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D i v e r s e a p p r o a c h e s t o m e n t a l

h e a l t h

SEMINAR

OUR AGENDA TODAYA significant movement towards a more resilient, inclusive society.

Nuzhat Ali

Vice-Chair

PHE Muslim Network

Abdul Ghafoor

Chair

Muslim Network Collaboration

Baroness

Ruby

McGregor- Smith

Tony Vickers-Byrne

Clare Moriarty, DEFRA

Jonathan Jones, Government

Legal Service

Professor John Newton

Chief Knowledge Officer

Public Health England

Isabella Goldie

Mental Health Foundation

Dr Ghazala Mir

University of Leeds

Emily Danby

MIND in Harrow

Bridging Cultures Coordinator

Ian Dalton

NHS Improvement

Chief Executive

O P E N I N G &

I N T R O D U C T I O N

A Y E A R I N

R E V I E W

B U I L D I N G A D I V E R S E A N D

I N C L U S I V E C I V I L S E R V I C E

F A C I L I T A T I N G L O C A L A N D

N A T I O N A L A C T I O N

C U L T U R A L I N F L U E N C E S

O N M E N T A L H E A L T HI N T E R A C T I V E S E S S I O N C L O S E

D R I V I N G D I V E R S I T Y I N

T H E W O R K P L A C E

A b d u l G h a f o o r

A y e a r i n r e v i e w

WALK IN THESE SHOES

INDEPEND-

ENTLY

TOGETHER

THE ART

OF

THINKING

DIVERSITY:

● Learning ● Perspective ● Experience

ART

T H E I M P O R T A N C E O F D E T A I L I NT H E A R T O F T H E C A R E O FT H E P A T I E N T

I f y o u t r y t o m a r k e t t o e v e r y o n e

y o u w i l l e n d a p p e a l i n g t o n o o n e

Q u a l i t y &

r e l e v a n c e

e x i s t s i n t h e

d e t a i l

1 .

2 0 1 7

But what

does th i s

mean in

re la t ion to

I s lam?

B E L I E F I N O N E G O D

Creator

Every organism & entity

Environment & elements

Sustainer

Every breath & heartbeat

Health & provisions

All-Knowledgable

Individual & CommunityWhat’s best for us

A M E S S A G E

R E P E A T E D

T H R O U G H O U T T I M E

From Adam to Muhammad

Role models

Guidance

Direction and principlesInsights (embryology, environment etc.)

Preventive measures

A U D I T A N D

A C C O U N T A B I L I T Y

Reward and recompense

Every person will be judged

based on their conduct and

intention

Responsibility

To God, family, those in need

and one another

S P I R I T U A L P R A C T I C E S A R E

A S S O C I A T E D W I T H B E T T E R

H E A L T H & W E L L B E I N G

Directed focus

Inward-looking reflection

Contemplative practices

o Increase compassion and empathyo Quieten the mind

Prayer elicits the relaxation response

o Gratitude & love

o Awe & fear

o Commitment & help

F a i t h b r i n g s

u n i q u e

p e r s p e c t i v e

a n d p r a c t i c e

2 .

Fa

ith

id

en

tif

y &

va

lue

si n f l u e n c e s o c i a l d e t e r m i n a n t s

L I S T EN I N G

T O S T A F F

I N CR EA S E

A WA R EN ES S &

E N G A G EM EN T

S UP P O R T H E A L T H

D E L I VE RY &

C O M M UN I TY

A C C ES S

S T R A T E G I C F O C U SS H A R E D A M B I T I O N

Proposal | Business plan | Events calendar

MUSL I M NETWORK

LA UNCH

2 0 1 7

2 2 5

M e m b e r s

N a t i o n a l

c o v e r a g e

A w a r d

w i n n e r s

H E A L T H A C T I V I T Y

Public health management of mass gatherings: Hajj 2017

Compassionate management

Fasting, diabetes and the Ramadan health guide

Fuel poverty winter walkHajj vaccination and health advice

PROMOTED WORKSHOPS & COURSES

• Bioethics & Islam masterclassdelivered by the Centre for Islam and Medicine

• Faith communities andmental health

• Break free from depression• THRIVE activities• MHFA & wellbeing training• Tackling domestic violence and

abuse in faith communities• NHS Blood and transplant

development• NHSE Health literacy webinar

Culturally sensitive patient experience workshop

Research

Scope

Design

Develop

Pilot

Revise

Securing approval

Launch

Maintain

H o w d o y o u c h a n g e a t t i t u d e s a n d p e r c e p t i o n s ?

T

O

G

E

T

H

E

R

I n f o r m r e s e a r c h ,

c o - d e s i g n ,

i n c r e a s e

e n g a g e m e n t

a n d r e a c h

3 .

B a r o n e s s R u b y M c G r e g o r -S m i t hD r i v i n g d i v e r s i t y i n t h e w o r k p l a c e

C l a r e M o r i a r t y

P e r m a n e n t S e c r e t a r y , D E F R A

& C i v i l S e r v i c e F a i t h a n d B e l i e f c h a m p i o n

T o n y V i c k e r s - B y r n e C h i e f A d v i s e r - D i v e r s i t y a n d I n c l u s i o n a n d S t a f f

H e a l t h a n d W e l l b e i n g , P H E

J o n a t h a n J o n e sP e r m a n e n t S e c r e t a r y , T r e a s u r y S o l i c i t o r a n d

H e a d o f t h e G o v e r n m e n t L e g a l S e r v i c e a n d

C r o w n ' s N o m i n e eC i v i l S e r v i c e H e a l t h a n d W e l l - b e i n g C h a m p i o n

B a r o n e s s R u b y M c G r e g o r - S m i t hS e n i o r a d v i s o r a n d P o r t f o l i o D i r e c t o r

B u i l d i n g a d i v e r s e a n d i n c l u s i v e c i v i l s e r v i c e

P r o f e s s o r J o h n N e w t o nF a c i l i t a t i n g l o c a l a n d n a t i o n a l a c t i o n t h r o u g h t h e P H E P r e v e n t i o n C o n c o r d a t

COMMUNITY PARTNERSSignatories to the PHE Prevention concordat for better mental health

5 0 0 + A F F I L I A T E

M O S Q U E S ,

C H A R I T I E S &

S C H O O L S

1 , 5 0 0 +

H E A L T H C A R E

P R O F E S S I O N A L S

& S T U D E N T S

1 0 0 +

P R O F E S S I O N A L

N E T W O R K S &

G L O B A L R E A C H

1 , 0 0 0 + D I R E C T

S U P P O R T /

C O U N S E L L I N G

2 0 K O N L I N E

I s a b e l l a G o l d i eD i r e c t o r o f D e v e l o p m e n t a n d D e l i v e r y , M e n t a l

H e a l t h F o u n d a t i o n

D r G h a z a l a M i rA s s o c i a t e P r o f e s s o r , U n i v e r s i t y o f L e e d s

E m i l y D a n b yM I N D i n H a r r o w , B r i d g i n g C u l t u r e s C o o r d i n a t o r

T h e i n f l u e n c e o f c u l t u r e a n d s o c i e t y o n m e n t a l

h e a l t h

Addressing Depression in Muslim

Communities

Ghazala MirShaista Meer, David Cottrell, Ruqayyah Ghani, Muhammad

Shabbir,

Dean McMillan, Allan House

Leeds Institute of Health Sciences, Touchstone Community Support Team

Sharing Voices Bradford, University of York,

Bradford District Care Trust

Higher levels and more chronic depression for some in Muslim communities compared to general population

97% of Pakistani people continue to have depression after a year compared to 45% in the general population after six months

(Spronston and Nazroo 2002)

2017 National IAPT data analysis - under referral : 2% Muslim (5% nationally); at 6 sites: 3.32% (8.39%)

Poorer treatment outcomes

Suggests current treatment may be inappropriate

Background and rationale Culturally appropriate treatment - promoted by NICE (2009) and

Department of Health (1999;2005)

Faith-sensitive therapies - potential to reduce levels of

depression and improve wellbeing (Koenig et al 2001).

People from Muslim backgrounds – religion a prime identity

(Nazroo 1997; ONS 2011) more likely to use religious coping

techniques for mental illness than other faith groups in the UK

(Loewenthal, Cinnirella et al. 2001);

Behavioural Activation (BA) - proven effective in clinical trials

(Ekers 2007). Focus on client values promising for adaptation to

meet the needs of Muslim clients.

WHY MUSLIMS? ‘Privileging’ /reducing disadvantage?

Socially included groups

Socially excluded groups

o Under referral/lower use of services

(access/stigma)

o More environmental stressors

o Higher levels of comorbidity

o Low representation amongst

therapists

Meeting

unm

et

need

Four phases broadly follow MRC guidelines for development of complex interventions:

PHASE 4: Piloting

Methods

PHASE 1:

Synthesis of

literature

(Walpole et al

2013)

PHASE 2: Interviews

with 29 key

informants

PHASE 3: Synthesis and

production of treatment

manual – 3 Advisory Groups

Lack of training reinforces poor engagement

with religious values; low confidence; potential

to replicate social exclusion

Social/historical context - negative

perceptions of Islam/religion vs. accepting as a

valid value framework

Attitudes towards religion/Islam in Western

culture - a private matter, ‘unprofessional’,

‘inferior, immoral, dangerous’

Overrepresentation of psychiatrists

without religious beliefs in the UK and US

EUROPEAN SOCIAL CONTEXT

Therapy flexibility

Islam-focus

BA-focus

Intervention will always be 100% BA

Reframe relationships

BA/Islam parallels

Sadness and grief are as normal responses to

difficult life events

not abnormal or ‘mad’

Stigma unjustified

think positively about self

Discouraging self-criticism or low self-

esteem

Hope feel less alone

being active

congruence between beliefs and actions

spend time on

self

look after self physically.

don’t just rely on God

small changes can have a major

influence

discourage extremism / obsessive behaviour

Develop meaning in life

Resilience

positive outlook

positive ways of thinking

Active response to the risk of harm

encourage interaction with

others

refocusing thoughts

Reduce isolation

Reframe experience

Self-help booklet: BA and Islamic

teachings

BA approach Being active/doing your part

Client booklet “Tie your camel”

“Prophet Muhammad (pbuh) noticed a Bedouin leaving his

camel without tying it. He asked, "Why don't you tie down your

camel?" The Bedouin answered, "I put my trust in Allah." The

Prophet said, "Tie your camel first, then put your trust in Allah"

(Tirmidhi)

Practice Case Study

BEFORE TREATMENT

Focus on punishment of Allah

Negative interpretation of ‘Sabr’ (patience)

“I’m not good enough…. I felt Allah had left me”

“There is nothing I can do”

AFTER TREATMENT

Began seeing her experiences as a ‘test’ and normalising this

Reasons to think about Allah’s mercy more than punishment

Understanding her own role as proactive

• Setting goals in line with her values.

• ‘Tie your camel’ teaching helped her.

Listing enjoyable things and not feeling bad for engaging in these.

Conclusions

• Fusion of frameworks

responds to needs, increases

referral rates

• Treatment does not

undermine or ignore values

• Enthusiasm of service users

acceptable to therapists

• Increases choice

• Requires support

Non stigmatised

model

Culturally acceptable framework

Positive interpretations

Mir, Ghazala, et al. "Adapted behavioural activation for the treatment of depression in Muslims." Journal of affective disorders 180 (2015): 190-199.

+ other resources

http://medhealth.leeds.ac.uk/info/615/research/327/addressing_depression_in_muslim_communities

This presentation presents independent research commissioned by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1208-18107). The views expressed are those of the author(s)

and not necessarily those of the NHS, the NIHR or the Department of Health

E m i l y D a n b y

C o m m u n i t y e n g a g e m e n t f o r m e n t a l h e a l t h i n i t i a t i v e s

Your Task• 6 groups (about 15 people per group), each around a flipchart.

• 30 mins- 3 questions. Please move on when the question changes.

• Pool your experiences- everyone contributes

• No time for verbal feedback- make sure your facilitator understands

your point and it’s written clearly.

• Owned comments- your name or organisation.

Question OneAs an organisation or community, what are the obstacles you have faced to communicating health messages to a diverse community?

- Specifically mental health

- Difference in obstacles faced by community groups and statutory services?

Question TwoAs an organisation or community, what resources do you have to promote good mental health to a diverse community?

- What resources are you missing?

- How can you fill the gaps? E.g., partnership working

Question ThreeOutline one concrete goal for your organisation or community to achieve this year to improve the mental health of your diverse patients/community.

- Can be small, but must be tangible

- Break it up into smaller steps

Thank you!

Emily DanbyBridging Cultures Coordinator

020 8426 0929

e.danby@mindinharrow.org.uk

I a n D a l t o n

C l o s i n g r e m a r k s

Celebrate it every day.

Diversity is the one true thing we all have in common.