Culturally Appropriate Mental Health Care for Somali Immigrants and RefugeesRecognizing cultural understandings of mental health to improve services
- Mental health services that engage the community in defining their needs are necessary for culturally sensitive practice with Somali immigrants and refugees (1;4)
- Availability of religious based treatment options such as readings from the Qur’an is an important part of mental health treatment for Somalis (2;3;4)
- School-based mental health services may be a more acceptable form of treatment for Somali youth (5)
In Somali culture, mental illness is the result of disordered social or spiritual relationships rather than individual mental problems (2). The cure is often specific readings from the Qur’an, or other rituals performed by a religious leader (2;3;6). Mental illness is often dealt with within strong social networks of family and friends, but it is highly stigmatized and rarely discussed openly (1;6;7). As a result, Somali immigrants and refugees usually only turn to formal mental health services as a last resort. While these are general trends, it is important to consider an individual’s relationship to the cultural conceptions of mental health, as well as the role of their cultural identity more broadly (8). In addition, it is important to address post-migration stressors rather than only pre-migration because post-migratory experiences are stronger predictors of mental distress (1;9). To provide adequate services to Somali immigrants and refugees, providers must find common ground with clients on the meaning of mental illness, and validate traditional methods of treatment (1). School-based services may be more acceptable for youth because of lower stigma in this setting, and their changing perspectives on mental health in the acculturation process (5;9).
- School officials
A Community-Based Participatory Research model was used in multiple studies, and it facilitated not only data collection, but further engagement with the local Somali communities (10;3;5). There were some quantitative or mixed methods studies. However, most were qualitative studies based on a mixture of interviews and focus groups. Some studies focused on Somalis in Europe, or refugees more generally but their information lined up with results from U.S.-based studies (1;2;6;10). One study was a review of studies on mental health for refugees, but the rest were original research.
Acculturation may affect the perceptions of mental health among Somali youth, but more research is necessary. Somali youth still displayed strong ties to their culture, but there is also evidence that their perceptions of mental health are different than that of their parents (5). Multiple sources addressed the importance of family as a source of support, but Somali adolescence also expressed unwillingness to talk to their parents about issues because their parents wouldn’t understand (5;6;7). Therefore, while there is significant literature on Somali conceptions of mental health, the literature is less settled on how this culture influences Somali youth in the U.S. However, the literature does seem to agree that school based mental health services are the best option for serving Somali youth (5;6;7).
Connections between Somali communities and mental health service providers help to ensure that services are accessible and culturally sensitive (1;4;5). In addition, the inclusion of Somali forms of healing as options for treatment may improve the acceptability of formal services among Somalis. This could include connections with religious leaders, availability of readings from the Qur’an, and engagement with social networks (1;2;3;6;7). However, in order to create trust between Somali communities and service providers, solutions should arise out of partnership to improve mental health treatment for Somali immigrants and refugees (1;4;5).
- Rural communities especially may lack access to Somali translators, and religious leaders
- The effects of integration into the host country on Somali attitudes towards mental health has not been adequately studied (5;6)
- It is important to attempt to improve services to Somalis without making assumptions about the needs or attitudes of any particular Somali immigrant or refugee (8)
Sources and Further Reading
1. Palmer, David. 2006. “Imperfect Prescription: Mental Health Perceptions, Experiences and Challenges Faced by the Somali Community in the London Borough of Camden and Service Responses to Them.” Primary Care Mental Health 4, no. 1: 45-56. http://www.researchgate.net/publication/233569776_Imperfect_prescription_mental_health_perceptions_experiences_and_challenges_faced_by_the_Somali_community_in_the_London_Borough_of_Camden_and_service_responses_to_them
2. Johnsdotter, Sara, Karin Ingvarsdotter, Margareta Östman and Aje Carlbom. 2010. “Koran Reading and Negotiations with Jinn: Strategies to Deal with Mental Illness among Swedish Somalis.” Mental Health, Religion, and Culture 14, no. 8 (October): 741-55. http://dx.doi.org/10.1080/13674676.2010.521144
3. Filippi, Melissa K., Babalola Faseru, Martha Baird, Florence Ndikum-Moffor, K. Allen Greiner and Christine M. Daley. 2014. “A Pilot Study of Health Priorities of Somalis Living in Kansas City: Laying the Groundwork for CBPR.” Journal of Immigrant and Minority Health 16, no. 2 (April): 314-20. http://dx.doi.org/10.1007/s10903-012-9732-1
4. Wolf, Kimberly, Rich Zoucha, Marilyn McFarland, Khlood Salman, Ahmed Dagne, and Naimo Hashi. 2014. “Somali Immigrant Perceptions of Mental Health and Illness: An Ethnonursing Study.” Journal of Transcultural Nursing 1, no. 10 (September): 1-10. http://dx.doi.org/10.1177/1043659614550487
5. Ellis, Heidi B., Alisa K. Lincoln, Meredith E. Charney, Rebecca Ford-Paz, Molly Benson, and Lee Strunin. 2010. “Mental Health Service Utilization of Somali Adolescents: Religion, Community, and School as Gateways to Healing” Transcultural Psychiatry 47, no. 5 (November): 789-811. http://dx.doi.org/10.1177/1363461510379933
6. Mölsä, Mulki Elmi, Karin Harsløf Hjelde, and Marja Tilikainen. 2010. “Changing Conceptions of Mental Distress Among Somalis in Finland.” Transcultural Psychiatry 47, no. 2 (April): 276-300. http://dx.doi.org/10.1177/1363461510368914
7. Jorden, Skye, Kimberly Matheson, and Hymie Anisman. 2009. “Supportive and Unsupportive Social Interactions in Relation to Cultural Adaptation and Psychological Distress Among Somali Refugees Exposed to Collective or Personal Traumas.” Journal of Cross-Cultural Psychology 40, no. 5 (September): 853-874, http://dx.doi.org/10.1177/0022022109339182
8. Groen, Simon. 2009. “Recognizing Cultural Identity in Mental Health Care: Rethinking the Cultural Formulation of a Somali Patient.” Transcultural Psychiatry 46, no. 3 (September): 451-62. http://dx.doi.org/10.1177/1363461509343087
9. Nilsson, Johanna E., Danah M. Barazanji, Ashley Heintzelman, Mubeena Suddiqi, and Yasmine Shilla. 2012. “Somali Women’s Reflections on the Adjustment of Their Children in the United States.” Journal of Multicultural Counseling and Development 40, no. 4 (October): 240-52. http://dx.doi.org/10.1002/j.2161-1912.2012.00021.x
10. Williams, Megan and Sandra Thompson. 2011. “The Use of Community-Based Interventions in Reducing Morbidity from the Psychological Impact of Conflict-Related Trauma Among Refugee Populations: A Systematic Review of the Literature.” Journal of Immigrant and Minority Health 13, no. 4 (August): 780-94. http://dx.doi.org/10.1007/s10903-010-9417-6