IMPACT OF IMMIGRATION ON MENTAL HEALTH IN MUSLIM POPULATION OF MICHIGAN

1. IMPACT OF IMMIGRATION ON MENTAL HEALTH IN MUSLIM POPULATION OF MICHIGAN By FARHA ABBASI MD

2. ALIEN TO AMERICAN • United States accepts more legal immigrants as permanent residents than any other country in the world. In 2006, the number of Immigrants totaled 37.5 million. • U.S. immigration use to be an economic venture, which inspired dreams of prosperity and opportunity .The fear of life has become the driving force now.

3. THE WAVE OF MUSLIM IMMIGRATION CREATING THE NEW FACE OF AMERICA • The number of immigrants from Muslim countries were nearly 1.5 million in 2000 and now number nearly 2 million. • Muslim immigrants to the United States are highly dispersed. The only town in the country with a substantial concentration of Muslim immigrants is Dearborn, Michigan, where they make up perhaps 30 percent of the population

4. NOT ALL ARE ARABS

5. WHY! • Muslims since 1965 have arrived in the United States for two main reasons. • The first is refuge, Tragic events in Muslim countries often lead directly to the emergence of a Muslim ethnic community in the United States. The Muslim countries being disproportionately dominated by dictators means that tyranny, persecution, poverty, violent regime changes, civil strife, and wars have driven some of the most talented and wealthy from Muslim countries in the Middle East, South Asia, and beyond. • The second major reason for immigration is education

6. WHO ARE REFUGEES? • Refugee is a person who owing to a well founded fear of being persecuted for reasons of race, religion nationality, and is unable to or owing to such fear is unwilling to avail himself of the protection of that country. [UNHCR] • The United States resettled the largest number of refugees in2001.Muslim countries like Iran, Iraq, Sudan ,Somalia and Afghanistan being the top ten countries producing the most refugees.

7. THE REFUGEE EXPERIENCE • Refugees are different from immigrants, they flee their country of origin for fear of persecution not out of personal choice, they are resettled in countries that they may not have chosen ,as their primary residence or with which they may not be familiar . They do not have the opportunity to prepare for their transition to a new country ,may find it culturally strange ,and may have skills that do not transfer well to their new environments.{STEIN,1986}

8. REFUGEES IN MICHIGAN • According to an estimate since 2004-2006 a total of 4187 refugees have been resettled in Michigan ,1890 in Lansing area only comprising of diverse populations ,out of which roughly 20%-30% are of Muslim faith.

9. FIGHT,FRIGHT,FLIGHT • Immigration may it be legal, illegal or as a refugee is a traumatic and stressful experience, fraught with hardships, fear of the unknown and social disruption. • Refugees additionally have to deal with the consequences of exposure to violence and political oppression. It can have severe and lasting impact on their mental well being.

10. CULTURAL BEREAVEMENT • Loss of familiar sights, sounds and smells. • Language barriers. • Norms, values and cultural beliefs, stark contrasts to host country. • Change of economic and social status. • Lack of social support. • Racial discrimination.

11. “ IT’S ALL IN YOUR MIND” • “Minority status ,experiences of prejudice ,social and economic disadvantages and communication barriers become a lamentable part of daily life adversely affecting the immigrant’s mental state.”…Dr Saeed Islam. • Due to how people behave, express and manifest is largely determine by their culture and ethnicity, mental diseases especially depression go largely undetected in immigrant populations.

12. STIGMA……SHROUD IT IN SILENCE • “Absence of evidence is not evidence of absence.” • Strong faith and spirituality in Muslim culture deems mental illness as the weakness of the soul, where keeping silent in face of suffering is the norm and to persevere is pious. • These tend to under seek the professional help as the stigma and shame of mental health is worse than their anguish. They usually end up in Primary care settings with vague pain and symptoms. Where they are either under or misdiagnosed.

13. MISMATCHED,MISUNDERSTOOD AND MISDIAGNOSED • The reasons for under diagnosing of depression in Transcultural settings: • Different description models used. • Patient’s unwillingness or inability to disclose mental or emotional issues. • Divergence of clinical features across cultures. • Language, cultural and racial barriers between patient and psychiatrists.

14. WHEN WORDS CAN’T DESCRIBE THE PAIN • Common expressions of distress include: • Country / culture Somatic idiom • India/Pakistan ‘sinking heart’, ‘feeling hot’, ‘gas’ • Nigeria ‘heat in the head’, ‘biting sensation all over the • body’, ‘heaviness sensation in the head’ • Mexican Americans ‘brain ache’, ‘brain exploding’, ‘uncontrollable’ • Chinese ‘shenjingshuairuo’ – neurasthenia • Dubai ‘sadridayeqalayya’ – ‘my chest feels tight’ • ‘taabana’ – ‘I am tired, fatigued’ • ‘jesmimetkasser’ – ‘broken body’ • United Arab Emirates‘theheart is poisoning me’ • ‘as if there is hot water over my back’ • ‘something is blocking my throat

15. ASSESSING DEPRESSION IN IMMIGRANTS • • Review sadness, joylessness, hopelessness, lack of energy, poor concentration. • • Look for biological symptoms such as loss of sleep and libido and appetite • variations. • • Determine the reasons for migration, preparations and the actual act of • migrating. • • Evaluate aspirations and achievements. • • Gauge social support and peer group contacts. • • Study negative life events, feelings of loss and grief. • • Appraise self-esteem and self-confidence. • • Ascertain whether any social skills deficit is present. • • Determine the degree of culture shock. • • Check cultural identity.

16. HEALTH FAIR • Sep. 7------------------------ • Greater Lansing Arab American Social Services (GLAASS), Sparrow Hospital, Ingham County Health DepartmentFamily & Community Development Servicesare delighted to jointly organize a HEALTH FAIR!!FREE BLOOD PRESSURE, CHOLESTEROL, BONE DENSITY, AND BODY MASS TESTING • MENTAL HEALTH SCREENING and FREE REFRESHMENTS too! • FRIDAY SEPTEMBER 7TH, 2007 • 12:00 PM TO 4:00 PM • WHERE:  at the Islamic Center Gymnasium920 S. Harrison Rd., E. Lansing, Inside the gym • When you come to the Jummah prayer, plan on coming early or on staying back longer ! • Free consultation from the best of the best expert professionals in town. The event is free and is open to all. • If you have any questions, please call 517-402-6225 • Download a flyer to the event at : http://www.lansingislam.com/dl/health_fair.doc Annual Fund Raising Dinner Sunday September 9, 2007

17. HIDE YOUR CARROTS IN THE CLOSET