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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