Hawa Ali has worked as a psychiatric nurse at Hennepin County Medical Center for 15 years and frequently provides the Quran to Muslim patients, who she said find it comforting to read the holy book when they are struggling during a mental health crisis.
Over the past three years, patients have been given a new resource: Hennepin Healthcare has hired three Muslim spiritual caregivers who not only provide peace of mind to patients, but also help reduce readmission rates for Muslim patients in the hospital’s inpatient psychiatric unit by more than two-thirds.
“There is a distrust of Western therapies, but when approached by a spiritual care professional, people are able to confront their challenges and take control of their behavior,” says Hawa. “Meeting someone who is spiritually empathetic makes a difference.”
In 2021, Hennepin Healthcare partnered with Open Path Resources, a Cedar-Riverside area-based nonprofit, to make spiritual care part of the medical plan, at the patient’s request. Muslim spiritual care providers now cover one-third of all spiritual care at the hospital.
This work in HCMC was funded through Hennepin Health’s $1 million investment in eight programs that will improve outcomes and care experiences for community members.
“We’ve seen a significant increase in the number of people of the Muslim faith,” said Hennepin Healthcare spokeswoman Christine Hauschild, “and our overall patient demographic has changed over the past decade, with an increased demand for services, particularly for the Somali community.”
According to Hennepin Healthcare, at least 7% of the hospital system’s patients are Muslim, and 10% of its psychiatric patients are Muslim.
Tracking the impact
The biggest impact has been in psychiatry: Medical workers have found that patients who identify as Muslim are more likely to be readmitted within 30 days of being discharged, according to Dr. Stamatis Zelis, a psychiatrist and director of the psychiatry training program at Ho Chi Minh City Hospital.
The hospital tracked readmission rates for inpatient psychiatric patients and found that after implementing Islamic spiritual care, readmission rates for Muslim patients dropped from 24% in 2019 to 9% in 2023.
“This is an intervention that focuses on how we, as caregivers, think about the different cultural languages that people use to express their distress,” Zellis says. “The spiritual caregivers are really helping to integrate that theme further into the overall treatment plan.”
One of the hospital system’s goals in partnering with Open Path Resources was to address high readmission rates. OPR was founded by Michael Van Keulen and Imam Sharif Mohammed to improve relations between Minnesota’s Muslim community and public agencies. The organization is based at Dar al-Hijra, Minnesota’s oldest Somali-run mosque.
OPR has interviewed more than 500 people and conducted surveys since 2013 to better understand the critical needs of the local Muslim community.
“The most complex places are the ones where there are biases, challenges and mistrust,” Van Keulen says. “Those are the places we wanted to dig deeper into.”
The most complex are the places where there are biases, challenges and mistrust, and we wanted to dig deep into those places.
Michael Van Keulen
The group found that Muslim patients end up returning to hospital because of stigma around taking medication, often perpetuated by their families and communities.
“There’s this perception that, ‘God is punishing me because I’m far from my religion,'” Sharif says, adding that spiritual care providers help patients and their families understand that medication is not against Islam and that mental illness is not a spiritual illness.
At the same time, Van Keulen said, the idea is not to pressure patients to take medication, but to build the trust needed for them to accept treatment.
A new model of spiritual care
Van Keulen explained that the spiritual care provider program developed by OPR is different from the chaplaincy program. The providers focus on caring for Muslims. They also follow up with patients after they leave the hospital. The spiritual care providers are OPR employees, but are part of the hospital’s care team.
Spiritual care providers in Ho Chi Minh City sit down with their patients, talk to them, pray with them and provide them with Qurans, prayer rugs and prayer schedules.
Van Keulen and Sharif, a former Muslim preacher himself, found that simply talking to someone who looks like them and understands their faith made patients more likely to accept treatment and trust their health care provider.
OPR also hosts community education events to combat stigma around mental health treatment and strives to ensure patients feel supported when they return home.
Sharif said doctors are trained to recognise the symptoms of mental illness, particularly anxiety and psychosis, and are equipped with the skills to listen non-judgmentally and provide empathy to patients.
“What people with mental illness need is a sense of belonging. You’re part of a community, you’re not alone,” Sharif says. “All of these elements are so important.”
One issue OPR is still debating is how to provide hijabs to Muslim women undergoing psychiatric hospitalization.
Inpatient psychiatric treatment, by design, imposes restrictions while patients recover from a mental health crisis. For example, a patient in extreme distress may not be able to wear a hijab because it could be used as a tool for self-harm. When a psychiatric patient requests a hijab, the answer is not so simple, Van Keulen said.
“Hospital rules used to be very strict, but now they’re not. There’s a lot more conversation, our spiritual care team is involved in de-escalation and resolution, and in some cases we’ve offered hijabs,” Van Keulen says. “What’s missing in healthcare is control over your own dignity.”
While strict rules around the hijab are less common in Ho Chi Minh City than they once were, patient safety remains a top priority, Van Keulen said. There is now respect for the safety that Muslim women feel by wearing the hijab, especially those in mental health crises, she added.
Hennepin Health and OPR are encouraging the integration of a similar model for spiritual caregivers to benefit Muslims during pregnancy, with chronic health conditions, Muslims suffering from substance use disorders, hospice patients, and their families.
Spiritual care models are not yet the norm
While Ho Chi Minh City has made great strides in improving mental health treatment for Muslim patients, Dr. Farha Abbasi, director of the annual Muslim Mental Health Conference and Consortium in Michigan, said such efforts are still not the norm nationwide.
“Physicians are contributing to health disparities by not being culturally wise, which is a major obstacle to providing appropriate care to patients,” Abbasi said. “Cultural competency training based on implicit bias is a good thing, but it’s not enough for a rapidly growing and diverse population.”
Abbasi has observed conditions in inpatient psychiatric facilities where there are limited language interpretation services, a lack of halal food available to Muslim patients, and strict rules regarding the hijab due to safety concerns. In addition to mental illness, the trauma experienced by Muslim migrants during migration also places an additional burden on patients.
“Are hospitals doing enough? I think they’re failing horribly,” Abbasi said. “Cultural sensitivity training needs to be taken to a much deeper level.” She encourages other hospital systems to hire cultural and spiritual liaisons for their diverse patient populations.
