Mental illness recognition and referral practices among imams in the United States

Imams are Muslim clergy whose community members rely on them for help with life stresses, and therefore play a significant role in addressing the counseling needs of the growing Muslim communities in the United States. We studied if imams could recognize mental illness and would be willing to make referrals. We mailed a questionnaire to a nationwide sample of imams. The survey included a vignette depicting a congregant exhibiting signs of depression. The survey elicited answers to questions about the etiology of the presenting problem, as well as recommendations for referrals to meet the congregant's needs. Imams recognized that the congregant's problem would not resolve without intervention. They expressed a broad range of attitudes toward etiology as well as helpful interventions. Although some imams reported that they would be willing to collaborate with mental health professionals, they reported infrequent consultation practices in their communities. The amount of the imams' previous consultation experience was correlated with greater willingness to collaborate in response to the vignette (p < .05), as well as recognition of the utility of psychiatric medication (p < .05). Imams' own counseling training was correlated with less willingness to collaborate (p < .05). In order to minimize disparities of mental health care for the growing Muslim population in the United States, a focus on imam collaboration and reciprocal consultation, including clinical pastoral training, would help Muslim communities to utilize clinical resources, and help clinicians to provide more culturally competent care. The traditional role of an imam is to lead prayers, deliver sermons, and conduct religious ceremonies, as well as to provide counsel to individuals and their families. Outside of the United States, imams even help resolve disputes that in the United States would be reserved for legal courts (Al-Issa, 2000; S. R. Ali, Liu, & Humedian, 2004). Therefore, in times of duress, Muslim communities call on their imam to reference and interpret their scriptures (Qur'an and Hadith) in order to ameliorate their distress. Imams are de facto mental health care providers.