Content note: This article contains descriptions of suicide and violence. If you or someone you know are struggling with suicidal thoughts, help is available 24/7 through the National Suicide Prevention Lifeline at 1-800-273-8255. Muslim youth can also call Naseeha’s confidential helpline at 1-(866) 627-3342 for support.

Muslim American adults are twice as likely to report a history of attempted suicide than Americans belonging to other religious traditions or no religion, according to a new study. It’s a rate even higher than experts feared, one that includes both local tragedies that families may be reluctant to report, and high-profile cases, like the shocking murder-suicide in Allen, Texas, that left an entire family dead in April and sent shockwaves through Muslim communities around the country.

The study’s authors told Prism that although they expected to encounter results that would corroborate what they had been seeing in a clinical setting, they were taken aback by the magnitude of their findings.

“The rate that people answered that they had had a suicide attempt in their lifetime was quite striking,” said Yale neuropsychiatrist Hamada Altalib, who co-authored the study, published July 21 in JAMA Psychiatry

According to psychologist Fahad Khan, few Muslims who feel suicidal seek help, seeing their struggle as a shameful and sinful personal matter they must overcome by themselves.

“Here in the Chicago area we’ve had several suicides in just the past few years,” said Khan, who works for the Khalil Center, a national network of Muslim mental and spiritual wellness centers. “I’ve been working in the Muslim community for at least seven years now, so I know it’s prevalent. I just didn’t think it was going to be that much.” 

Faith and mental health

The survey found that close to 8% of Muslim respondents reported making at least one suicide attempt in their life, as compared to 6% of Catholics, 5% of Protestants, and 3.6% of Jewish people. The data reflects a randomized national sample and also asked Muslims to self-report their level of religiosity. But researchers found no correlation between respondents’ religiosity and record of suicide attempts, complicating popular conceptions among many Muslims that a higher level of religious observance prevents mental health issues.

“Sometimes in our community we talk about how faith alone can protect against suicide,” said Rania Awaad, a clinical psychologist and founder of Stanford University’s Muslim Mental Health and Islamic Psychology Lab who co-authored the study. “We should be talking about spirituality, yes, but also about mental and physical wellness—mind, body, and soul.”

This holistic understanding of wellness is critical, especially for imams and other trusted religious leaders who work with vulnerable individuals, Awaad added. While some academic literature has found that a strong religious identity can be a protective factor against suicide, religious leaders—who can form a first line of defense against mental health crises—should know that religious observance is not a panacea.

Psychologists who spoke to Prism emphasized how social isolation and financial strain during the pandemic have also taken a heavy toll on many people’s mental health. The data collected from another recent survey supports their observations—amid the pandemic, about one in three Muslims reported feeling suicidal or having thoughts of suicide in therapy. That’s on top of anti-Muslim discrimination, xenophobia, police brutality, and bullying, along with the impact of poverty, anti-Black racism, refugee and immigrant experiences, sexual and gender-based violence, and other crises, all of which can also be factors for suicide risk.

“Sadly, many of our community and religious leaders do not have the proper training and dismiss warning or telltale signs,” said Shaykh Yasir Qadhi, a popular Texas-based imam, in a video supporting a suicide prevention training program for imams led by Awaad’s new organization, Maristan. He then quoted an oft-cited Quranic verse: “Whoever saves one life is as if he saved the life of all of humanity.”

Teaching the scholars

It wasn’t long ago that many imams ignored Awaad when she tried to discuss the importance of mental health awareness with them. In just a few years, however, that initial resistance has changed, with many now actively seeking help in handling mental health cases among their congregations. It was only after tragedies such as the 2018 murder-suicide involving two children who were killed by their Muslim mother in Virginia—who was well-known in the region as an active member of one of the country’s most prominent mosques—that many Muslim leaders were willing to acknowledge to the severity of the issue. Awaad herself said she began focusing on suicide prevention within Muslim communities after a teen’s 2017 suicide in the Bay Area, where she lives.

“The whole community came to a halt,” Awaad recalled. “Many people could see themselves or their kid in that deceased child’s shoes, and that local incident really kind of began the whole conversation.” 

The models she now uses and teaches for grieving and the healing sessions were developed in the wake of that suicide. Through her work helping congregations heal from such tragedies across the country, Awaad’s new organization Maristan has produced a manual on suicide response for Muslim communities. She is also raising funds to train and certify 500 imams and religious leaders on suicide prevention and response this year. Within five years, she hopes to have leaders within each of America’s approximately 3,000 mosques certified in suicide prevention.

Most recently, in the immediate aftermath of the Texas murder-suicide case, with just a few hours of notice, about 100 imams and community leaders participated in a virtual emergency suicide response training Awaad organized. Awaad shared tips for leading their congregations through the grief and sensitively dealing with the issue of suicide in sermons while maintaining Islam’s prohibition against suicide.

“The imams all stayed on afterward and it actually was midnight when I finally said, ‘I think we all need to sign off,’” she recalled. “They needed that support and understanding of how to talk about suicide, what to say, how to carry the community forward after this tragedy.”

Imam Abdul Rahman Bashir, who leads the Islamic Association of Allen, was one of the leaders who attended. “As an imam I have dealt with many a loss and family tragedy, but in no way could I have imagined to be the at the helm of such a disaster,” he explained in a video for Maristan. ”My mind was grappling with so many thoughts on which angle to even personally process, let alone steering the community.” 

Many imams have long seen Muslims’ mental health crisis coming in the wake of post-9/11 discrimination and counterterrorism efforts, said Imam Abdul Malik Mujahid, who has delivered many sermons on mental health to his congregation in Chicago.

“Imams know what goes on in their congregations,” he said. “More than 500,000 Muslim doors were knocked by the FBI … that is quite a bit of pressure.” When he held a retreat for local imams in the early 2000s, most cited counseling as their congregants’ top need. 

Still, one 2012 study of American imams’ mental health awareness and referral practices found that while imams serve as “de facto” mental health providers, less than half of those surveyed had any form of experience or training in psychology and most rarely consulted with mental health professionals. However, through projects like Maristan and the Khalil Center, that’s beginning to change.

Ten years ago, Muslim psychologist Hooman Keshavarz founded the Khalil Center as a nonprofit mental and spiritual wellness organization with the aim of “advancing the practice of professional psychology rooted in Islamic principles.” Since then, the center has treated more than 10,000 patients and held more than 100,000 therapy sessions. Today, it has a team of 30 practitioners, including Khan, and several branches across the U.S. and Canada.

“The Khalil Center has singlehandedly shifted the discussion for imams,” said Mufti Abdullah Nana, an Islamic scholar in California. While individual Muslims have long worked in psychology and therapy, “we hadn’t had a separate counseling center dedicated to Muslims or programs just for training imams.”

The center has already trained more than 1,000 imams in mental health awareness through its eight-hour Muslim Mental Health First Responder Training program. The program, launched in 2016, is taught by licensed mental health professionals with formal Islamic studies training. A survey of 128 participants in the Khalil Center’s program found that although most were regularly involved in situations that required responding to mental health issues, 70% had no prior mental health training.

Now, Nana said, more imams are working in the mental health field on their own, as well. One of Nana’s own students spends his days studying Islamic sciences, and spends his nights taking phone calls from people who are close to committing suicide.

Growing awareness

Ten years ago, resources to guide mental health practitioners in working with Muslim patients were extremely difficult to find. Psychologist Samira Ahmed, founder of the Michigan-based Family and Youth Institute, decided to begin addressing suicide prevention and awareness in Islam when a Muslim woman contacted Ahmed asking for resources to help her local Muslim community cope with the recent suicide of a member. However, Ahmed struggled to find tools that would address suicide while accounting for the cultural and religious issues with which U.S. Muslims were grappling. During her own training in clinical psychology, she had never received any instruction in working with Muslim patients. She also recalled how responses to her work within her community differed widely in public and private statements. 

“We had people saying, ‘This is not an issue within our community. Why are you guys making it an issue?’ while at the same getting private responses saying, ‘Thank you so much for doing this. I have been struggling for many years,’” she said.

Now, a suicide prevention and response toolkit and a Friday sermon template produced by the Family and Youth Institute are just one of many mental health resources for North American Muslims. As of last year, about a third of U.S. mosques are offering mental health counseling services, either through in-house programs or referrals, per the Institute for Social Policy and Understanding.

Mainstream organizations training clinicians are also realizing the need for cultural competency in working with Muslim patients, particularly as researchers increasingly link anti-Muslim discrimination and policies to negative health outcomes. Awaad’s lab at Stanford has been commissioned by the American Psychiatric Association to produce a continuing education course on Muslim mental health, as well as clinical textbook on the topic. Muslim clinicians themselves are also increasingly gravitating towards faith-based fields such as Islamic psychology and Islamically-integrated psychotherapy, as taught by organizations including the Khalil Center and the Al-Karam Institute, through which practicioners fuse Islamic spirituality and Western therapeutic approaches to building psychological wellbeing.

There is also the Muslim Wellness Foundation, home of the annual Black Muslim Psychology Conference, and a number of community clinics run by and specializing in mental health care for Somali refugees and immigrants. There are phone lines including the Khalil Center’s hotline, the Naseeha Muslim Mental Health Hotline, Muslim American Society’s AMALA Muslim Youth Hopeline, the Calls for Comfort “warmline” for Muslim women, and Sound Vision’s 24/7 crisis text line, which recently found that 13% of Muslim youth who reached out to the line pre-pandemic spoke about committing suicide.

Texas’ nonprofit Safa Institute researches Muslim mental health and works to make culturally competent therapy more accessible while Michigan’s Institute for Muslim Mental Health has compiled a mental health care provider directory. The New York-based volunteer group Heal Collective works to improve mental health awareness among Muslims and has certified about 2,000 participants in mental health first aid courses, including at mosques and Islamic schools around the country. The organization SEEMA runs support groups for those with mental health conditions and their loved ones and seeks to end stigma among Muslims. And a slew of new apps such as Sakeenah, Halaqah, Sabr, and Ruh aim to help Muslims improve their mental and spiritual health through mindfulness and guided meditation.

Muslim mental health care providers and advocates say they are heartened by this explosion in resources aimed at their community, and the use of tools from social media posts to peer discussion groups to Friday sermons to deliver the message to vulnerable Muslims across the country. To be sure, the taboos and stigmas—particularly around discussing suicide—are stubborn. But with every download of the suicide prevention toolkit she created in 2017, Ahmed reminds herself, a life may have been saved.

“The biggest thing for people to know is that resources are there,” Ahmed said. “They are free. They are accessible 24/7. And they are tailored to your Muslim American reality.”

Aysha Khan is a journalist in Boston. She covers religion and culture with a focus on American Muslim communities.