Refinery 29 UK
In 2018, a report submitted to the government as part of an independent review of the Mental Health Act concluded that “profound inequalities exist for people from ethnic minority communities in accessing mental health treatment.” Research overwhelmingly suggests that those from Black, Asian and minority ethnic (BAME) communities are more likely to suffer from mental health issues than their white counterparts.
“Have you tried therapy?” Many of us who have experienced mental health issues will have heard these words. What I have come to know, as a British Pakistani Muslim, is that therapy is difficult in a different way for those of us who have intersectional identities. Instead of a place to explore our trauma, therapy can quickly become a place where we have to explain our non-white selves as well as our culture and faith practice because those we are speaking to have no reference point by which to understand us other than what is said in the media.
Cognitive behavioural therapy (CBT) is one of the most commonly used therapies to treat anxiety and depression. It is regularly available on the NHS (although there are waiting lists) but because of the way in which NHS CBT is practised, it is secular and void of faith consideration. In my experience of therapy, only the parts of me that the counsellor could understand were seen and acceptable; the other parts weren’t discussed further because they were alien. Or my faith was considered to be the problem. And so, for me, therapy became yet another trauma to live through rather than the safe haven it was promised to be.
Further research conducted by Muslim Youth Helpline (MYH) and researcher Jamilla Hekmoun showed that over a third (37%) of younger respondents aged 16 to 22 went to nobody for support and when asked, “Do you feel you have enough easy access to help when you need it?” more than 40% answered, “No, not really”.
Aisha, 24, has been going to therapy since the age of 19 for her depression and anxiety. Over the years she’s seen a few therapists and her current therapist is a woman of colour. When I ask her why she wanted to have a Muslim therapist, she tells me that she worries about “giving the community a bad name” when speaking to a non-Muslim therapist because she has no idea what their point of reference will be when treating people from her cultural and religious background. Aisha echoes a sentiment that many have shared with me while also highlighting a very real fear of being judged by the preconception that Muslim women are “oppressed or submissive” and have no agency within their community and religion. Often those of us with intersectional identities live between or within two cultures and when it comes to mental health, both of these cultures can hold stigmas around going to therapy or suffering from mental health issues.
For a British Muslim, therapy can become a place where we have to explain our non-white selves as well as our culture and faith practice.
In some cases, this can lead to young Muslim women giving up on mental health services altogether, to their own detriment. I also speak to Jodie Wozencroft-Reay, a Muslim convert who is a holistic cognitive behaviour psychotherapist. She weaves her faith into her therapy practice with clients. “I’ve been on both sides!” she explains to me. “After experiencing an Islamophobic attack, I took this to therapy with me and I remember the therapist saying, ‘Does that really happen?’ and that moment felt invalidating because my experience was being denied. With a non-Muslim practitioner, my faith identity felt denied.”
She continues: “Muslim women often experience barriers to accessing mental health spaces due to the guilt, shame and blame associated with not fitting the stereotypes expected of them. Not only does this prevent them accessing those spaces, it exacerbates their mental health struggles.”
Jodie adds that her faith now informs her work. Prior to her current role, she worked with children and young people and was unable to bring religion into her practice. “Putting on a secular hat just felt wrong with some patients,” she explains. This is important because, as Aisha notes, there can be a huge amount of stigma surrounding mental health within the Muslim community. “The notion of jinn [being possessed] comes up a lot with clients,” Jodie explains. “I think this is all a wider part of a lack of education of how mental health is addressed in the Quran and hadiths [the teachings of the Prophet Muhammad]. So I make my practice of CBT compassion-focused while maintaining a consciousness of God throughout. For example, I’ve used faith in practice to challenge the client’s inner critic and remind them Allah is merciful. One client decided that every time they had certain thoughts they would pray two rakats [a voluntary prayer] and this has transformed their life.”
One of the other prevailing cultural stigmas in Muslim communities is that struggling with mental health issues means you have a ‘weak’ commitment to faith and you should pray more. Although this seems to be the attitude of elders in the community who potentially weren’t afforded the opportunity to discuss their own mental health issues, and is recognised as problematic, it has been seeded in the minds of the younger generations.
The Muslim Youth Helpline (MYH) is a free national service founded almost 20 years ago by three Muslims who felt a safe space for their community to discuss these issues was lacking. Director Maaria Mahmood tells me that many of the callers who use the service are looking for some sort of spiritual guidance or having a crisis of faith. MYH doesn’t give advice but it does offer a counselling service which focuses on active listening and signposting to other organisations as well as imams and masjids [mosques] within the community who they have worked with for a long time and can support those in need.
Putting on a secular hat just felt wrong with some patients … So I make my practice of CBT compassion-focused while maintaining a consciousness of God throughout. Jodie Wozencroft-Reay
Twenty-six-year-old Shahed initially suffered from severe anxiety attacks at university. When she told her mum that she was going to therapy, her response was that “anxiety is a part of life”, which Shahed felt brushed away her struggles and made her feel “isolated and lonely, and sometimes as if I was making it all up in my head. Or as if I was leading this double life. I think it’s made me feel more distant from my parents, because they either don’t fully believe the extent of my anxiety or just don’t know from me subsequently hiding it.”
Mental health support is particularly important for young Muslim women. Shaista Gohir is the co-chair of the Muslim Women’s Network UK (MWNUK), which has been running a free helpline for six years. “Domestic violence and mental health issues are quite significant,” she explains, “and unfortunately the NHS doesn’t meet the needs of the BAME community in terms of mental health. Religion is quite important – for many, it’s a coping mechanism and this seems to be disregarded in mainstream counselling.”
Shaista tells me that NHS waiting lists for mental health services are long. Last year, a report by NHS Digital into IAPT (Improving Access to Psychological Therapies) found that 87.3% of patients who were referred to talking therapies were seen within six weeks. However, a patient’s second appointment is where the regular treatment begins and the BBC reported that one in six patients waits over 90 days for a second appointment. Between the first and second appointment, many are left in limbo. Shaista adds: “Another barrier for many of these women, especially older women, is the language barrier. MWNUK counsellors are able to speak Urdu / Punjabi / Mirpuri and we are now looking for counsellors that are able to deliver sessions for us in Arabic and Bengali.” Between long waiting times and language barriers, who, if anyone, are these women turning to in their hour of need?
Among my own friendship group, the question “How do I even begin to find a Muslim therapist?” comes up again and again. I usually direct people to the Muslim Counsellor and Psychotherapist Network, a directory of Muslim therapists and counsellors founded by counsellor Myira Khan. “Is it expensive?” is often the next question and yes, therapy is expensive. That’s why an organisation like MWNUK, which offers free therapy to Muslim women, is incredible but extremely oversubscribed.
There is still so much stigma when it comes to how Muslim women struggling with their mental health can access support. Yet there is hope. Spaces are being created for those who need help, offering them the chance to be vulnerable without stigma and without dehumanising their experiences, and that has to be better than nothing.
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