Understanding the ‘complete’ patient: faith and mental health

sarah-profileSarah Hobbs

This article is part of Public Spirit series on Faith and wellbeing.

Currently, mental health assessments in the NHS take very little account of personal and contextual factors such as ethnicity, culture, class and faith – despite a number of GPs and community organisations highlighting the problems with this. In this article, Sarah Hobbs of the London-based award-winning social enterprise Maslaha introduces the project, ‘Talking From The Heart’, designed to directly address the distinctive mental health issues being faced by Muslim communities in the UK.

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A group of actors suddenly leap into action and personify the emotions of anxiety, fear, and hope. The group of Somali women who are watching the brief skit clap with approval, and we overhear one say, ‘this is exactly how I feel’.

It’s an interesting approach to tackling mental health issues, but as the manager of Midaye, a Somali-run organisation, tells me, ‘We’re a very visual and aural culture, that’s why film or theatre has a better impact’.

At the event, which was aimed at raising awareness of mental health issues in the Somali community, there was also a conversation about GPs attending a lecture on the importance of cultural understanding in the therapeutic process.

It is hard to believe that there still needs to be a lecture to make the case for understanding the faith or cultural landscape of a patient. This is especially important when dealing with such a complex subject as mental health, which can be affected by emotions, physical pain, social and environmental factors.

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“There is no word for ‘depression’ in Arabic, Somali, Sylheti or Urdu.”

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The rise of mental health issues in Muslim communities is a concern that is constantly raised in the course of our health work. During our work in diabetes, cardio-vascular disease and perinatal mortality, nurses and doctors have constantly raised depression as an issue among their Muslim patients. There is a recognition that not enough is being done to tackle this in terms of education for patients as well as practitioners.

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A still from a Maslaha film Talking From The Heart’ about mental health in Muslim communities

Resources are needed that widen the language around ‘mental health’ so that the vocabulary used makes sense to patients and their families. This may well involve using the language of faith but also using film, music, or art to create a more intellectually, emotionally, and spiritually relevant education campaign. And, as in our other work, practitioners and communities have to contribute to the making of these resources if deep change is to take place.

We frequently meet people who will never be heard in the mainstream media or give lectures to audiences of thought-leaders, practitioners and policy makers. Yet these very people in their consistent struggle to improve their communities are an immense untapped source of knowledge.

A Bangladeshi mother with three children recently described to us the difficulty of being with a husband who suffers from depression. She is the sole wage earner, living in a deprived area of London. She has some family support but her husband refuses to accept he needs any type of therapeutic help. There are also cultural taboos surrounding mental health which she has to contend with. This Bangladeshi mother told us how her story was repeated a number of time across the estate she lived in.

In partnership with AT Medics, London’s largest group of NHS GP practices, Midaye, and the Somali, Pakistani and Bangladeshi communities across London, we have produced a resource on depression and anxiety. ‘Talking From The Heart’ has been positively received by different sectors of the healthcare profession, community and faith organisations, and patients. We believe a large reason for this is because these same groups were involved in advising, creating and disseminating the resource. We combine faith, culture and medical perspectives, and use film, design and music to help reinforce health messages, with the ultimate aim of creating a new vocabulary around mental health. The resource is used in GP surgeries and hospitals as a resource and training tool but also in libraries, internet cafes, mosques, community centres and schools across the country as well as internationally. Our work permeates everyday environments and the resources become an organic process.

This diverse collection of partners with their varied perspectives and skills has enabled us to develop a practical, innovative resource, in spite of the fact that there is no word for ‘depression’ in Arabic, Somali, Sylheti or Urdu.

Developing the resource required talking to patients, therapists, Islamic scholars, GPs, imams, and members of the Somali community who may not feel comfortable accessing therapeutic services. It required a good listening ear and is in contrast to the standardised approaches that you might currently find in the NHS. At present questionnaires such as the PHQ9 are used by GPs to score whether a patient may be suffering from depression. This questionnaire does not take into account culture, faith, class or education and both patients and doctors have pointed out this obvious flaw. A standardised approach may be easier to implement and measure but it will not get to the root cause of problems and certainly not involve communities in the decision-making or creative process when tackling social issues.

A recent meeting with a local council illustrated the reticence, by no means unusual, to tailor a product or service, rather than be suitable for ‘the whole community’. This should not be an either/or situation; it depends on who makes up the ‘whole community’. The assumption that to be suitable for ‘everybody’ means ‘generic’ is by no means the best way of impacting communities. Particularly in a country as diverse as Britain, being suitable for ‘everybody’ means we should look closer at who ‘everybody’ is, and work accordingly in order to have resonance.

Professor Mohammad Hashim Kamali in his book, Principles of Islamic Jurisprudence, cites examples of scholars, academics, and philosophers discussing the need for a collective effort when applying Islamic law to social issues. The diverse nature of a country or society, and complexity of social issues demands input from the whole community, for example experts in medicine if dealing with issues around organ donation.

This kind of rich diversity, this mix of people is our most valuable asset during our projects and leads to unexpected innovation, new ways of addressing long-standing problems and new networks of collaboration for the future.

We need to understand the ‘complete’ patient, and use all the tools at our disposal such as faith and cultural language if we are to tackle some of the most pressing health issues affecting our communities.

Sarah Hobbs is Senior Project Manager at Maslaha, a charity that aims to tackle the most pressing issues facing Muslim communities and create a greater understanding of Islam from a cultural and historical perspective.

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All images courtesy of Maslaha. All rights reserved.

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