Which way is Mecca? Being a Somali Refugee in UK mental health services by Mushtag Kahin

Imagine being on a psychiatric admission ward, surrounded by complete strangers and professionals unable to communicate. You want to leave, but are stopped by staff, and you do not know why.

The only Halal food options are curries which are not part of your cuisine, mundane and too spicy for everyday meals. You want to order food, but you cannot verbalise this to staff. It is the middle of the pandemic and your family are not allowed to visit. You miss your children whom you can only speak to through the airlock window. You do not know which direction is Mecca to pray your five mandatory Islamic daily prayers. You are forced to take psychotropic medication, but you do not why, nor can you verbalise the side-effects you are experiencing. Not only are your freedoms taken away, but also your dignity. You have to cover up at all times as strangers check on you every hour, including night time. You feel lonely, bored and do not know to switch to the hospital Wi-Fi to speak to your family.

There are no words for depression in the Somali language. There are no psychiatric diagnoses and little awareness of mental illness in general. In Somali people with serious mental illnesses are often locked up or chained for rest of their lives. You are perceived as either “sane” or “crazy” with little chance of recovery. Your first contact would be with spiritual healers as you may be possessed by Jinns (spirits). There is hardly any psychiatric care and therapy is non-existent and unheard of. Coming to the UK as a refugee you might not know about mental health services and that the first point of contact is through your GP. Somalis often come into services when they are at crisis point or via criminal justice. Mental health services are not equipped to deal with the needs of Somalis and there is a lack of Somalian mental health professionals, especially therapists, in the UK.

The pandemic has highlighted structural inequalities in society. There were higher numbers of deaths amongst ethnic minority people and staff working on the frontline. Brent, where there is a large Somali community, was hit very badly by COVID-19. It was only after awareness-raising by Somali-British journalists in the Guardian that NHS funding went into the community to tackle inequalities, information and awareness.

Somalia is an oral society and Somali people are known for being storytellers and poets. As a clinician, when I work with Somali people, I do not see ‘patients’ but people with untold stories. Listening to their stories is a privilege that I do not take for granted. To be let into expressions of vulnerability is sacred. Because Somalia is an oral community, the literacy rate is often low. Therefore, information should be shared orally in our native language.

I remember once being told that a Somali patient was doing “unusual activities” when they were washing their feet in the sink not knowing they were performing ablution. I also heard about a middle-aged Somali woman confined to her bedroom who was left untreated in the community for 7 years whilst her ex-husband and her relatives brought daily food to her and her young child. Mental health professionals were rebuffed at the door and did not make extra efforts to safeguard her. Eventually, her ex-husband was advised to contact a tailored Somali mental health project worker who advocated on his behalf. They arranged for a Mental Health Act Assessment and the woman was sectioned and diagnosed with schizophrenia. She and her family did not have to suffer like this if mental health services had not failed her.

There are no in-service transcultural services in London and NHS leadership has not addressed this yet. This is even more worrisome when Black people are 4x times more likely to be sectioned under the Mental Health Act. There are hardly any BAME mental health advocates on wards and membership of Mental Health Act panels lacks diversity. Finally, there is a lack of BAME people in leadership roles – there are only two ethnic minority CEOs in London (one was appointed this year due to institutionalised racism).

Transcultural training should be mandatory in Universities and Trusts. There should be transcultural workers in every Trust and yearly anti-racism training for professionals, leaders and students. Specialist services need to be community centred, culturally and spirituality sensitive. Service providers need to implement trauma informed practices and interventions. Interpreters and Somali professionals should be trained in mental health awareness and translators should be employed by Trusts. We need to acknowledge Islamophobia and its impact on mental health. Communities are not “hard to reach”, services are.

Mushtag Kahin is a Somali registered Nursing Associate and Community Engagement Practitioner in London

This is a sample article from the Winter 2021 issue of Asylum {28.4].  Subscribe to Asylum magazine.