religion can play an important role in mental health.
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I surmise that these prejudicial attitudes can deter Muslims with mental health problems from seeking help from mainstream mental health services. Now, Dr Ghazala Mir and colleagues have attempted to address this limitation. Mir and her research team adapted a type of talking therapy, behavioral activation, by incorporating Islamic principles. This faith informed intervention was used in the treatment of depression in Muslims and was associated with positive outcomes. It is currently being rolled out across NHS mental health care providers throughout the UK. Racism is a huge issue in mental health care services. For example, if you are a black person, you are four times more likely to be detained under the Mental Health Act compared to non-blacks.
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If you are a Muslim under the care of mental health care services, you are eight times more likely to be referred to the government’s controversial counterterrorism programme Prevent. God help black Muslim people with mental health problems in the UK.

In this step, Dr Ahmed Hankir responds to a question we put to him about what he considers to be the main barriers to accessing mental health support for Muslims.

Dr Hankir is an NHS Consultant Psychiatrist and a lived experience expert of mental health problems. The barriers he puts forward are low levels of mental health literacy among Muslims; mental health stigma; social and economic circumstances; identity crisis; racism and Islamophobia. Dr Hankir carefully explains how each of these barriers impact on Muslim mental health.

In this video Dr Hankir makes direct links between mental health and the socio-economic and socio-cultural contexts of British Muslim communities that were outlined earlier this week in Activity 4: Muslims in Britain.

In the next step, we consider the importance of recognising diversity and contextual factors when designing health interventions and promotion for Muslim communities.

Signposting

You can learn more about Dr Hankir’s lived experience of mental health on his website.

Dr Hankir mentions the work of Dr Ghazala Mir, Associate Professor at Leeds University during this video. If you would like to find out more about her pioneering work on behavioural activation therapy, please visit her webpage where open-access resources are available.

G Mir, S Meer, D Cottrell, J Kanter, D McMillan, A House, Culturally adapted therapy for the treatment of depression in Muslims: European Journal of Public Health, Volume 26, Issue suppl_1, November 2016.

Over to you

If you could ask Dr Hankir a question about the barriers Muslims face to accessing mental health support, what would it be? Take a look at the questions other learners ask and see if you can offer an answer or add to the question.

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Understanding Muslim Mental Health

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