The mental health of British Muslim women
This is an edited version of a panel presentation that I gave to the Muslim Women’s Network (MWN), at their AGM on the 9th May 2014.
In 2009 the CQC conducted a the sixth and last census of the ethnicity of inpatient NHS and independent mental health and learning disability patients. This census revealed that 4% of patients reported themselves as Muslim. This, at the time was just above the representation of the British Muslim population. Additionally, this percentage only takes into account the number of Muslims with Mental Health difficulties in inpatient settings – it does not account for those who are being treated by their GP, or have not reported their poor mental health.
This gives you a flavour of the extent of mental health problems amongst Muslims in the UK.
Whilst I led the Muslim Youth Helpline mental health problems were the leading issue on the helpline, cutting across all other issues. Some 29% of calls related to mental health problems and these ranged from severe and enduring mental illnesses such as psychotic disorders to common mental disorders, like anxiety and depression.
Globally 1 in 4 of us are likely to suffer with a diagnosable mental health problem during our lifetime, so it is no surprise that British Muslims also suffer with mental health issues. However what I have observed is a concerning trend that British Muslims are becoming increasingly ill with poorer mental health outcomes. If this trend is left unchecked we will see significantly disproportionate numbers of British Muslims within inpatient care. Similarly to the disproportionately high number of Muslim prisoners in the UK.
My sense is that there are likely already high numbers of British Muslims dealing with mental health problems, however they are not being recognised and treated by mainstream services and organisations, thus neither are they getting the appropriate and adequate support. Often the most marginalised, with poor educational and employment outcomes, British Muslims are often hard to reach. And they are becoming progressively isolated as they are continually scrutinized and every aspect of their life is examined – from schooling to what they eat and wear. This scrutiny comes on top of the existing continual questioning of our identity – are you Muslim? British? English? And which one comes first.
A particular concern is that of the mental health of young South Asian British Muslim women. Data from NICE (National Institute for Health and Clinical Excellence) indicates that South Asian women do not necessarily suffer with higher rates of mental disorders. Yet research also tells us that South Asian girls in particular Muslim girls are at high risk of bulimia, self harm and suicide. However simultaneously, research examining the rates of mental health issues such as eating disorders indicates a low percentage of women using services.
Clearly there is a puzzle here – why are we seeing low numbers (or at least not significantly high?) of South Asian women presenting to services yet they are at risk of suicide and self harm? Through my experience of working within these communities, I can only conclude that, as mentioned previously, that mental health problems amongst these communities remain unrecognised and undetected. Also many young women speak of a fear of contacting mainstream services – a fear of being misunderstood, and a fear of their culture being blamed as the sole and root cause of their issues. There is huge mistrust and often young girls are stereotyped. Services often fail to understand the nuances of culture and faith. At one extreme they diagnose and manage young South Asian girls on the basis of broad stereotypes or on the other are scared of taking appropriate action when a young girl is in harms way in case they are culturally insensitive.
The following case studies (trigger warning) were presented to the audience, to provide a picture of the types of issues faced by British Muslim women in the UK. Details of the case studies have been changed to protect the confidentiality of the service users.
Hawra
Hawra is a British teenager from an Arab background who suffered various forms of abuse, including violent abuse, at the hands of her former boyfriend. After reporting him to the police and pursuing charges against him, he has continued to call and threaten her with violence if she does not drop the charges.
She did not receive any support from her family, despite informing them of the abuse, as they felt her having previously been in a relationship brought shame onto the family. As a result of this pressure, Hawra considered dropping the charges and marrying her ex-boyfriend. Hawra felt she needed an additional layer of support, to the support she was receiving from mainstream agencies, that would help reconnect her to her community and family.
Fahmida was British woman from a Pakistani background in her early twenties who was looking to move away out of her parental home. It became apparent that Fahmida had been beaten by her parents, and had suffered other forms of abuse, over a long period of time. She had hoped for many years that the abuse would stop as she became older. However when this did not happen she felt moving away would be the only recourse to stop the abuse.
Fahmida
Fahmida sought help through a support worker at university, but she felt that she also needed support from someone who understood her cultural and faith background. She has found the idea of moving out of home difficult as she was afraid she may be ostracised from her family and community as a result.
Fahmida wanted a safe space in which she could discuss her options with those who will understand the aspects of her problems related to her faith and cultural background, without fear of being either judged or misunderstood.
Hannah
Hannah was a 17-year-old Muslim girl living with her parents at home. One night she had an argument with her father and left her home at 2am, after which she was then attacked and raped. Hannah later found that she was pregnant and had an abortion. During her ordeal at no point did she disclose the rape attack either to the police, friends or family or to any other statutory professional. Neither did she seek help and emotional support whilst making the decision to have an abortion.
Hannah had eventually told her aunt about the rape. Her aunt responded negatively blaming Hannah for her ordeal. As a result Hannah felt isolated and had feelings of guilt and anxiety, saying that she felt “broken and empty”. Hannah stated that she couldn’t talk to someone face to face.
Sophie
Sophie was a 22 year old girl suffering with bipolar disorder. She had a very difficult relationship with her father and her family did not accept her condition as mental illness. She was receiving help from a psychiatrist who recommended a talking therapy known as Dialectical Behaviour Therapy, however her parent’s did not agree to her attending this.
Sophie was raped in her childhood by a close relative, however her family swept this under the carpet and did not do anything about it. During Sophie’s early teens she started to get depressed, this affected her life at school when she started to truant and smoke cannabis. Since her late teens, she has been taking medication however her condition worsened with her being violently abusive towards her young brother and other people on the street. Her doctors knew about her behaviour and her psychiatrist has asked her to voluntarily admit herself into specialist care. If she didn’t do so then it is likely that she would be sectioned.
Recommendations
In short, mental health problems in British Asian communities are a challenge we must deal with collectively – both in terms of mainstream services and attitudes inside communities. If we allow our feelings of shame and denial to continue to stop ourselves or those around us from seeking help, then we risk not only failing young Asian people but also creating a situation in which in twenty years time, Asian people will be nearly 18 times more likely to end up hospitalised for a mental health disorder.
In the same vein, mental health services need to ensure that the recommendations made by the Department of Health in 2005 in it’s action plan ‘Delivering Race Equality’ are actually delivered. It’s widely recognised failure underscores the need for a deeper official inquiry into the state of our mental health services, and their chronic incapacity to cater sufficiently for BAME groups.
Ultimately, better services require a different approach: engaging with communities effectively, in a way that is culturally and faith sensitive, providing better information to both communities and health professionals, better monitoring of ethnicity, and finally more research to understand the complex multifaceted factors affecting the mental health of Asians and Muslims within the UK.
Akeela Ahmed MBE 