Stanford psychiatrist focuses on mental health needs of Muslims

Photo, of Rania Awaad giving a recent talk, by Anum Ahmad

Prior to studying medicine, Stanford psychiatrist Rania Awaad, MD, studied Islamic law. As a local religious leader, she said that many people in her community are actually surprised to learn that she’s also a physician.

However, this dual training is at the heart of Awaad’s research and clinical work, which focuses on the mental health needs of Muslims. I recently spoke with her to learn more.

What are the mental health challenges faced by Muslims?

“In our recent sociopolitical climate, there’s been quite a bit of negative focus on Muslims and other groups. And we have the highest level of hate crimes against Muslims ever in American history — about six times higher than post 9/11.

In the Bay Area, we have a consortium of mental health and general medical providers who are trying to figure out how Islamophobia — the fear of the Islam religion or Muslims — affects the general health of Muslims. So far, we’ve seen a lot of anxiety, depression and post-traumatic stress disorder.

There’s already quite a bit of PTSD within the community, because many Muslims that immigrate to America come from areas of conflict. Current policies can trigger immigrants’ underlying PTSD, anxiety and depression, as I recently described in the American Journal of Psychiatry.”

Are there barriers to mental health care for your patients?

“There’s a lot of paranoia about medical providers documenting their issues in an electronic medical record. They’re afraid this medical information will be combined with a Muslim registry. Initially we told patients not to worry, because unconstitutional things like that don’t happen here. But then the travel ban helped substantiated their fears.

There are also barriers directly tied to faith beliefs — concepts like the evil eye or spirits. If someone is having psychosis, for example, people may say he is possessed and should be taken to his religious leader instead of a mental health professional.”

What can you do to overcome these challenges?

“Mental health professionals can approach a patient’s faith leader for a religious consultation. I help train chaplains and imams and I’m also teaching doctors to engage with faith leaders. For many people, their faith is a source of strength and support. So leaving that out completely means that you’re not really providing adequate, holistic care.

There are a limited number of mental health professionals proficient in understanding the Muslim faith and culture. Through the Khalil Center, I’m working with other dual-trained practitioners to develop a manual, book and training seminar on Islamic psychology from a practical clinical perspective. We’re trying to provide guidance for practitioners without Islamic training to work with this unique minority group.”

How did you end up specializing in the mental health needs of Muslims?

“I thought I was going to be an ob/gyn. But during medical school, I married my husband who is an imam and a director of a nonprofit. At one point he told me what our community really needs is someone who can work in mental health, based on what he saw as a community leader. He inspired me to become a psychiatrist.

I also feel my dual training was meant to be. In high school I embarked on a lifelong journey of formal Islamic studies training. I’m currently a professor of Islamic Law at Zaytuna College, a Muslim liberal arts college in Berkeley. My dual training kickstarted the Stanford Muslim Mental Health Lab and Wellness Program that I founded and direct, and it has allowed me to lay the groundwork to train others.”

What are some other things you’re working on?

“The SMMH Lab is part of a consortium that is studying the effectiveness of integrating faith concepts with therapy for different faith communities — Muslim, Jewish and Christian groups. We’re using evidence-based, objective metrics like the depression inventory scale.

I also oversee the Bay Area Muslim Mental Health Professionals group, which has led to many other initiatives like a Bay Area Muslim mental health community advisory board and a crisis response team.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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On caring for suicidal patients: A psychiatrist reflects

Photo by Counseling

Many hospital psychiatrists work in emergency rooms, psychiatric wards and intensive care units where they treat patients who have intentionally harmed themselves. Stanford psychiatry resident Nathaniel P. Morris, MD, writes about his experiences caring for suicidal patients in a recent opinion piece in JAMA.

Depression, psychosis, substance abuse, post-traumatic stress disorder or other psychiatric illnesses can drive individuals to cause themselves severe physical harm, he writes..

Once life saving measures are taken, hospital psychiatrists are called whenever self-inflicted injuries are suspected. “We play a part in stabilizing patients, from evaluating whether patients need involuntary commitment, to managing agitation, to reviewing patients’ home psychiatric medications,” Morris says. But at the core, psychiatrists try to figure out why the patients hurt themselves, he adds.

While caring for these deeply ill patients, psychiatrists need to manage their own emotions, Morris says. In the piece, he depicts what it feels like when he walks into the rooms of suicidal patients, having to hide his reaction to their shocking injuries and, following the advice of a senior physician, “act like he’s seen worse.”

He also admits his concern over releasing patients once they are doing better:

“Yet I always have a sinking feeling as discharge dates approach. I worry about what will happen when my patients leave the controlled environment of the hospital… I try to accept that I cannot control my patients’ fates. But their stories stay with me. When I leave the hospital, I often find myself scanning the faces around me, looking for the ones seared into my memory, hoping to see that my patients are okay.”

It is work he never completely leaves behind, Morris confesses. His experiences offer him a closeup look, albeit a pain-filled one, into the lives of the mentally ill.

So Morris hopes to spread awareness of the harm caused by depression and other psychiatric issues, explaining in the piece:

“Americans worry that people with mental illness will hurt others, but we don’t talk enough about the horrors that distressed people inflict on themselves.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Advice on how to cope with the threat of school shootings

Image by Clker-Free-Vector-Images

Like older adults who grew up with the imminent threat of nuclear bombs during the cold war, children are now growing up with mass shootings — the new normal.

Since the Columbine massacre in 1999, kids began participating in school lockdown and active-shooter drills. Some also face metal detectors, bulletproof Shelter-In-Place bunkers and other security measures in their schools. Classrooms no longer seem like a safe place and this stress may be impacting our children’s long-term health and development.

Victor Carrion, MD, a professor of psychiatry and behavioral sciences at Stanford, studies the interplay between brain development and stress vulnerability. In a recent Stanford Magazine article, he offers some advice on how families can cope with the stress of school safety:

  • Parents should proactively talk with their child about difficult topics in a developmentally sensitive way.
  • If parents are worried about their child’s stress level, they should look for a change in function. Very young children can become clingier. Older kids often convert depression or anxiety into physical symptoms like a stomach ache or headache. And adolescents frequently withdraw.
  • School drills should include three steps: a school orientation about the drill, the actual drill practice, and a follow-up discussion to help children process how they felt during the exercise.
  • School administrators, teachers, parents, police and the community need to work together to create an environment where the child feels safe, secure and protected.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.