Mental illness has long been associated with external evil forces in cultural and religious belief systems - sinfulness, evil eye/jealousy, curse or

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2 Mental illness has long been associated with external evil forces in cultural and religious belief systems - sinfulness, evil eye/jealousy, curse or possession (Hillier & Jewell, 1983; Rashid et al, 2012). Owing to religio-cultural beliefs many choose to seek spiritual advice or interventions from traditional faith/spiritual healers first port of call (Leavey, 2008 as cited in Rashid et al 2012:654) or as the sole treatment.

3 Research supported by Faith Matters To explore why people seek spiritual interventions rather than (or in addition to) medical treatment Case Study design Narrative interviewing Self-declared a PREVIOUS mental health/psychiatric condition for which they sought a guidance/ intervention from a Spiritual/Faith Healer (did not have to have been clinically diagnosed AND the participant did not have to have sought medical treatment).

4 Imams /Mawlānās/Mullahs, Sheikhs (Religious Leaders/Scholars) Hakims (Traditional Healers/Herbalists) Pirs, Spiritual Healers (within and external to community/faith group)

5 Prayer support and/or Qur anic guidance Treatment for physical ailment (Herbal remedies) Curse/black magic/evil eye removal (for marriage problems, physical ailments, mental health problems) Exorcism (for mental illness/personality disorders) seen as possession rather than MH problem.

6 1. stigma attached to mental illness within communities 2. didn t feel traditional western medical practitioners were supportive in terms of importance of faith 3. didn t want to take medication 4. curious 5. wanted a quick fix 6. desperate for help

7 1. Personal recommendation from family/friends 2. Saw popularity of spiritual healers in community perceived community acceptance, assumed effectiveness of treatment 3. Heard radio advert / read newspaper advert were curious

8 One of the Spiritual Healers [I went to] did a ceremony with dried chillies [over my child s head] and then burned the chillies. He said that if my child had the evil eye on her then burning chillies would make a smell and burn your eyes they don t normally if they are dried and then burned this did make my daughter better (Hosna) My cousin had a mental health problem, probably schizophrenia, but my aunt and uncle refused to take him to a doctor they did not want anyone to know what was going on in their house they were ashamed, it was like they felt they had not been good enough Muslims and now their son was possessed. So they sent him to a Spiritual Healer who did an exorcism it didn t work he killed himself a few days later (Sarah)

9 I went to see a Spiritual Healer for anxiety [probably paranoia] stirred up by one of my aunties. He [the Spiritual Healer] told me my husband WAS having an affair. He gave me this bottle of dirty water with gold in and told me to put some in my bath everyday for a week. Once the bottle was empty I was to chuck it in the sea it cost me 500 it didn t make me better, it just exacerbated my symptoms Oh yeah, and my husband wasn t even having an affair (Sameena) I saw an Imam for counselling it took ages, like weeks, coz I had to wait for a female to be present but it was good, it did work.i talked stuff through and then he told me to go read [the Qur an] Surah Al Baqarah is the most effective remedy it can be read directly or played in the house from a recording. (Kareema)

10 I did go to my GP but he was not helpful. I told him I didn t want to take medication for depression because I don t believe in it it was a Christian GP Practice and when I said my faith [Islam]was an important part of my life and I wanted it considered in my treatment, he actually suggested I convert to Christianity (Hafsa) No I didn t [go to see a doctor],not this time. They don t help you, they just send you to see someone else who doesn t understand your culture or about your beliefs they just think you re crazy that s ironic isn t it? (Umar)

11 Medical practitioners to: understand the importance of cultural or religious beliefs to individuals. recognise importance of faith and beliefs in healing/treatment. consider a faith component to any treatment plan collaborate with religious leaders (referrals in both directions etc) examples of good practice