Diverse approaches to mental health - presentations

D i v e r s e a p p r o a c h e s t o m e n t a l
h e a l t h
SEMINAR

OUR AGENDA TODAY
A significant movement towards a more resilient, inclusive society.
Nuzhat Ali
Vice-Chair
PHE Muslim Network
Abdul Ghafoor
Chair
Muslim Network Collaboration
Baroness
Ruby
McGregor- Smith
Tony Vickers-Byrne
Clare Moriarty, DEFRA
Jonathan Jones, Government
Legal Service
Professor John Newton
Chief Knowledge Officer
Public Health England
Isabella Goldie
Mental Health Foundation
Dr Ghazala Mir
University of Leeds
Emily Danby
MIND in Harrow
Bridging Cultures Coordinator
Ian Dalton
NHS Improvement
Chief Executive
O P E N I N G &
I N T R O D U C T I O N
A Y E A R I N
R E V I E W
B U I L D I N G A D I V E R S E A N D
I N C L U S I V E C I V I L S E R V I C E
F A C I L I T A T I N G L O C A L A N D
N A T I O N A L A C T I O N
C U L T U R A L I N F L U E N C E S
O N M E N T A L H E A L T H
I N T E R A C T I V E S E S S I O N C L O S E
D R I V I N G D I V E R S I T Y I N
T H E W O R K P L A C E

A b d u l
G h a f o o r
A y e a r i n
r e v i e w

INDEPEND-
ENTLY
TOGETHER
THE ART
OF
THINKING
DIVERSITY:

● Learning ● Perspective ● Experience
ART

T H E
I M P O R T A N C E
O F D E T A I L
I N
T H E A R T O F
T H E C A R E O F
T H E P A T I E N T

I f y o u t r y t o m a r k e t t o e v e r y o n e
y o u w i l l e n d a p p e a l i n g t o n o o n e

Q u a l i t y &
r e l e v a n c e
e x i s t s i n t h e
d e t a i l
1 .

2 0 1 7
But what
does this
mean in
relation to
Islam?

B E L I E F I N
O N E G O D
Creator
Every organism & entity
Environment & elements
Sustainer
Every breath & heartbeat
Health & provisions
All-Knowledgable
Individual & Community
What’s best for us

A M E S S A G E
R E P E A T E D
T H R O U G H O U T T I M E
From Adam to Muhammad
Role models
Guidance
Direction and principles
Insights (embryology, environment etc.)
Preventive measures

A U D I T A N D
A C C O U N T A B I L I T Y
Reward and recompense
Every person will be judged
based on their conduct and
intention
Responsibility
To God, family, those in need
and one another

S P I R I T U A L P R A C T I C E S A R E
A S S O C I A T E D W I T H B E T T E R
H E A L T H & W E L L B E I N G
Directed focus
Inward-looking reflection
Contemplative practices
o Increase compassion and empathy
o Quieten the mind
Prayer elicits the relaxation response
o Gratitude & love
o Awe & fear
o Commitment & help

F a i t h b r i n g s
u n i q u e
p e r s p e c t i v e
a n d p r a c t i c e
2 .

Faithidentify&valuesi n f l u e n c e s o c i a l d e t e r m i n a n t s

LI STENING
TO STA FF
I NCREASE
A WA RENESS &
ENGAGEMENT
SUPPORT HEA LTH
DELIVERY &
COMMUNITY
A CCESS
S T R A T E G I C F O C U S
S H A R E D A M B I T I O N
Proposal | Business plan | Events calendar
MUSLIM NETWORK
LAUNCH
2 0 1 7

2 2 5
M e m b e r s
N a t i o n a l
c o v e r a g e
A w a r d
w i n n e r s

H E A L T H
A C T I V I T Y
Public health management of mass
gatherings: Hajj 2017
Compassionate management
Fasting, diabetes and the
Ramadan health guide
Fuel poverty winter walkHajj vaccination and health advice
PROMOTED WORKSHOPS & COURSES
• Bioethics & Islam masterclass
delivered by the Centre for
Islam and Medicine
• Faith communities and
mental health
• Break free from depression
• THRIVE activities
• MHFA & wellbeing training
• Tackling domestic violence and
abuse in faith communities
• NHS Blood and transplant
development
• NHSE Health literacy webinar
Culturally sensitive patient
experience workshop

Research
Scope
Design
Develop
Pilot
Revise
Securing approval
Launch
Maintain
H o w d o y o u c h a n g e a t t i t u d e s a n d
p e r c e p t i o n s ?
T
O
G
E
T
H
E
R

I n f o r m r e s e a r c h ,
c o - d e s i g n ,
i n c r e a s e
e n g a g e m e n t
a n d r e a c h
3 .

B a r o n e s s
R u b y
M c G r e g o r -
S m i t h
D r i v i n g
d i v e r s i t y i n
t h e
w o r k p l a c e

C l a r e M o r i a r t y
P e r m a n e n t S e c r e t a r y , D E F R A
& C i v i l S e r v i c e F a i t h a n d B e l i e f c h a m p i o n
T o n y V i c k e r s - B y r n e
C h i e f A d v i s e r - D i v e r s i t y a n d I n c l u s i o n a n d S t a f f
H e a l t h a n d W e l l b e i n g , P H E
J o n a t h a n J o n e s
P e r m a n e n t S e c r e t a r y , T r e a s u r y S o l i c i t o r a n d
H e a d o f t h e G o v e r n m e n t L e g a l S e r v i c e a n d
C r o w n ' s N o m i n e e
C i v i l S e r v i c e H e a l t h a n d W e l l - b e i n g C h a m p i o n
B a r o n e s s R u b y M c G r e g o r - S m i t h
S e n i o r a d v i s o r a n d P o r t f o l i o D i r e c t o r
B u i l d i n g a d i v e r s e a n d i n c l u s i v e c i v i l s e r v i c e

P r o f e s s o r J o h n
N e w t o n
F a c i l i t a t i n g
l o c a l a n d
n a t i o n a l a c t i o n
t h r o u g h t h e P H E
P r e v e n t i o n
C o n c o r d a t

COMMUNITY PARTNERS
Signatories to the PHE Prevention concordat for better mental health
5 0 0 + A F F I L I A T E
M O S Q U E S ,
C H A R I T I E S &
S C H O O L S
1 , 5 0 0 +
H E A L T H C A R E
P R O F E S S I O N A L S
& S T U D E N T S
1 0 0 +
P R O F E S S I O N A L
N E T W O R K S &
G L O B A L R E A C H
1 , 0 0 0 + D I R E C T
S U P P O R T /
C O U N S E L L I N G
2 0 K O N L I N E

I s a b e l l a G o l d i e
D i r e c t o r o f D e v e l o p m e n t a n d D e l i v e r y , M e n t a l
H e a l t h F o u n d a t i o n
D r G h a z a l a M i r
A s s o c i a t e P r o f e s s o r , U n i v e r s i t y o f L e e d s
E m i l y D a n b y
M I N D i n H a r r o w , B r i d g i n g C u l t u r e s C o o r d i n a t o r
T h e i n f l u e n c e o f c u l t u r e a n d s o c i e t y o n m e n t a l
h e a l t h

Addressing Depression in Muslim
Communities
Ghazala Mir
Shaista Meer, David Cottrell, Ruqayyah Ghani, Muhammad
Shabbir,
Dean McMillan, Allan House
Leeds Institute of Health Sciences, Touchstone Community Support Team
Sharing Voices Bradford, University of York,
Bradford District Care Trust

Higher levels and more chronic depression for some in Muslim
communities compared to general population
97% of Pakistani people continue to have depression after a year
compared to 45% in the general population after six months
(Spronston and Nazroo 2002)
2017 National IAPT data analysis - under referral : 2% Muslim (5%
nationally); at 6 sites: 3.32% (8.39%)
Poorer treatment outcomes
Suggests current treatment may be inappropriate

Background and rationale
 Culturally appropriate treatment - promoted by NICE (2009) and
Department of Health (1999;2005)
 Faith-sensitive therapies - potential to reduce levels of
depression and improve wellbeing (Koenig et al 2001).
 People from Muslim backgrounds – religion a prime identity
(Nazroo 1997; ONS 2011) more likely to use religious coping
techniques for mental illness than other faith groups in the UK
(Loewenthal, Cinnirella et al. 2001);
 Behavioural Activation (BA) - proven effective in clinical trials
(Ekers 2007). Focus on client values promising for adaptation to
meet the needs of Muslim clients.

WHY MUSLIMS? ‘Privileging’ /reducing disadvantage?
Socially
included
groups
Socially
excluded
groups
o Under referral/lower use of services
(access/stigma)
o More environmental stressors
o Higher levels of comorbidity
o Low representation amongst
therapists
Meeting
unmet
need

Four phases broadly follow MRC guidelines
for development of complex interventions:
PHASE 4:
Piloting
Methods
PHASE 1:
Synthesis of
literature
(Walpole et al
2013)
PHASE 2: Interviews
with 29 key
informants
PHASE 3: Synthesis and
production of treatment
manual – 3 Advisory Groups

 Lack of training reinforces poor engagement
with religious values; low confidence; potential
to replicate social exclusion
 Social/historical context - negative
perceptions of Islam/religion vs. accepting as a
valid value framework
 Attitudes towards religion/Islam in Western
culture - a private matter, ‘unprofessional’,
‘inferior, immoral, dangerous’
 Overrepresentation of psychiatrists
without religious beliefs in the UK and US
EUROPEAN SOCIAL CONTEXT

Therapy flexibility
Islam-
focus
BA-focus
Intervention will always be 100% BA

Reframe
relationships
BA/Islam parallels
Sadness and grief
are as normal
responses to
difficult life events
not abnormal or
‘mad’
Stigma
unjustified
think positively
about self
Discouraging self-
criticism or low self-
esteem
Hope feel less
alone
being active
congruence between
beliefs and actions
spend
time on
self
look after self
physically.
don’t
just rely
on God
small changes
can have a major
influence
discourage extremism /
obsessive behaviour
Develop meaning
in life
Resilience
positive
outlook
positive
ways of
thinking
Active response to
the risk of harm
encourage
interaction with
others
refocusing thoughts
Reduce
isolation
Reframe
experience

Self-help booklet: BA and Islamic
teachings
BA approach Being active/doing your part
Client booklet “Tie your camel”
“Prophet Muhammad (pbuh) noticed a Bedouin leaving his
camel without tying it. He asked, "Why don't you tie down your
camel?" The Bedouin answered, "I put my trust in Allah." The
Prophet said, "Tie your camel first, then put your trust in Allah"
(Tirmidhi)

Practice Case Study
BEFORE
TREATMENT
Focus on punishment
of Allah
Negative
interpretation of ‘Sabr’
(patience)
“I’m not good
enough…. I felt Allah
had left me”
“There is nothing I
can do”
AFTER TREATMENT
Began seeing her experiences as a ‘test’
and normalising this
Reasons to think about Allah’s mercy more
than punishment
Understanding her own role as proactive
• Setting goals in line with her values.
• ‘Tie your camel’ teaching helped her.
Listing enjoyable things and not feeling bad
for engaging in these.

Conclusions
• Fusion of frameworks
responds to needs, increases
referral rates
• Treatment does not
undermine or ignore values
• Enthusiasm of service users
acceptable to therapists
• Increases choice
• Requires support
Non
stigmatised
model
Culturally
acceptable
framework
Positive
interpretations

Mir, Ghazala, et al. "Adapted behavioural activation
for the treatment of depression in Muslims."
Journal of affective disorders 180 (2015): 190-199.
+ other resources
http://medhealth.leeds.ac.uk/info/615/research/327/a
ddressing_depression_in_muslim_communities
This presentation presents independent research commissioned by the National Institute for
Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant
Reference Number PB-PG-1208-18107). The views expressed are those of the author(s)
and not necessarily those of the NHS, the NIHR or the Department of Health

E m i l y D a n b y
C o m m u n i t y
e n g a g e m e n t
f o r m e n t a l
h e a l t h
i n i t i a t i v e s

Your Task
• 6 groups (about 15 people per group), each around a flipchart.
• 30 mins- 3 questions. Please move on when the question changes.
• Pool your experiences- everyone contributes
• No time for verbal feedback- make sure your facilitator understands
your point and it’s written clearly.
• Owned comments- your name or organisation.

Question One
As an organisation or community, what
are the obstacles you have faced to
communicating health messages to a
diverse community?
- Specifically mental health
- Difference in obstacles faced by community groups and statutory
services?

Question Two
As an organisation or community,
what resources do you have to
promote good mental health to a
diverse community?
- What resources are you missing?
- How can you fill the gaps? E.g., partnership working

Question Three
Outline one concrete goal for your
organisation or community to achieve
this year to improve the mental health of
your diverse patients/community.
- Can be small, but must be tangible
- Break it up into smaller steps

Thank you!
Emily Danby
Bridging Cultures Coordinator
020 8426 0929
e.danby@mindinharrow.org.uk

I a n
D a l t o n
C l o s i n g
r e m a r k s

Celebrate it every day.
Diversity is the one true thing we all have in common.

Diverse approaches to mental health - presentations

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