Month: December 2013

On advertising for Jinn in mental health services

Despite having worked in mental health for some years, I know very few people outside work who earn their living in quite the same way I do. Since going back into academia (a fancy way of saying ‘trying to qualify’) three or four years ago that has changed slightly, but it’s only since I began to use Twitter for work purposes that I’ve started to build networks in psychology outside of the region in which I live and work. On the whole, my interactions are with people at a roughly similar stage of their careers, but the great thing about Twitter is that there are no restrictions on who you talk to or what you say.

Over the weekend, I came across this, and it provoked a little debate:

Jinn

For the unmitigated, a Jinn is essentially a spirit. They are a common concept amongst people from Africa, Asia and the Middle East, but most cultures have equivalents. Jinn can possess you and they are generally seen as bad. The only way to rid yourself of the spirit is to go to some kind of religious or spiritual healer and I believe that such folk do a creditable trade, even in the secular metropolis that is London. My colleagues on Twitter were rather uncomfortable with it. I confess I took a rather different view. I should state that I have not verified its authenticity but that I have no reason to doubt it. My colleagues thought that the flyer was deceptive, because it suggested that if you made contact you would be provided with a spiritual approach when, in fact, the service would give you Western medicine. I disagree in several ways. I see the flyer and its careful choice of language more as a ‘hook’ with which you can encourage people to approach services when they would otherwise be reluctant to do so. Services are generally set up so that you have to see your GP and request a referral. This does not work well for all groups and we are well aware that there are an awful lot of people, often from groups which are already marginalised, who do not access services simply because of the rigmarole required to do so. Being of Asian origin myself, I have a fairly good understanding of the fear that surrounds statutory services and the avoidance that can result.

But there remains the issue of the help that will be offered. We do not, routinely, offer spirit healing in the NHS. There is no reason that MH services cannot be culturally sensitive, however. I know lots of clinicians who are sympathetic to non-medical approaches to what is commonly-labelled ‘mental illness’. The region that this flyer refers to, South & West Yorkshire, includes areas such as Bradford, well-known for its South Asian population. I would imagine that clinicians would be trained to work with people from a range of backgrounds and with a range of beliefs and that they could help those in distress without dismissing their beliefs. Additionally, this flyer relates to an Early Intervention Team. Such teams typically work with young people who have recently noticed unusual experiences. They try to work with the young person and their family for a couple of years (family work is a precious commodity and one that is rarely available in adult services), helping the person to either rid themselves of the things which are distressing them, or, if not, aiding them to live full lives despite them. They try to help the person to get better and remain well .EITs try to get people put of mental health services, not stay in them, but they can’t do that unless the person comes to them in the first place.

Is it still deceptive? I don’t think so. On the contrary, I actually think that attributing unusual beliefs and perceptions to Jinn could be quite useful clinically. One approach that psychologists use is called narrative therapy. This simply allows the person to tell their narrative; their story. It encourages them to name the thing that is causing them difficulty and externalise it. This enables a person who is experiencing low mood to call their experience ‘depression’, for example, and see it as separate from themselves. Thus, they are not staying in bed all day because they are lazy or feeble; it is ‘depression’ which makes it hard for them to do the things they want to. Again, this is a subtle difference: narrative work allows the person to recognise that they have strengths and the motivation to change but that there is something powerful which they find it difficult to overcome. In narrative therapy, the person is not the problem, the problem is the problem and we help the person become stronger than the problem by building on their skills and increasing their confidence in their own ability. If someone already attributes their unusual experiences to a Jinn, they have externalised the problem of their own accord and an approach such as narrative therapy could well be appropriate. It is also an approach based on the person’s view of the problem and has the potential to be very culturally-sensitive. It can be combined with family work and there is good evidence of its effectiveness when applied in this way.

So, all in all, I don’t share my colleagues’ scepticism of the flyer. It may be a stab in the dark, certainly, but, really, what does it cost to print a few flyers and stick them up? It’s hardly a drain on resources. But it indicates that, finally, we are trying to adapt our ways to encourage people to seek help. If it works, terrific. If not, we’ll have to think again. Crucially, though, we’re finally thinking about it and trying to make ourselves more accessible and less frightening. All statutory services need to do that and for too long, we’ve failed to do so adequately. This may not be the start of a wholesale revolution, but it’s a start, and as far as I’m concerned, it could well be the beginning of something rather interesting.

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