The search for acceptance

As a Muslim, my adolescent years were a particularly difficult time of my life. My appearance and lifestyle seemed to be worlds apart from the peers I tried so hard to fit in with – I wore a hijab, never came close to experimenting with alcohol, needed permission to go out with my friends and could not, under any circumstances, talk to boys. Adolescence is often, for everyone, a time of wishing to fit in with peers whilst also striving to develop a sense of individual identity. In a Muslim community it's just the same, but with the added challenge of developing an identity within the religious community and wider society too.  

Things which were simply a part of life for my peers were unheard of to me. While this was challenging in itself, struggling with my mental health alongside this did not always help. The stigma around mental health occurs worldwide, but it is often still dismissed in Muslim communities as something which young people (and adults) are immune to. Common responses to mental illnesses I have heard over time include "you need to have more faith in God", or "if you prayed more, you would not have depression". The most frequent response to a suicide in our communities is "suicide is a sin, that person cannot be forgiven by God". 

At a time of social development, hearing comments like these can leave young Muslims lacking acceptance from their own religious community, whilst often also struggling to find acceptance in wider society due to their beliefs and lifestyle. 

Barriers in accessing services 

As someone who accessed CAMHS as a service user, then later began my career in mental health in inpatient and then community CAMHS, I have always felt a close connection to the service. Through both personal and professional experiences, I noticed a number of barriers that young people from Muslim communities can face when accessing mental health services. 

One such barrier is around parental input, which is rightfully valued in CAMHS. Whilst ensuring young people have strong social support, the potential judgement from families can prove to be more of a hindrance than anything to mental health. Developmentally, adolescents may already place more value on the influence of peers over parents, albeit depending on context (Biddle et al, 1980). With the added concern of parents struggling to even acknowledge the challenges of mental illness and a fear of judgement, deciding to access mental health services can be particularly daunting.

Although I was lucky enough to have a family willing to learn about mental health to help and understand me, I faced similar challenges in fear of disappointing them or facing their own stigma. A large element of this came from perception and this concept of "family reputation" within our Muslim community. To this day, talking or even sitting here and writing about my experiences fills me with fear of judgement from my community or how my family will be perceived once people know I have struggled with my mental health. So as a teenager, with far less confidence than I have now, this was a massive barrier in even opening up to my parents and is something which many young people struggle with. 

Aside from barriers within the Muslim community, fear of potential discrimination or more specifically Islamophobia from healthcare professionals can also act as a barrier. For young people, exposure to racial discrimination can be a daily battle. It exists in schools, on public transport and increasingly on social media which are all major parts of life. This can easily prevent people from attempting to access mental health services out of fear of potential discrimination, either perceived or actual, from professionals intended to help and support. 

Barriers within services

Perhaps when considering the developments we have made in fighting the stigma around mental health, particularly from the younger generation who seem more able to share experiences and discuss the topic, it may be that the most challenging part is what happens when we actually do access services. We might make the decision to open up in a Muslim community or family where shame and stigma are associated with mental illness, only to be faced with mental health professionals who, like the peers we seek acceptance from, are nothing like us. Mostly through no fault of their own, they cannot understand the challenges, shame and pressure young people from Muslim communities, and other minority backgrounds, face to bring them to the point of actually accessing services. This may not even be a lack of cultural or religious awareness, but something as practical as a language barrier. Having shadowed assessments with refugees and asylum seekers in CAMHS, I have seen firsthand the barrier in really hearing and understanding someone's story through a translator. 

Something which irrefutably has a negative impact on mental health is discrimination, especially amongst young people (e.g. Milburn et al, 2010). Speaking to someone who has no way of understanding the pain of experiencing racial abuse can be extremely difficult and isolating, presenting a large barrier in engagement with services. As young people, finding your own identity is challenging enough but with the added stressors of racial prejudice and discrimination, this can feel near impossible. When faced with healthcare professionals who may have their understanding of such challenges limited to an Equality and Diversity e-learning, seeking support for mental health can feel pointless and exhausting. 

Challenging these barriers

So what can we do about this? Unfortunately, there is no easy answer. For the Muslim community, it is important to discuss how mental illnesses are recognised by Islam and although we are taught to turn to God and find peace in our faith, we are also encouraged to seek professional help in times of need. Even when struggling to distinguish between culture and religion, the Muslim community are making developments in breaking the silence around mental illness. Charities such as Muslim Youth Helpline were formed to provide cultural and religiously sensitive support to Muslims around the world, particularly young people, struggling with challenges such as mental illness or identifying as LGBTQ+ in a Muslim community. While we have a long way to go, our communities are making steps to progress in understanding mental health and while this is essential to providing support for young people, it must come alongside cultural and religiously sensitive support from healthcare professionals outside of Muslim communities. 

Increasing representation, a particular problem in the field of Clinical Psychology, is essential. While this hardly comes as news, it is possibly the most important step that must be taken in working towards providing cultural and religiously sensitive support, which can improve treatment outcomes (Kalibatseva & Leong, 2014). Not only would this target more practical challenges such as language barriers, but it would allow service users to have easier access to healthcare professionals who are more likely to understand certain religious or culturally specific challenges, such as racial discrimination, which could be impacting mental health.

Aside from increasing representation, which is a long-standing issue, there are a multitude of things healthcare professionals can do on a day-to-day basis. Part of this may be to simply acknowledge their own lack of understanding about certain issues faced by Muslims and those from other minority backgrounds. Out of the many incredible healthcare professionals I have met both as a service user and in my career, the majority, although lacking firsthand experience in these specific challenges, did not hesitate to try to educate themselves and learn from people who did have the experiences, including myself.

It is also important to acknowledge our own implicit biases when it comes to working with those from a minority background, and work to recognise and challenge our own assumptions and judgements. While this can be uncomfortable, challenging the stigmas we hold from our own experiences can allow us to break down some of the barriers standing in the way of providing appropriate care to young people. Formulating treatment plans with service users rather than for them, taking into consideration their own views about mental illness and factors which could be impacting them, is more important than ever in this context. 

Mental health professionals, particularly those who work with adolescents at a key time in their lives, are able to value the importance of identity and acceptance which can be an essential part of challenges faced by young Muslims. By acknowledging these challenges as stand-alone struggles aside from the normality of the adolescent experience, we can strive to provide cultural and religiously sensitive support for more person-centred care. 

- Sumayya Alidina is an Assistant Psychologist working in community CAMHS in Kent as part of NELFT NHS 

References 

Biddle, B. J., Bank, B. J., & Marlin, M. M. (1980). Parental and Peer Influence on Adolescents. Social Forces, 58(4), 1057–1079. 

Kalibatseva, Z., & Leong, F. T. L. (2014). A critical review of culturally sensitive treatments for depression: Recommendations for intervention and research. Psychological Services, 11(4), 433–450. 

Milburn, N. G., Batterham, P., Ayala, G., Rice, E., Solorio, R., Desmond, K., Lord, L., Iribarren, J., & Rotheram-Borus, M. J. (2010). Discrimination and Mental Health Problems Among Homeless Minority Young People. Public Health Reports, 125(1), 61–67.