Muslim Mental Health Conference

A Key to Building A Healthier and Resilient Community By Farha Abbasi MD

Resilency “Resiliency is the essence of a global

positive framework...” Asa Don Brown

Diversity

115,000 Muslims living in Michigan including in the

Lansing area

Diversity •  most US Muslims are first- and second-

generation immigrants •  some trace their origins to the early days of

colonization.

Diversity

four-fifths of American Muslims are: •  African-Americans •  Arab-Americans •  South Asians (Bagby, 2001).

Diversity one fifth •  African, East Asian, European, •  Caribbean, and Latino descent Qamar-ul Huda, 2006

U.S.-born Whites of Western European descent, who may not present as a "stereotypical" Muslim, but do in fact follow Islam Pew, 2007

Diversity

Spirituality and religion •   The Qur’an, “the word of God,” serves as

“a guide and a healing to those who believe”

Qur’an, 41:44

Spirituality and religion

• The Hadith (traditions and sayings of the Prophet Mohammed) also provides guidance for moral and ethical behavior. • Following Islamic directives is believed to promote a high quality of life and a healthy mental state Qur’an 2:177

The Qur’an considers a number of psychosocial issues, such as care for the ill, marital and family relationships, child-rearing, honesty, justice and modesty.

�  Both men and women are expected to dress in a way which is modest and dignified; the traditions of female dress found in some Muslim countries are often the expression of local customs.'

HIDE YOUR CARROTS IN THE CLOSET

Shrouded in silence I needed words because unhappy families are conspiracies of silence. The one who breaks the silence is never forgiven. He or

she has to learn to forgive him or herself.

Jeanette Winterson

Stigma “absence of evidence is not

evidence of absence” n  Muslim culture deems mental illness as a weakness of the soul •  keeping silent in the face of suffering is the norm and to persevere is pious.

Stigma •  stigma and shame of mental illness worse than suffering. •  reluctance to seek professional help •  vague pain and somatic symptom presentations •  frequent misdiagnosis

To Persevere? n  Illness is part of human suffering regarded

as a way of atoning for sins. n  Reward may be greater if suffering is

endured with patience and prayer.

•  Illness believed to be a divine test of level of piety, devotion and loyalty of the faithful. •  98% of survey respondents asked about perceptions of mental illness agreed that life stressors are a test of one’s faith. •  84% of respondents believed in devil possession of mentally ill persons. Abu-Ras & Abu-Bader (in press)

Djinn/Evil eye n   It is believed that when alternate beings, such as Jinns, possess individuals, hallucinations, delusional beliefs and disorganized behavior may result. n  Other purported supernatural causes are black magic and the evil eye.  

•  Some believe that envy (intentional or not) can invoke negative consequences and charms, markings, jewelry, prayers or rituals are used to distract jealousy and envy. • 

• Curiously, beliefs and practices pertaining to demonic possession, witchcraft, black magic, and the use of exorcists, charms and magic potions are not condoned or supported by the Qur'an or the Hadith

Mental health international epidemiologic data

demonstrate: n  rate of schizophrenia in Muslims is similar to that of non-Muslims. n  Higher rates of depression in women versus men (as seen in U.S populations)

•  Anxiety disorders as prevalent in Muslims as in non-Muslims, •  High rates of PTSD in Muslim men and women facing post-9/11-related trauma and discrimination (Abu-Ras & Abu-Bader, in press).

Disorders also seen n  Post traumatic stress disorder n  Major depressive disorder n  Generalized anxiety disorder n  Panic Disorder

•  Adjustment disorder •  Somatization. •  Psychosis •  Substance Abuse

Addiction •  The low rate of alcohol abuse in Muslim

countries also true for adherent Muslim populations in the United States

Hanolt •  Muslims born in the U.S. are more likely to

drink than immigrant Muslims Haddad, 1987 •  Drinking alcohol is taboo, Muslims who do

drink are less likely to report their use out of shame.

•  South Asians chew areca nut (in the leaves of betel nut plant) which, when combined with smokeless tobacco, raise cardiovascular disease risk factors Croucher, 2002 , Warnakulasuriya, 2002

•  Use of tobacco and culture-specific psychotropic substances is more rampant and problematic Zaman et al., 2004

•  Ethiopian Muslims chew khat, a tea- like plant used recreationally for its release of amphetamine-like substances Alem et al, 1999

•  Hookahs are becoming increasingly popular among Muslims and the broader American community

suicide   Suicide is strictly forbidden in Islam

because it supposedly curtails the possibility of entrance into religious Paradise. Generally low suicide rates are seen across.

.

•  Low rates of completed suicides are reported in Muslim countries. •  Suicidal ideation and attempts are relatively high, particularly in young women experiencing intergenerational conflict, domestic violence

Family Unity and Elderly

•  Extended and multi-generational households are common for Muslim Americans.

•  The elderly typically live with their adult children who provide care

•  The Muslim family provides security and all essential personal, emotional and material support to its members

Al-Haj, 1989 Hassouneh &Kulwicki, 2007

Watson, 1995

•  Community support, commitment, and sharing of responsibilities and obligations are valued Abu-Ras, 2003 •  Members of collectivist cultures depend on each other as well as institutions and organizations for social support, security, safety, and acceptance Buda & Elsayed-Elkhouly, 1998

Without such customary support systems, isolation and loneliness can set in. This may impede adjustment to U.S. society, and increase vulnerability to stress or trauma

Women in Islam n Islam sees a woman as an individual in

her own right, with the right to own and dispose of her property and earnings.

n A marriage dowry is given by the groom to the bride for her own personal use, and she keeps her own family name rather than taking her husband's.

Honor killing

n  An honor killing is the homicide of a member of a family or social group by other members, due to the belief of the perpetrators that the victim has brought dishonor or shame upon the family or community.

n  It is a traditional practice that occurs in various cultures

Aasia Zubair

MUSLIM MAN AGAINST DOMESTIC VIOLENCE

n  "Imams Speak Out: Domestic Violence Will Not Be Tolerated in Our Communities," asking all imams and religious leaders to discuss domestic violence in their weekly sermon or their Friday prayer services.[

Youth

n  Muslim youth may be at higher risk for anxiety and depression (Al-Hinai 2006), religiosity appears to be a protective factor Vasegh&Mohammadi2007

•  Studies conclude that religiosity is an important positive factor in negotiating the stress of acculturation

Amer & Hovey, 2007

•  religiosity and spirituality are positively associated with adolescent peer group status, academic achievement, emotion regulation, pro-social behavior, and self-esteem, as well as educed antisocial/problem behavior and internalizing behavior French 2008

Religious beliefs and cultural identity among Muslim youth and adolescents may impact the way they address issues of substance use, immigration, and the need for peer affiliation. Marsiglia et al.,2005 , Timimi, 1995, Bhuiet al 2005 , Newman 2006

n While  religiosity  is  a  protective  factor  for  mental  disturbance,  perceived  religious  discrimination  has  been  shown  to  in9luence  sub-­‐clinical  paranoia  in  Muslim  American    youth    

n                                                                                                                                                                                                                               Rippy  &  et  al

Why so serious?

n  A Yale University Study demonstrated that 50% of all Arab Americans surveyed had clinical signs of depression.

Amer 2006

In interviews with three hundred thousand US households, “anger, stresses, and worry are more likely to be reported by some groups of Muslim Americans than by their racial counterparts and other faiths” Gallup Center for Muslim Studies "Muslim Americans: A National Portrait."

•  Muslim Americans were the least likely religious group to be thriving, especially when compared with Jewish Americans and Mormons. •  Muslim youth age 18 to 28 were the least happy and most angry compared to the youth of other faith groups.

Beyond 9/11

in structured interviews of New York Arab Americans regarding the 911 attacks participants identified several common areas of concern including:

n  fear of hate crimes n  anxiety about the future n  threats to their safety n  loss of community n  isolation n  stigmatization.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Wahiba  Abu  Raas  

Fight, Fright, Flight n  Immigration, legal, illegal or as a refugee

is a traumatic and stressful experience, fraught with hardships, fear of the unknown and social disruption.

Refugees additionally have to deal with the consequences of exposure to violence and political oppression with severe and lasting impacts on mental well being.

Cultural Bereavment n  Loss of familiar sights, sounds and smells. n  Language barriers. n  Norms, values and cultural beliefs, stark

contrasts to host country.

•  collectivistic to Individualistic focus. •  interdependent to Independent thinking. •  change of economic and social status. •  lack of social support. •  racial discrimination.

“ It’s All In Your Mind”        “Minority status, experiences of prejudice

social and economic disadvantages and communication barriers become a lamentable part of daily life adversely affecting the immigrant’s mental state

                                                                                                                                                                                                                                                                                                                                                                                                                                       Saeed  Islam  

Given cultural and ethnic mismatches between caregivers and patients, mental disorders, especially depression, often are not recognized in immigrant populations.

Objectives

n  Improving awareness of the frequency and importance of mental health issues

n  Training Imam’s/chaplains to better understand behavioral disorders, handle mental health crises and to be able to refer to mental health services.

•  decreasing the sense of isolation by teaching cultural competencies to the non-Muslim providers •  education about Islamophobia as a form of racism •  creating more understanding around spiritualism /religious practices.  

n   provide health related information in various languages and improving access to interpreters.

n  Train cultural consultants and advocates to help navigate complicated health care systems

•  dealing with acculturation issues to improve integration in the host society by improving language skills, cultural understanding, community support and vocational skills.

Proposal

•  We propose a Community Engagement Project for the Muslim Community to address stigma and thus improve access to and the acceptance of mental health care in these communities.

Goals

n  Awareness n  Acceptance n  Access

Hierarchy of Help-Seeking

Alternative Medicine Practitioner Community Elder Religious/Spiritual Leader

Primary Care Provider

Mental Health Services

Family - Immediate or Exended

Acceptance

Acceptance Self Awareness

Social Adaptation

TOLERANCE COLLABORATION

AVOIDANCE ACCEPTANCE

COEXIST

TOLERANCE COLLABORATION

AVOIDANCE ACCEPTANCE

COEXIST

THE OTHER’S NEEDS

O U R N E E D S

awareness n  active listening n  cultural sensitivity n  trauma management n  community-based activities n  community empowerment

ACCESS n  Barriers to care n  Health Disparities

n  Faith Based Mental health

Role of the Islamic centers n  This growing population relies heavily on

Islamic Centers to support their social, religious and spiritual needs.

� The Islamic center of Lansing is continuously expanding to keep up with this growing demand. During a recent Friday congregation 700-1000 people attended, including children and women

MUSLIM MENTAL HEALTH CONFERENCES

n  First conference in 2009-Islam and Mental health

n  Sixth conference –April 24-26 2013 in Dearborn n  “Barriers to Access to mental health care” n  Average attendance-100-200 n  Targeted audience-students ,residents, mental

health providers n  Muslim community, Islamic centers and Imams.

Impact Factor

n  Awareness of Islamophobia. n  Cultural competency trainings n  Trained cultural aides MSU n  Collaborated with SAMHSA, Minority

fellowship-American Psychiatric Association, Psychiatry Department Michigan State University College of Osteopathic medical school.

Impact factor

n  Increased awareness in Muslim community regarding mental health issues

n  More willingness to access mental health treatment

n  More than 300 Imams and community leaders trained as First Aid Mental health providers over the years.

n  Successful collaboration with local Islamic center.

References   Muslim Mental Health inc. with Nathan Kline Institute: Muslim Mental Health Guidelines.

Osman Ali Clinical Assistant Professor Bellvue Hospital Wahiba Abu Ras PhD Assistant Professor, Adelph University Hamada Hamid DO MPH Fellow, Neurology, Yale University