HEALTH: Addressing mental illness stigma in Somali diaspora

Monday, July 25, 2011

Post-traumatic stress, depression and anxiety disorders are the most common mental health problems experienced by Somalis who fled their country to settle in the UK, according to Abdi Gure, a community development worker for Mind, a mental health organization based in Harrow, north London.

Uncertainty over immigration status, housing and language barriers can compound mental illness but fear of being stigmatized may prevent sufferers from seeking support from their community as well as from the mental health services. 
"There is a perception that mental illness is incurable," Gure says. "In Somalia, our perception of mental health is very different. We don't have the equivalent word for 'depression' in the Somali language. We only think of mental health if someone starts behaving bizarrely and may pose a risk to others; authorities are only involved when the situation has reached crisis point."

Negative perceptions of mental illness mean those seeking treatment can end up feeling neglected and excluded from the community: "When someone suffers from other illnesses, he or she will get a lot of visitors, but individuals receiving treatment for mental illness don't receive the same level of compassion; often people fear for their safety and don’t visit them as a result," Gure said.

Gure has set up Hayaan, a voluntary organization that recruits and trains a team of "peer educators" from the Somali community to help increase awareness of and access to mental-health support in the wider community in Harrow.

Ali Ahmed, 41, is training to become a peer educator; he used to suffer from psychotic depression caused by substance abuse. His family, initially unable to understand his illness, sent him to Borama, in the self-declared republic of Somaliland, “to get married and settle down”, but when he failed to get better, his father called the police and placed him in detention against his will.

"They locked me up for a month in a mental health hospital," Ahmed said. "At that point, I was just depressed, but to them I was already gone."

Following his release, Ahmed went back to the UK and after hearing about Gure’s project, he approached Mind and was able to get the help he needed.

"There isn't a lot of support for people with mental health problems in our community; Hayaan provides that support," Ahmed said. "This is why I want to work as a volunteer here, I want to help others who are in the same position I was in."

Awareness-raising

There is a lack of data specifically relating to mental health in the Somali community, which could be due to the fact that Somalis are categorized as “Black African” on medical forms; it is not possible to disaggregate the number of Somalis seeking help for mental health from the available data.

The broad ethnic categorization adopted by the National Health Service (NHS) can hide the different needs of migrant communities from health providers, says Sile Reynolds, Mind's senior policy and campaigns officer.

Reynolds said: "Health services are still designed to meet the general needs of the population and do not necessarily address the needs of migrants. Service providers are struggling with getting information to migrant communities as well as getting information back from those communities. It’s a two-way process and the challenges that come with it have yet to be overcome."

The need to engage individual communities when delivering service was also highlighted in a report published in 2008 by the local health authority in Tower Hamlets — a borough in east London with a significant Somali population.

The report concluded that mistrust and misunderstanding of how mental health services worked prevented people from seeking professional help; participants, especially older women, believed those seeking treatment for mental illness were not given proper medication but were “tied [up] and put away in a room” or given an injection to subdue and vegetate them.

Many admitted that in the first instance, they sought the assistance of religious leaders to read verses from the Quran to an individual they believed “possessed by evil spirits” rather than contacting the mental health services.

The NHS in Tower Hamlet has now created the Faith in Health project , which works with local imams and mosques through the East London Muslim Centre to raise awareness.

Marie Carmen Burrough, the senior public health strategist for Tower Hamlets, said: "This month we facilitated a series of teachings and training sessions on mental health to equip imams with accurate and culturally appropriate information on mental health and illness, local services and how to access these. The imams are encouraged to disseminate this information further throughout the faith community via the delivery of Friday sermons and other community educational sessions."