Somalia: My two cents on mental illness in the Somali community! As an individual of Somali decedent and a mental health professional it breaks my heart to see tragedies that can be prevented yet happen every day.

The tragedies of mentally ill individuals who aren’t given the appropriate care in order to sustain their lives have scarred my community. As some of these individuals end up committing suicide, homicide, or petty crimes that would result on spending many years in jail. The number of Somali individuals who have proper diagnosis of mental illness is small; however, the number of mentally ill individuals receiving proper services such as medication, therapy, and support services are close to nonexistence. One would think this day and age in the first world mental illnesses are addressed appropriately.

Growing up, I used to see mentally ill individuals in the streets as kids chased them and called them names such as “nin waalan” which translates to “crazy man”. These individuals normally looked like they haven’t bathed in months or eaten in days.  This experience taunted me and left me with questions than answers. Many questions echoed in my head over and over as my mind refused to accept the harsh treatments of mentally ill individuals.

In my early college years, I took a class called general psych and was impressed with learning about different mental health disorders. This was enlightening as it opened a window of understanding and a channel to mental health. The vivid memories of mentally ill individually that taunted me throughout time came back to life. This time it has a name and it is called mental health disorders. Post-Traumatic Stress Disorder (PTSD) stood out for me and I found myself drawn to wanting to learn more information about it.

The actual definition of PTSD in the Diagnostic and Statistical Manual of Mental Disorders V is “exposure to actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual directly experiences the traumatic event; witnesses the traumatic event in person; learns that the traumatic event occurred to a close family member or close friend (with the actual, or threatened death being either violent or accidental); or  experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related).” (DSM-V)

Considering the fact that many Somalis came to the US as a result of civil war and most of them have witnessed horrific traumatic events pushed me towards wanting to learn about mental illness, yet emphasizing on PTSD and war trauma.  “Immigrants and refugees experience multiple losses including loss of homeland loss of loved ones. Immigrants, and most certainly refugees, have likely endured one or more of the following traumatic events prior to resettlement: malnutrition or famine, violence, political persecution and torture. Past trauma and current adjustment challenges increase the risk of developing behavioral and mental health problems” (Psych world).

As for the Somali community, the literature related to mental health is limited to crazy/insane or stupid and there are over 2 dozen of different terms related to mental illnesses in this country. Mental illness is considered a big taboo in the Somali community and its issues are kept under the surface which reinforces the idea of not seeking services. The greater disparities in mental health in this community include language barriers, cultural barriers that stigmatize mental illness, providers who lack the cultural competency to effectively treat and lack of resources.

Language barrier is a major issue in this community as many people don’t poses the skills to facilitate a complete conversation in English. Of course, there are interpreters in most health setting, thus, the effectiveness of these interprets and how much of the communication is lost in translation remains mystery.

Most interpreters aren’t trained in the mental health field and many of the acronyms used by mental health professionals are foreign to them; yet they continue to provide services anyways. Even, if the interpreter is trained how much of the knowledge can be obtained by one simple training. Mental health professionals go to school many years and spend thousands of hours in clinical setting to effectively provide service; however, interpreters used by these professionals don’t receive any trainings and if they do it is one day or so.

In my professional opinion, problems with mental health in the Somali community aren’t addressed appropriately and barely get the attention it needs. There is a wide gap in the service delivery model that is currently being used and in order to bridge that gap we have to be able to come up with effective solutions. The problems that face Somalis who are struggling with mental illnesses are far worse than that of their counterparts in the mainstream. We have a community that doesn’t have enough educational background on mental health and mental illnesses are foreign to the average Somali individual. On the other hand, we have service providers that don’t have the cultural competencies that are necessity for anyone receiving mental health services.  Last but not least, not enough resources are available to individuals seeking out services which makes mental health services in the Somali community such a headache and inadequate.

To gap this bridge we need people who encompass the cultural background of this community; yet, have the educational requirements to effectively serve such needs. It is vital to use providers who speak the same language as the patients, for this not only saves money but is far more effective than using interpreters.  If we put more emphasis on creating friendly and culturally sensitive centers we might be able to remove the taboo and barriers on mental health services in this community. Centers that can provide proficient mental health service will include people who are aware of the cultural stigma and are trusted by the individuals seeking services. All in all, providers who not only understand the stigma but can also relate to the individual is essential.

This battle is far from over, as I still struggle to comprehend my own community’s view and lack of tolerance on mental illness. This community is in dire need of basic education and a campaign to eradicate the stigma on mental illnesses.

Hodan Hassan (Hodanheello)