Many issues simmer deep underneath the surface in Minnesota's Somali community. One of them is mental illness.
Obvious symptoms of cognitive illness are plenty in the community. Discussions about getting professional help are defeated by fear of shame. The few brave enough to seek help face insurmountable obstacles. These factors make mental illness the greatest public health challenge facing the Somali community.
Mental illness is not unique to Minnesota’s Somali community. Many Minnesotans from all walks of life struggle with mental illness but the Somali struggle is exacerbated by culture which hasn’t acknowledged the condition.
This essay reviews how the debate about mental illness in the majority culture flows down to sub-cultures like that of the Somali community. It reviews how statewide factors hinder patients getting professional mental health services. The essay also discusses how two killings committed by two Somali men with mental illness is emblem of more widespread condition. It concludes by highlighting grass-root efforts to bring professional mental health services to those struggling with the condition in Minnesota’s Somali community.
Mental illness is contentious topic in Minnesota's majority culture. Pharmaceutical companies, healthcare insurance providers, patient advocates and public interest groups argue over therapies and medications.
The relationship between drug manufacturers including those prescribe to treat mental illness and doctors who prescribe them has been challenged by patient advocates and public interest groups.
In 2013, ProPublica estimated the amount of money drug manufacturers gave to health care professionals at nearly $1.4 billion.This is on the top of research dollars sanctioned by everyone.
Both drug makers and health care professionals dispute the figure. This type of back and forth debate adds more doubt in a public already skeptical of mental illness medications.
Patient advocates have been encouraging health insurance providers to reform access to counseling. Many health insurance policy carriers limit the number of sessions a patient can visit behavioral therapist. Health insurance policy providers also reimburse different rates for the same services. For example, a behavior therapist affiliated with large health institution is paid more compared to a solo practitioner. These rules and many more make difficulty for patients to get individualized help.
The stigma around mental illness is intense in Minnesota’s majority culture, a culture that prides itself for openness. Civic groups and community activists recently confronted stigma in mental illness with the creation of elaborate campaign dubbed "Make It Ok". The goal of the public campaign was to get people to talk about mental illness.
While the majority community wrangles over best practices and efficiencies, Minnesota's Somali community is struggling where to start. Medication is ostracized. Access to culturally competent behavior therapists is virtually none existence. Stigma is much higher.
Mental illness is largely unacknowledged in Minnesota’s Somali community and considered a taboo. It’s viewed by many in the community as a spiritual gap rather than medical condition.
Some in Minnesota's Somali community including this author believe mental illness is more widespread than two cases with tragic ends. Many more Somalis struggle with various forms of mental illness without ever committing violence. The two cases with tragic ends garnered significant press coverage and readers might be familiar with them so let's start by quickly recapping them.
Ahmed H. Aden killed 15 years old Abdisamd Sheik-Hussein, an up and coming community leader in Kansas City, Missouri by SUV over ran. Prior to Kansas, Aden lived in Minnesota and struggled with mental illness. He was stereophonic going in and out of Hennepin County Medical Center psych award. Aden Left Minnesota for Kansas to temporarily live with relatives according to family members. Aden showed up mosque in both cities spewing religion insults. He was asked to leave each time.
The second killing occurred 2013 in Minneapolis when an elderly man killed another elder man using metal pipe and butcher knife. Bashir Jama, 63 years old killed Jama Mohamed, 86 years old. Jama told friends that he was afraid of demons inside the body of the victim. Jama misconfigured victim’s body in attempt to remove the demon. Many in the community struggled trying to make sense of the gruesome scene. Violence against an elder is considered a community violation in the Somali culture. Violence an elder by another elder is considered a major curse.
Two macro-factors contribute to mentally ill Somalis taking innocent lives. First one is lack of access to treatment in both counseling and medications. The second factor is stigma. The combination of the two makes mental illness lethal.
Rarely Somalis seek help from mental health professionals. As consequence, alternative treatments emerged. Some patients have found solace in one treatment or combinations of treatments. Some, like Aden and Jama have not found anything that worked.
One treatment popular in the Somali community has been changed of environment. Patients are sent to places where a relative lives like Somalia. The hope is that experience of different atmosphere will help settle down an anxious mind. Often times patients came back more sick. Adan was sent to Kansas City in hope of different environment helping him. Unfortunately, he only got worst.
Another treatment has been to double down of spiritual activities and prayers. Faith leaders encourage more players. Those with financial resources take pilgrimage trip to Mecca and Medina, Saudi Arabia. The experience of visiting two of Muslims’ holiest sites has helped some patients and has not helped others.
Some patients have opted traditional treatment. In Somalia, traditional healers used various names and description for mental illness.
Traditional healers provided herbal medicine and counseling. Some healers burned incense and played music during the counseling session.
The footage above is from Somali documentary of traditional healer being studied by Italian physiatrist during behavioral therapy session. It’s believed to be from 1980’s. In the footage, people in red are former patients who have been treated and can provide therapy sessions to others now, an equivalent of peer-to-peer counciling recommended by organizations like National Alliance on Mental illness(NAMI).
A traditional counseling session like the one in the footage almost always includes live dancing. Anecdotal evidence shows that patients feel temporary relief after a session with traditional healer. The patient in the footage, a teenage boy, was carried to the center but felt well enough to join the dance during session.
Those services have been imported to Minnesota. The problem with traditional healing is price. It can be very expensive. Community sources quote anywhere $250 a session up to $3,600. No health insurance policy covers this type of service.
Low income who can’t afford become more anxious. They borrow money to cover the cost. The debt brings more anxiety making their condition worst.
The prevalence of mental illness in Minnesota’s Somali community has created a room for vigilante healers to thrive. Vigilante healers disguise themselves either in faith or tradition and take advantage of patients. On accession, patients have been fed with toxin. Vigilante healers present public health risk to the community.
Although their effort is hamstrung by severe shortage of resources, some leaders in the Somali community are working to address mental illness through conventional methods.
Mohamed Mohamud who leads Somali American Parent Association (SAPA), a nonprofit that works to connects parents with school districts has observed the havoc mental illness brings in the lives of parents. SAPA recently received small grants from Department of Human Services (DHS) to evaluate ways to add mental health service component to his organization.
Mental illness is the greatest public health challenge facing Minnesota's Somali community. It can’t be addressed in isolation from macro-factors in the state. The high profile killings are signals of more widespread health condition. Often times these signals are misinterpreted squandering opportunities one after another. Expanding and supporting grass-root efforts like that of Mohamud’s in collaboration with faith and inexpensive traditional healing provide a path forward.