The influence of religion on the understanding of, and attitudes to, mental health

Background: In the UK, primary care providers are involved in delivering community care and are the gatekeepers to specialist services. The second most frequent reason for consulting the General Practitioner relates to mental health difficulties. There may be variations in the pathways to care for Muslims with mental illness. The literature showed a paucity of high quality literature in the field of Islam and mental health. Objectives: The thesis investigated the aspects belonging to the Islamic faith, which are most important to Muslims suffering from mental health difficulties and illness. The study focused on gaining a deeper understanding how Islamic beliefs and views influence the perceptions and attitude of Muslims towards mental health and illness and how this helped them cope or did not. Connected to this was the objective of identifying barriers and facilitators relevant to pathways to care, involving existing care systems and Muslim scholars who may be consulted. Methodology: A qualitative approach was utilised to address the research questions. Semi-structured in-depth interviewing took place with Muslim patients and scholars. 16 patients from 12 different ethnic groups were interviewed. All the patients had experience suffering from mental illness. 17 traditional scholars from 10 different ethnic groups participated in the study, 13 male and 4 female scholars. Results: The study highlighted a number of important insights in relation to the interface between Islam and mental health. Muslims hold a specific view in the outlook on life, pain and suffering. These views fall outside the realms of mental illness. Islam facilitates a sense of purpose and meaning of life. In the Islamic tradition, health, well-being, emotional and mental health are recognized and conceptualised in a distinct manner through expressions, meaning and strong spiritual dimension. However the majority of scholars were only familiar with a small number of emotional concepts in the Qura'an and Hadith. Religious beliefs influenced the perceptions of Muslims towards mental health and illness along with alternative explanations and notions such as punishment and weak faith explored. Understanding and dealing with emotions was less frequently highlighted by scholars in comparison to other coping strategies. The pathway to care for Muslims was examined and highlighted specific factors that might act as facilitators or barriers to accessing mental health care. Muslims hold a different model of mental health. Even if distress is recognised as a mental health problem, there are barriers for Muslims accessing help. Muslims also utilised diverse coping strategies in a holistic manner, some of which were specific to their faith. Muslims accessed scholars in their role supporting people with mental 12 health issues but there were some negative experiences when attending the mosque and dealing with Imams. Scholars held a limited understanding of mental health and mental illness. Discussion: It was imperative to understand the nuances that exist in Islamic concepts and its context relevant to the person. It was argued there needed to be an understanding of how these concepts connected to the understanding of the individual, their spiritual development and how the person chooses to practice their faith. Islam for Muslims was not necessarily understood to be about prevention of depression or other mental health difficulties. Rather, it was perceived as a means to understand their experiences and alleviate pain and suffering. Belonging to the Islamic faith could help with certain circumstances, which also depended on the context and the persona's understanding and application of their faith. Furthermore, faith provided a mechanism for the individual to develop resilience and facilitate recovery. There is a richness of specific concepts used in Islamic tradition which has not been previously described in medical literature. Muslims adopted a variety of coping strategies which centred on different levels including individual, community, relationship with God & Prophet Muhammad and religious practices. The impact of emotional difficulties and distress and usefulness of strategies for the person needs to be considered. Social strategies shaped by a religious outlook were utilised. Conventional approaches and Islamic concepts are not mutually exclusive and may be seen as complementary. People may resort to spiritual practices to avoid dealing with emotional difficulties. The strengths of the study included the methodological process, with the recruitment of diverse participants and qualified scholars. There was a deeper analysis of the concepts and findings highlighted the importance to contextualise these concepts in relation to the individual. The study was limited as it did not consider the socio-political background of scholars, no recruitment of participants took place from the third sector and all the interviews took place in English. Conclusion: There are important facets of the Islamic faith in relation to mental health and well-being that are of value to Muslims. Central to this is the distinct ontological perspective Muslims hold. The understanding of emotional and mental health from an Islamic perspective does not necessarily rely on realms of illness or scientific outlook. The Islamic paradigm is conceptualised in a distinct manner and does not fit with the traditional western medical model. It is evident the prism through which Muslims understand their religious beliefs cannot be ignored as they influence perceptions towards mental illness, care and treatment. An awareness of these areas can improve an understanding of the pathway to care for a Muslim, accessibility to services and explanatory models. Muslim scholars play a crucial role in supporting individuals with mental health needs. Here lies an opportunity to develop community based interventions and address the challenges in relation to training needs.