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Mental Health stigma in Islington’s Somali community
Mental Health stigma in Islington’s Somali community
Executive summary Summary We found that there is an undeniable and deep-rooted stigma surrounding Mental Health within Islington’s Somali community. Stigma means people with a Somali heritage do not seek support when they experience mental health problems. This can have a devastating impact on their lives, their families and the wider community. There is a growing desire from people within this community to allocate resources to address this situation. This presents an opportunity to work with statutory services to firstly improve access to mental health services and secondly to provide sufficient education to members of the Somali community to improve outcomes
Context
● The Mental Health Foundation’s research has found that people from black and minority ethnic (BME) groups are more likely to disengage from mainstream MH services.
● Time to Change’s research found that a third of BME people report experiencing discrimination from within their own communities because of their mental illness.
● In 2017, Galbur Foundation and The Peel institute worked with young Somali to make a video about their experiences around mental health. The participants chose the theme of stigma, and explained its negative influence within their community.
● In 2018/19, The Peel and Galbur Foundation, with the support from Islington CCG have undertaken a community research project to further explore the issues around MH stigma within the Somali community in Islington.
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Findings Through a mixed method research involving community research, group discussions and a roundtable discussion with community leaders, we found that:
1. Young people showed greater awareness of mental health issues than their parents
2. Roughly a third of respondents said they had personal experience of mental health issues but only about half of these said they had sought any sort of help for these issues.
3. Young people did not immediately name problems with access or service design as the reason they had not sought help. Parents’ experience of mental health services was mixed
4. They did mention concerns about shame and a reluctance to discuss private or personal matters
5. When given possible reasons, most respondents said that stigma had stopped, delayed or discouraged them from getting treatment “a lot”
6. The Somali community is diverse in which some are well informed on matters to do with mental health and others less so. There are people of all ages and positions within the community who are keen to talk about their community’s experiences around mental health and want to take action.
7. The specific and traumatic experiences of many Somali parents caused by the civil war in Somalia and their journey as refugees add additional complexity to the situation.
Recommendations
1. Programmes to support Somali parents with their mental health 2. Build on Time To Change’s work to break down the stigma around mental health
in the Somali community 3. Educate community leaders and institutions on both mental health issues and
mental health services 4. Explore innovative approaches of bringing mental health services and the Somali
community closer together, for example: 5. Utilising Somali heritage mental health professional 6. Training representatives or clerics from mosques to lead their own mental health
sessions 7. Providing safe space where the community can access multiple services. 8. More bilingual staff, literature and services in the Somali language 9. Better partnership and collaboration between mental health service providers
and Somali charities Additional resources for charities that work with “hard to reach” members of the community
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Contents Executive summary 1
Summary 1
Context 1 Findings 1 Recommendations 2
Background 4 The Peel 4 The Galbur Foundation 4
Methodology 5 Designed questionnaire 5 Community researchers 5 Interviews with young people 6 Workshop for parents 6 Interviews with parents 7 Roundtable with community leaders 8
Results 9 A good understanding of mental health 11 Not asking for help 11 People did not immediately name problems with access or service design as the reason they had not sought help 12 When asked to what extent stigma had stopped from getting treatment most said “a lot” 12 Racism and a perception of intolerance were named as significant causes of exclusions, especially by young people 13
Feedback from parents and community leaders 14 Parents were shocked by the findings 14 They agree that stigma around mental health is significant in their community 14 Parent’s experience of mental health services was mixed 14 Community Leaders agree that mental health is a significant and unaddressed issue in their community partly because of stigma 15 Awareness of the issue is variable 15 The community can feel divided between young people and parents 15 The role of faith 15
Appendix A Questionnaire 16
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Background Islington is well served with youth mental health and other therapeutic services. However members of the Somali community, including young people, often do not access key therapeutic services. There is currently a lack of evidence-based analysis as to why members of this community do not utilise therapeutic services and what can be done to change the situation. This project is designed to build the evidence base. The Peel The Peel has been working with and supporting Islington residents for over 100 years. We have extensive experience of designing and delivering community based work with a range of partners and communities. We are Islington’s ‘Strategic Neighbourhood Partner’ for Clerkenwell. The Peel have a track record of engaging with diverse groups, including via youth projects, including the Eritrean Youth Club, Urban Hope Youth Project, Al-risala Mosque, Muslim Welfare House, The Challenge and Year 11 students at Highbury Grove Academy. Also parent groups at various children’s centres and primary schools, including groups of largely Somali mums at Duncombe and Pooles Park primaries. The Galbur Foundation The Galbur Foundation was founded 2014 and initially ran projects just in Africa before starting to deliver in Islington. Galbur are devoted to empowering local young people from disadvantaged backgrounds and helping hard-to-reach groups and their families to reach their potential and make positive changes in their lives. Galbur foundation undertook community research in October 2017 into the Somali community’s view of the arts. Galbur recruited, trained and supported bilingual Somali volunteers to speak to people in mosques, shisha cafes, women-only Somali cafes & shops on 7 Sisters Road. Findings from this work directly informed the development of Galbur’s ‘Promoting Mental Health through arts & culture’ programme. In 2018, in partnership with The Peel, they created the ‘Mental Health not Sihr’ film which they have since shown to groups of parents and held discussions around barriers the Somali community face around accessing therapeutic support services.
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Methodology Designed questionnaire An eight question survey was designed in partnership with Islington CCG. (See Appendix A for the survey) The survey was designed to understand respondent's views and experiences of mental health as well as their views about isolation and social exclusion. The survey included a shortened version of the “Barriers to Access to Care Evaluation BACE-3”, giving respondents the option of saying whether a given reason has stopped or delayed them from getting treatment. Some of the reasons are coded as being related to stigma (e.g. “Concern that I might be seen as ‘crazy’”) while others are not (e.g. “Being unsure where to go to get professional care”) Community researchers We recruited and trained people with a Somali heritage to be community researchers. During a half day workshops using a variety of techniques, we taught them:
● Interviewing skills ● Our approach to providing ongoing support ● Health and safety procedures ● Research ethic & data protection best practice
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Interviews with young people The community researchers then used the survey to interview secondary school aged Somali heritage young people in a variety of settings in the community including cafes and parks. Any young people identified as needing additional support were either referred to an appropriate agency or supported directly by Galbur Foundation mental health staff. Workshop for parents We analysed the surveys results and created an ‘initial findings’ document. We then presented and discussed our findings to a group of Somali heritage parents. These were not the parents of the young people. This was done in a community centre near the Al-Risaalah mosque.
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Interviews with parents Our community researchers then interviewed Somali heritage parents using the same approach and survey.
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Roundtable with community leaders Finally, we held a roundtable with Imans and other Somali community leaders to discuss both our findings and to explore possible recommendations.
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Results Numbers engaged
● We trained 5 Somali young people to be community researchers. ● The community researchers spoke with 30 young people of Somali heritage. ● We ran a workshop with 26 Somali parents (22 women and 4 men) to discuss our
findings and possible recommendations ● The community researchers spoke with a further 19 parents of Somali heritage ● We held a roundtable for 6 Somali community leaders including representatives
from Finsbury Park Mosque, York Way Mosque and Al-Risallah mosque Gender We had a roughly even gender split when interviewing the young people, but interviewed significantly more female than male parents. As might be expected, it was harder to reach dads than mums.
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Tenure Almost all of the participants said that their household rented their accommodation from Islington Council or a Housing Association.
Disability None of the parents we spoke with self-identified as having a disability or long-term illness, whereas a significant minority (9%) of the young people did.
Religion Unsuprisingly, everyone we spoke with identified as a Muslim.
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Analysis of survey results A good understanding of mental health The young people we spoke with had a good understanding of issues relating to mental health. They could name symptoms and conditions and spoke confidently on the topic. The parents’ understanding of mental health related issues was more varied. While some felt confident discussing the topics, others felt less sure.
What does ‘mental health’ means to you? Young People “A problem faced by our community which mostly caused psychological problems” “Mental health to me is the health of your mind” “A personal condition in regard to their psychological and emotional wellbeing” Parents “It covers many aspects such as depression, schizophrenic, madness, anxiety etc.” “Mental health consists 3 parts emotional, psychological and social wellbeing. It about how to handle or deal with stress and depression.” “Mental health means any disorder that comes to human being psychology or mentally”
Not asking for help Roughly a third of respondents said they had personal experience of mental health issues, higher than the national average. However, only about half of these said they had sought any sort of help for these issues.
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People did not immediately name problems with access or service design as the reason they had not sought help No respondents spontaneously mentioned problems with mental health services as the reason they had not sought help. Although in later discussion aspects of service design were mentioned, no one initially cited, for example, a lack of awareness of services, services not been open at suitable times of the day or previous bad experiences with services. People did, however, mention concerns about shame and a reluctance to discuss private or personal matters.
Please describe why you chose not to ask for help for your emotional or mental health needs
“I would not want to talk to somebody else about my emotions. I would rather keep my feelings to myself... I believe that certain emotions or feelings are too private therefore I would rather keep my feelings to myself” “I feel like what's done been done and can't be helped” “I don't think anyone can do anything about my problems that I cannot do for myself” “I feel as though even if you ask for help others aren't going to understand your situation. They'll act so different around you one they find out what your issues are”
When asked to what extent stigma had stopped from getting treatment most said “a lot” When respondents were asked, of a number of possible answers, whether “any of these issues ever stopped, delayed or discouraged you from getting, or continuing with, professional care for a mental health issue?”
● 61% said that stigma had discouraged them "a lot" from getting treatment. ● Everyone said an item from the list had discourage them "a little" and 79% said a
reason had discouraged them "a lot" ● People said that "Thinking I did not have a problem" and "Wanting to solve the
problem on my own" were most significant barriers ● “Not being able to afford the financial costs involved" and "Having had previous
bad experiences with professional care for mental health" were the least significant barriers
Young people Everyone said there were barriers to getting support and 3/4 said there were major barriers 55% said that stigma was a major barrier
Parents Everyone said there were barriers to getting support and 84% said there were major barriers 71% said that stigma was a major barrie
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Racism and a perception of intolerance were named as significant causes of exclusions, especially by young people None of the parents we spoke with said they had ever felt excluded but nearly 1 in 5 young people said they had.
Have you ever felt excluded? “when I went to school I was the only Muslim and little amount of black people” “at school I'm the only hijabi” “in primary school no one was my friend because I was different”
Similarly, around a third of respondents said that they felt that they couldn’t go to things in their local community.
Do you ever feel like you can’t go to things that are happening in your local community, or sign up to activities? Or do you ever feel like you can’t use particular services (health,
council run or community based)? “I won't fit in” “being cared of being judged for how I look” “Not enough activities for muslim girls. It's mainly for boys/men”
And many related isolation to their identity as Somali heritage Muslims
What does feeling isolated mean to you? Do you ever feel isolated? “Yes, when I'm in non-Muslim populated areas I feel out of place” “Yes, not being welcomed into a group because you're different” “Isolation means feeling like people don't see your emotional needs as being important. No I don't feel emotionally isolated, salah (prayer) and Quran help me emotionally”
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Feedback from parents and community leaders Parents were shocked by the findings When we discussed our findings with Somali heritage parents we found that they were shocked and saddened. Their identity as parents gave them a particular perspective on the situation, namely that:
● Parents have not had support for their mental health problems, for example relating to the trauma of leaving Somalia and so are unable to support their children
● Young people are more educated about mental health issues than their parents. Parents often aren’t aware of issues or services. This is one of a number of “language barriers” that mean parents find it hard to discuss these matters with their children
They agree that stigma around mental health is significant in their community There was a strong agreement that there is significant stigma around mental health in the Somali community.
● Mention was made of the “red scarf” and people being told to “make the fire by themselves” if they were labelled as “crazy”
There then followed an interesting discussion of how the workshop itself was useful breaking down stigma, as people were learning from other’s experiences. Parent’s experience of mental health services was mixed Parents had had mixed experiences with mental health services. We heard stories about:
● A time a parent had fainted at the GP when she had gone to seek support around anxiety
● A parent had talked with a professional but felt it had not made a difference ● Another talked about being given the wrong medication and the negative
consequences However, there was agreement that the parents would trust GPs to refer them and their family to specialists and would trusts hospitals in an emergency
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Community Leaders agree that mental health is a significant and unaddressed issue in their community partly because of stigma Everyone who attended the roundtable agreed that mental health is a significant issue in the Somali community. There was discussion around postnatal depression, teenagers experiencing anxiety and rates of loneliness and isolation. As one person put it “This problem is everywhere” Many of the participants highlighted the importance of gossip within the Somali community. People may hide their problems, not wishing to confide in leaders out of fear of gossip or young people may be scared to tell their parents for a similar fear. Particular mention was made of the ambivalent feelings people have around taking taking any medication, not just medication for mental health related issues. Awareness of the issue is variable While the Somali community is diverse and different people have different levels of awareness about mental health issues and services, there was consensus that:
● GPs are trusted and see as the main person to refer to ● There is widespread skepticism that talking therapies can solve problems ● Many have an ‘extreme’ picture of mental health and many only recognise very
severe mental health problems as being ‘real’ ● Imans are keen to grow their knowledge and confidence in this area
The community can feel divided between young people and parents The community leaders made reference to the “cultural conflict” that can take place within the community, with parents that don’t speak English and young people that “look like us but not inside like us” The role of faith Faith plays a complicated role within these discussions. On the one hand, there was a recognition that it is inappropriate for people with mental health problems to be simply told to read the Quran and scandalous that some people are charged hundreds of pounds for ‘ruqya’. On the other hand, there was a consensus of the need for a “middle ground” between Islamic faith and NHS services
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Appendix A Questionnaire The Peel & Galbur Foundation - mental health research 1.) Do you have personal experience of mental health issues? [ ] Yes [ ] No
What does mental health mean to you?
2.) Have you ever asked for help for any emotional or mental health issues? Yes [ ] No [ ] 2a.) if no, in your own words, please describe why you chose not to ask for help for your emotional or mental health needs, if yes, who did you ask and what was your experience of asking for help – what happened next (there is no right or wrong answer)?
3.) Why do you think you or someone like you might not get help for emotional or mental health needs?
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4.) Below are a list of things which might stop, delay or discourage people from getting professional care for a mental health issue, or continuing to get help. Have any of these issues ever stopped, delayed or discouraged you from getting, or continuing with, professional care for a mental health issue?
Not at all A little Quite a lot A lot Being unsure where to go to get professional care 0 1 2 3 Wanting to solve the problem on my own 0 1 2 3 Concern that I might be seen as weak for having a mental health issues 0 1 2 3
Fear of being put in hospital against my will 0 1 2 3 Thinking the problem would get better by itself 0 1 2 3 Concern about what my family might think, say, do or feel 0 1 2 3 Feeling embarrassed or ashamed 0 1 2 3 Preferring to get alternative forms of care (e.g. traditional / religious healing or alternative / complementary therapies) 0 1 2 3
Not being able to afford the financial costs involved 0 1 2 3 Concern that I might be seen as ‘crazy’ 0 1 2 3 Thinking that professional care probably would not help 0 1 2 3 No professionals from my own ethnic group being available 0 1 2 3 Concern that people I know might find out 0 1 2 3 Dislike of talking about my feelings, emotions or thoughts 0 1 2 3 Concern that people might not take me seriously if they found out I was having professional care 0 1 2 3
Concerns about the treatments available 0 1 2 3 Not wanting a mental health problem to be on my records 0 1 2 3 Having had previous bad experiences with professional care for mental health 0 1 2 3
Preferring to get help from family or friends 0 1 2 3 Thinking I did not have a problem 0 1 2 3 Concern about what my friends might think, say or do 0 1 2 3 Having no one who could help me get professional care 0 1 2 3
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5) Have you ever felt excluded?
If yes – can you please describe when and how?
6) Do you ever feel like you can’t go to things that are happening in your local community, or sign up to activities? Or do you ever feel like you can’t use particular services (health, council run or community based)?
-If no What sorts of activities have you joined in with, in your local community? And/or – what sorts of services do you use? If yes – when have you felt like this, and why?
7) What does feeling isolated mean to you? Do you ever feel isolated?
If no - Is there anything you do to prevent you feeling isolated? If yes -Is there anything you have tried doing to feel less isolated?
8) As a result of what we’ve discussed today, is there anything we can do to help you or someone like you with the issues discussed?
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About you First name: Surname: Address:
Tel: Post code: Email: Demographic information Sex: [ ] Male [ ] Female [ ] Non-binary [ ] Prefer not to say Date of birth: Does your household own or rent their accommodation? Religion Owns [ ] No religion [ ] Jewish [ ] Rent from a private landlord [ ] Christian [ ] Muslim [ ] Rent from the council [ ] Buddhist [ ] Sikh [ ] Rent from a housing association [ ] Hindu [ ] Other [ ] Do you have a disability, long-term illness or health condition [ ] Yes [ ] No
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