Stigmatizing and Denying Mental Health Problems Create Unnecessary Pain
By Marwa Mahmod
Sep/Oct 2024
Canada is often referred to as a “Cultural Mosaic” for its ethnocultural and religious diversity. While Muslims are a relatively small minority, they are one of the country’s largest minority groups and have more than doubled their numbers within 20 years. According to Statistics Canada, from 2001 to 2021 this population increased from 2.0% to 4.9%. In fact, after Christianity, Islam is Canada’s second most reported religion — nearly 1.8 million (1 in 20) people self-identify as Muslim.
Canada’s Muslims, 63.1% of whom are immigrants, represent a variety of racialized groups. While Ontario and Quebec have reported the highest number of Muslims, this minority is expected to continue to grow nationwide. Like all minorities, especially religious ones, Muslims have unique needs and challenges that influence their collective mental health and well-being.
Understanding Mental Health
To better understand Canada’s Muslim mental health landscape, we should ponder the WHO’s definition: “[A] state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.” While it can include anxiety, depression, mental and psychosocial disorders, mental health is so much more than just the absence of mental disorders. We should think of it as being on a spectrum or continuum — one that affects how we think, feel and act toward ourselves and others.
A variety of individual, social and structural determinants of health interact to protect or challenge our mental health. Individual psychological and biological factors, such as emotional skills and genetics, can make people more vulnerable. Exposure to unfavorable social, economic, geopolitical and environmental circumstances, such as inequality and violence, can also increase one’s risk. Risk factors that occur during developmentally sensitive periods, such as in early childhood, are especially detrimental.
In contrast, protective factors are elements in our lives that help strengthen our resilience and ability to cope, thereby minimizing the risk of mental health challenges. These can include individual, social and emotional skills and traits; quality education, gainful employment, positive social interactions; along with faith, families and communities that support resilience, safety and cohesion.
Current Efforts to Help
Muslim have progressed as a community, whereas discussing mental health remains a taboo topic. Misconceptions, such as the belief that poor mental health indicates a lack of faith or is a divine punishment, can contribute to internalized stigma and wondering if there is something inherently wrong or inadequate with oneself. The emotional impact of self-stigma can often be greater than the symptoms initially experienced, as it destroys self-esteem, self-efficacy and one’s outlook on life. This shame-based vicious cycle further isolates us from seeking support.
Over the past 20 years, several Canadian organizations and institutions have sought to increase awareness and destigmatize seeking treatment for mental health conditions. The Mississauga-based Naseeha Mental Health (www.naseeha.org) is a registered nonprofit, Islam-inspired organization with a newly added branch in the U.S. In addition to a 24/7 confidential, anonymous and free helpline across North America, its team develops and facilitates various psychoeducational programs in addition to a web therapy program that offers sliding scale fees and free therapy for qualifying low-income clients.
Naseeha also provides crisis support to families and communities struck by tragedies, such as the June 2023 terrorist attack in London, ON, that claimed the lives of four Muslim family members and left a nine-year-old boy seriously injured and orphaned. This tragedy was the worst crime against Muslims in Canada since the terrorist attack during January 2017, in which a gunman murdered six worshippers at the Islamic Cultural Centre of Quebec City and injured nineteen others.
600% Surge in Helpline Calls
Experiences of Islamophobia, xenophobia, racism and discrimination can significantly impact mental health, for they can create a pervasive sense of fear and lead to chronic stress, anxiety, depression, social isolation and PTSD. During November 2023, Naseeha Mental Health reported an alarming 600% surge in helpline calls from predominately Muslim Canadians experiencing marginalization in their schools and workplaces, as well as symptoms of anxiety and depression due to the ongoing genocide in Palestine.
One of this community’s biggest challenges remains the need for more culturally sensitive mental health services nationwide. This became particularly heightened during the Covid-19 pandemic, especially for those Muslims living in more remote areas who had to struggle to access these already limited supports.
Cedarway Therapy (https://cedarwaytherapy.com/), a private practice in Ontario, provides a range of in-person and virtual individual, couples and family therapy; diagnostic and psychoeducational assessments services; and group sessions and workshops. Their team of clinicians treat clients across the lifespan, including young children and the elderly, by using different evidence-based modalities in diverse languages while integrating Islam and faith-based counselling — which has been a growing demand.
Research has consistently demonstrated that religion and spiritualty are protective factors of mental and physical health, both of which are intrinsically tied together. Higher levels of spirituality have been found to increases hope, purpose, coping strategies, resilience and gratitude, with clients seeing a reduction in symptoms of anxiety and depression. Muslim clinicians who understand their community are better equipped to provide appropriate, individualized, culturally sensitive and therapeutically effective care, because they offer a deeper awareness of Islamic teachings and cultural nuances.
Emerging Themes
In my own clinical practice, I’ve observed a few common topics among Muslim clients: coping with symptoms of stress, anxiety and depression; navigating family and romantic relationships; managing faith-based dilemmas; and addressing childhood and intergenerational trauma. Other themes include loneliness, caregiver stress, acculturation, academic and workplace stressors, divorce and single parenthood, domestic violence, parent-youth conflict and marital issues.
Currently, the most prevalent theme among my adult clients is navigating relationships with emotionally immature family members who lack self-awareness, especially in a manner that aligns with their cultural and religious values. On the other end of the spectrum, addiction is one of the fewest presenting issues I have come across. At face value, rates of substance abuse and addiction may seem low compared to other groups. However, research suggests that Muslims living in Western societies are more likely to have addiction issues than those living in Muslim-majority spaces. In addition, Muslims in Canada are less likely to access mental health services than the general population.
Addiction stigma is particularly prevalent. According to Ahmed Hassan (addiction psychiatrist, Toronto’s Centre for Addiction and Mental Health [CAMH], www.camh.ca), among the reasons for this are misconceptions about available services; fears that treatment will be disclosed to employers; and beliefs that addiction is shameful, sinful and shouldn’t be discussed outside the family. Naturally, all of these deter individuals from seeking support and treatment, thereby increasing isolation.
Likewise, Muslim clients are generally reluctant to seek therapy for other addictions, such as pornography, sex, sexual shame, infidelity and other such issues. Professionally speaking, I don’t believe that our community necessarily faces fewer challenges with these issues when compared to the general population. Instead, we tend to conceal them and hesitate to seek support and treatment due to cultural and religious shame, fear of judgment and perceived cultural notions of hayaa (modesty).
As a clinician, I work collaboratively with clients to identify their therapeutic goals to address presenting issues. Treatment planning can include providing psychoeducation, learning various coping strategies, developing effective communication skills, identifying values, discussing boundary setting, processing emotions, expressing needs, challenging negative thoughts, safety-planning, developing self-awareness, fostering gratitude, nurturing kindness and compassion for self and others, highlighting strengths, exploring collective healing and reclaiming intergenerational wisdom and gifts.
Looking Forward
Despite the growing Muslim population, there is a lack of academic research focused on their mental health needs. Over the past few decades, Muslims working in the social and health sectors have raised concerns over the need for a collaborative national strategy that addresses the realities impacting their mental health and well-being, among them various forms of stigma, limited culturally competent care and services, systemic barriers, and socioeconomic and political factors. Addressing these issues requires a multifaceted approach and cohesive strategy that involves collaboration among healthcare providers, researchers, community and spiritual leaders, and policymakers.
Several organizations and institutions are doing incredible work to support and address these concerns. However, most of them are based in Ontario, a reality that needs to be changed in order to expand access to evidence-based culturally and spiritually appropriate mental health resources and services nationwide. Immigration experiences, including acculturation challenges and encounters with racism and discrimination, significantly impact mental health outcomes.
Developing and integrating an anti-oppressive lens and decolonized approach to therapy is crucial for creating a more equitable mental health care system that addresses systemic inequities, enhances cultural competence, fosters social justice and advocacy, improves overall therapeutic outcomes and empowers Muslims. By developing a more comprehensive understanding and addressing our unique needs and barriers, we can make mental health services more accessible and effective while cultivating thriving and resilient families and communities.
Marwa Mahmod is a registered psychotherapist in Ontario. She has acquired significant experience in supporting the community due to her roles at Nisa Homes, Naseeha Mental Health and Cedarway Therapy.
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