Somali-American imams fight stigma of mental illness

Imam Ahmed Ibrahim recently stepped in to help a young Somali-American man who'd grown increasingly withdrawn and gloomy.

At his south Minneapolis mosque, Ibrahim offered support he had perfected over almost 25 years as an imam: readings from the Qur'an and prayers to recite morning and night. But Ibrahim also did something new: He gave the man a list of local therapists and urged him to seek help.

In the past year, Ibrahim and other Somali-American imams have gathered monthly to learn how to spot the signs of mental illness and steer mosque members to professional help. Hosted by Fairview Health Services, the training enlists the imams as key allies in chipping away at the stigma of mental illness and skepticism of mental-health treatment among Somali-Americans.

"The reality is that when Muslims face problems, the first place they come is the mosque," said Ibrahim. "When we make referrals, people take that seriously."

The training is among a spate of new efforts nationally to recruit faith leaders — Muslim, evangelical Christian and others — to counter deep-rooted notions of mental illness as a sign of spiritual failing or demonic possession.

In 2012, the University of Minnesota Medical Center conducted an Affordable Care Act-mandated survey of community needs in Minneapolis' Cedar-Riverside neighborhood. Mental-health issues emerged as a top concern.

Sahra Noor, the medical center's community health director at the time, said some residents still deal with the fallout of fleeing a brutal civil war and with the stresses of starting over in America — from joblessness to family conflict.

A multiyear study of refugees from Somalia at a Minneapolis clinic published in 2010 found that more than 30 percent showed symptoms of psychosis and 15 percent suffered from depression, problems the study tied to war trauma and other factors. But Somali-Americans are often reluctant to seek professional help.

"In our culture, we think people are either crazy or well, and who wants to be called crazy?" said Noor. "But you feel comfortable talking with the imam at your mosque."

However, said Osman Harare — a onetime physician in Mogadishu, the capital of Somalia, who now leads the nonprofit East Africa Health Project in the Twin Cities — imams' time-honored prescriptions to pray harder and come to the mosque more often fall short for some struggling mosque members. Some local Somali-Americans turn to self-appointed healers who purport to exorcise the "jinn" they say cause mental illness, sometimes charging hefty fees.

Noting the disproportionately low rates at which Muslims seek out professional help, a national survey of 63 imams recently found lingering reservations about western treatments of mental illness.

Presented with a case study of a severely depressed person, imams often saw stress, but they also cited a religious crisis and a weak personality as likely culprits. They rated more active participation in the mosque as most effective and medication as least helpful.

These attitudes are by no means unique to Muslim communities. Efforts are underway nationally to spur more open conversation about mental illness in evangelical Christian congregations, more education about mental health in seminaries, and new partnerships between clergy members and clinicians.

In fact, Noor said, the outreach to imams she envisioned in response to the Fairview survey was modeled on similar initiatives in African-American Baptist congregations.

When she ran the idea by Somali elders, they warned that imams would balk. Instead, all 10 south Minneapolis imams that Harare approached signed on and — except for one who returned to Somalia last year — they've stuck with the project in its second year.

Dr. Farha Abbasi, a Michigan State University psychiatry professor, said similar training projects are gaining traction in several Muslim communities across the country. The university hosts an international Muslim mental-health conference. It brings together faith leaders and mental-health professionals who tackle "prickly topics," including challenges faced by gay Muslim youth.

"The mental-health movement is becoming really vital in the Muslim community," said Abbasi, adding, "Faith can be a strong tool to promote resilience if used correctly; if perverted, it can be fatal."

Since late 2013, the Minneapolis imams have covered a wide range of topics — depression, addiction, bipolar disorder, and treatment options from cognitive behavioral therapy to medication — in monthly sessions led by a Somali therapist, Ahmed Hassan. During case-study readings and role play, the imams wave red napkins when they hear a "red flag" for mental illness.

Ann Ellison, Fairview's community and church relations director, said the imams also got guidance on how to weave discussion of mental health into their Friday prayers in a bid to fight stigma. Several mosques hosted workshops after Friday prayer, attended by an estimated 400 people. The project inspired one participant, Imam Sharif Mohamed, to become the first Muslim religious leader to join Fairview's Clinical Pastoral Education program as resident chaplain.

Fairview has mostly anecdotal evidence that imams are making referrals. But training organizers point to a 50 percent increase in Somali-speaking patients seeking addiction treatment at Fairview's Riverside campus since 2013.

Cawo Abdi, a Somali-American sociology professor at the University of Minnesota, said that single-handedly combating the stigma of mental illness and treatment in the community would be tough even for an influential group like the imams. They can face suspicion that they are taking money from hospitals in exchange for referrals. Still, the training effort is a start, she said.

Imam Sheikh Sa'ad Musse Roble said the training has been eye-opening. He used to think of mentally ill people as running down the street, shedding their clothes and raving. He has come to realize that a mosque member can dress well and speak coherently, but quietly grapple with "a small mad." He has also come to believe that mental-health professionals can be key partners to "spiritual doctors" like him.

Ibrahim, one of the imams, has shared a list of mental-health providers with several members of his modest storefront mosque, where a smartphone buzzes often from the skirts of his traditional garb. The depressed young man who consulted him did seek out treatment, and in the following months, Ibrahim noticed he was in better spirits.

Another man had declared he was "dying" under the burden of job stress and marital problems. The man also followed Ibrahim's advice to seek professional help, but the imam couldn't prevail upon him to take the anti-anxiety medication he was prescribed or make the recommended lifestyle changes, such as more exercise.

Mohamed, the Fairview chaplain, recently got a call from an acquaintance whose sister had seen a traditional healer who prescribed Qur'anic readings and herbal medicine. But she was still refusing to eat, sleeping fitfully and exploding in screaming fits. Did the imam know of any other techniques to drive away the woman's jinn? Mohamed told the man that he would meet with the woman to offer spiritual support — but that she should also see a mental-health professional.

"Religion is still important, but it's also important to seek help from a scientific perspective," said Mohamed. "They are not against one another."

Mila Koumpilova • 612-673-4781