 very proud and happy to be able to partner with ISP for this work. Now, a little bit about what we're going to be covering today, we are setting out really today to talk about access to mental health care during the COVID-19 pandemic, particularly for Muslim health care workers. We also want to explore, excuse me, the possible complications of discrimination for the Muslim health care workers and to understand what kind of coping mechanisms they used during this process. And some of the findings that we're going to present today have been interesting and expected, and some are not so much, so we'll share all of that soon. Also to let you know that we were able to receive ethics or IRB from Stanford University, and our work is very much a cross-sectional survey that, which we went to many different platforms to really reach out to the Muslim health care workers, and it was held soon after the pandemic started, so really January to May of 2021, if we can take you back to that point in time. In terms of what I'll be presenting to you today is the results of what are 49 items of a survey that looked at demographics, but also psychological distress, discrimination, coping strategies, and what were the sources of that stress? And as Daria mentioned earlier, our sample size was nearly 700, 692, to be exact. A little bit about why it is we decided to do this work. Here's some research, if I can take you back to 2020, right at the start of the pandemic itself, and there was a research coming out that was actually quite concerning, and saying that out of all the different groups of people, the health care workers, and this is broadly not just Muslims, all health care workers and people on the front lines are really the ones experiencing probably some of the most increased distress and anxiety and detrimental well-being because of all the work they were doing, fearing for their own well-being at the same time of trying, of course, to care for others. And beyond that, there was a lot of social isolation due to the pandemic, but also a feeling of disconnection from friends and family and just being on the front lines nonstop that really significantly worsened their mental health outcomes. Now, pre-pandemic, we already know that health care workers who came from minority backgrounds were less likely to feel supported and have increased stress. So we imagined that during the pandemic, this would be even more complicated and actually compounded, which is what some of the early research was in fact showing. Lastly, that American Muslim health care workers were really understudied. We didn't have much data at all to point to. So this is really the impetus of the work here. Now, if we look at American Muslim health care workers, here is what we knew kind of going in. We knew that there was social isolation from coworkers post 9-11, these last two decades have been particularly difficult. Islamophobia has definitely been on the rise. There was also additional scrutiny in hiring them as clinicians or as health care workers, whether these are doctors matching for residency or whether they're in any other form of health care. Also on the patient side, after they're in the field, patients refusing to be cared by Muslim health care workers because, again, of discrimination or Islamophobia. And then high levels of kind of job turnover and a decreased sense of belonging. This is what the literature showed before our study. And so our question really was, how did COVID-19 impact this population? If you add to it the discrimination that they felt at being Muslim on top of everything else that was happening in COVID-19. Here's a little bit about our sample. And here are some of the, you know, initial results that I'll share with you. Three quarters of the survey respondents for women, which is really interesting, of course, to think about what that means in terms of the health care setting and also those who chose to take the study. In terms of ethnicities, we really did our very best. I want to reassure you our very best to try to reach out to many different segments of the Muslim community. And in certain populations, we really did try to oversample particularly our Black and African American Muslim populations. But there's just very little data altogether on in certain subgroups of the Muslim population. And so you'll notice here that the majority of our population is Asian and Arab, but you'll also find that the category for those who are wondering about other, I'll just say off the bat here, that they are populations like Latinx communities, Afro-Caribbean and other subgroups who are maybe very slim in terms of their overall numbers that we put together in the other category. So that's a little bit about who was able to take the survey. And then when we look to who were the survey respondents in terms of age, we find that the majority, if you look at the yellow and the orange here basically are, you know, and all the other slumber parts of the pie there, is under the age of 40. There is, of course, a subset that's over the age of 40, but it's important to note that there is a younger age group altogether in the survey. Okay. Half of the survey respondents were physicians because we did try to do a very interdisciplinary kind of study here where we looked at all types of healthcare workers, but this is also to point out who exactly was in the study, including, you know, beyond physicians like nurses and therapists, dentists, anybody who was really on the front line of doing COVID work were exposed to COVID from their patient populations. And one in five of our survey respondents said that they had high contact with COVID-19 patients. And if you look to, you know, here where it looks like high risk, which is the orange, and then medium risk, there is a pretty significant kind of exposure to COVID from those who took the survey versus those who are kind of just virtual, for example. This particular slide is of importance. And when I want to take just an extra moment to really focus on with you, because it shows up again later in our findings as a very important point, more than half of the survey participants reported that religion was extremely important to them. And you see that in the orange column. But if you look at the light blue column next to it that says very important, you'll see that if you combine these two together, over 90% of our survey population felt that religion was extremely important to them. And I'll say right off the bat here that this was a self-administered question. This was a question that there was a self-report, excuse me, that they were meant to really ask, you know, answer on their own behalf, how important they felt religion was. So we're really talking about a sample here that felt that religion was a really important part of their daily life practice. And I'll come to this point again later, but it's really important that we talk about a faith-based group that we bring in questions about their faith into the discussion to see whether it is or not a form of coping they were using. We'll come to this again. Also, according to the poll, the ISPUs, American Muslim poll in 2020, the numbers are actually very similar. So you'll find that over half of that population, and that was, I should clarify here, the American Muslim poll that ISPU does every year is a cross-sectional poll. It is, the sampling from it is not like our sample, which would be called a convenience sample, people who chose to enter into the survey, versus the annual poll is actually something that is more cross-sectional and happens where really whoever picks up the phone, if you will, it's a random sampling is the one who's asked the questions, yet the numbers match very, very closely. And so I just want to point that out that we didn't, even though that was an interesting finding in our survey, it's actually very similar to the American Muslim population in general. Now we come to the impact of COVID, our findings, the impact of COVID on mental health and distress, and here are some of the main findings that we came to. Stress, including psychological distress and anger, which is very interesting here and important to bring up, were all increased as a result of the COVID-19 pandemic. Four out of five healthcare workers experienced increased stress, and while this is something we probably would assume, you know, that would have happened, it's important to kind of see the exact numbers. It's obviously a very high important point to talk about the majority here. If you look to discrimination, you'll find that nearly half of our sample reported at least one form of discrimination. And if you're wondering what different kinds of discrimination we looked at, we looked at religious discrimination, like Islamophobia, for example, we looked at things like gender-based discrimination, we looked at religious-based discrimination. And when there was at least one form of discrimination, it definitely had a higher level of psychological distress, like depression and anxiety, associated with it. And certainly this is true if it was a combination of multiple different forms of distress. And if it ranged anywhere from, if you had one or more form of the discrimination, from two times to even six times as likely to report serious psychological distress. We also know that Islamophobia in the workplace, but we found rather that Islamophobia in the workplace, actually was associated with increased healthy coping mechanisms. And I know this might come as an interesting point to people, like what does that mean exactly? For us, when we looked at healthy different coping mechanisms, we looked at religious-based ones, and also ones that we consider to be neutral. For example, things like calling your friends and family, exercising, taking a walk. In addition to the religious forms of coping mechanisms, where things like praying, reading, doing, for example, different forms of religious coping. And we found that those were increased when people experienced Islamophobia. We also found when people experienced racial discrimination in the workplace, that those were associated with decreased healthy, healthy coping mechanisms. And we'll talk about all of these in a slide coming up just very soon here. Now, nearly one in three Muslim healthcare workers report occasional or regular Islamophobia outside of their workplace. This is very important to understand the implications kind of broadly, that it's not just within the workplace. Muslims are also Muslim outside of their workplace, and therefore they're carrying this kind of stress with them and experiences from Islamophobia everywhere they go. And when you think about what that means, and you look at the other forms, not just Islamophobia, but all the gender and racial discrimination, it's all additive. And I think that's really important to understand in the larger scheme of the study. I promise we talk a little bit about coping strategies. So here they are. When we look at behavioral coping strategies, we were talking about, you know, for example, healthy coping strategies. So take a look with me at the columns here. You'll see there's items like calling friends and family, or making more prayers like dua, or things like exercising or reading good and or extra prayers or journaling, right? And so you have all different forms of types of coping, both religious and non, and all of them were considered to be used and certainly the most utilized were calling friends and family and making more dua or supplication. In terms of the most commonly used unhealthy coping mechanisms was eating comfort food. And I want to make an important point here, that these are not necessarily, you know, we're not kind of putting a judgment call on these things, rather what we're saying, they're pretty much neutral in those cases. But when you look at the literature, these behaviors are often linked to avoidance and addictive behaviors, which is why we were making sure that we added them here and looked at them. So eating comfort food is the highest, but you can also see shopping online, sleeping more than usual, tobacco products or drug and alcohol. And to see that, you know, kind of the range of what people were doing, especially if it was considered to be unhealthy ways of coping. Also, gratefulness is an important concept that I want to point out here. And you'll see that it's a very high percentage, 93% say that they try to remember the blessings and thank Allah, in order to cope through the COVID-19 pandemic and the work they were doing on the front lines. Also looking to for a lesson from Allah in this situation, what does this all mean was something that happened quite often along with some of the other cognitive-based thoughts that you see listed here. Now cognitive coping, we found that there was a lot of mental health care utilization that was increased by the Muslim health care workers in COVID-19. And we were very happy to see this actually, to know that there was an increase from before COVID to after COVID to actually reach out to mental health care professionals. This trend is something that's worth pointing out because it is a shifting trend in the general Muslim community and we're glad to actually see that's happening. Now, the key finding is just to summarize everything that I mentioned here, kind of just bring us back and conclude. We found here are some of the key things. Copic strategies, right? Some of them are linked with increased stress. Also that remembering blessings and thanking Allah was widely protective and I get important to discuss when talking about faith communities and research. Seeing a mental health professional as we mentioned was actually not only increased but also widely protective. So these are really important strategies when thinking about how to move forward in helping our Muslim health care workers. Finally, our recommendations really is to make sure that mental health care is accessible and it allows for religious coping mechanisms to come into surface so that therapy can be culturally and religiously congruent for those who are trying to reach out to the mental health care support. Also, because of the high levels of Islamophobia, we very much recommend incorporating Islamophobia awareness and prevention to make sure that this is part of any of the existing DEI or diversity, equity, and inclusion type programming in health care settings or other educational settings. Furthermore, we also want to say that whatever maladaptive coping mechanisms there have been that showed up, we want to make sure we build awareness amongst American Muslim health care workers because this is an ongoing pandemic. We're not quite out of it yet and there's a lot more to really help build and educate our community and to note the point about gratefulness, right, to be grateful or the Arabic term shukr, right, the Islamic term. So here to this that this is part and parcel of the religion of Islam and for that reason to make sure it's incorporated in any sort of mental health being type programming because of how high level it was reported amongst our population here. And then we want to make sure that we incorporate mental health care into the coping strategies that we propose. So in conclusion, I invite you all to read the entire report. You can find it on ISPU's website and to join their mailing list, it's isp.org backslash sign up. And particularly our report, there's the link there and we can put it in the chat if you'd like to access the entire report and read in more detail. And I thank you all very much for this for tuning in for this part of it. Back to you, Delia. Thank you so much. Thank you so much, Dr. Rania. And I want to bring on our two other panelists now, Dr. Mona Masoud and Marguerite Hill. Somebody can thank you for having me. Thank you for being here. Let me just introduce Dr. Mona and Marguerite. Dr. Mona is an outpatient psychiatrist in the greater Philadelphia area and a board member of a nonprofit community mental health organization called Muslim Wellness Foundation, which many of you of course are familiar with. And this organization provides mental health and educational services to the community. Dr. Masoud is also the founder and chief organizer of the Physician Support Line. And I'd also like to introduce Marguerite as well. Is Marguerite on? There you are. My Zoom is the problem. Marguerite is the executive director of Muslim ARC and is an adjunct professor, blogger, editor, and freelance writer with articles published in How We Fight White Supremacy, Time, Huffington Post, Al Jazeera English, Islamic Monthly, and Muslim Matters. She has five years of full-time experience working in community organizations and five years of experience in administration and technical writing in Silicon Valley, small businesses, and startups. And there's much more to say, but I will stop there just to give our panelists time to express their thoughts about this report. And I'll start with Dr. Mona. You started a very interesting and important project on the Physician Support Line that was providing mental health support to physicians during the pandemic. And it's been operating for more than a year now. Can you tell us some of the lessons that you learned and some of the key observations that you that you noticed since you launched this project? Yes. Just a little bit of introduction about the Physician Support Line itself. I was just looking at the timeline and it's like so many things with COVID. It's been over two years now since the launch. And it's been quite telling the lessons we have learned from our colleagues and mentors and peers speaking on the Support Line. So the Physician Support Line is a grassroots effort run by over 800 volunteer psychiatrists nationwide to unapologetically support medical students and physicians, which started off as navigating the pandemic, but then started including many intersections of our personal and professional lives over the course of these past two years. And the goal, inshallah, is for it to be sustainable ongoing. And a few lessons that really stick out to me and I think are relevant for physicians right now is the intersection of so many different identities that we have. In one hand, we were called into action for being the frontline of this pandemic due to our training and our knowledge and being put in that position. And so that was the expectation, this expectation of heroism, which was not something that as flattering as it may have been that people had said that to us. For us, it was quite a bit of pressure because we were all going into this pandemic very much as lost as many of the people we were taking care of. And we didn't have all the answers. This was the novel coronavirus for us too. But we also felt this intrinsic pressure of people are counting on us. We have to somehow create hope. We have to be able to not only save lives of our patients, but it really felt that the stakes were so high if we were not able to deliver on this promise or this expectation of heroism. And it was something that it was not an easy thing to share with others. Our own anxieties, our own fears that we were not going to be able to do this, that this task was too impossible for us to be able to do. And there was so much fear that went into it, fear of contracting the illness ourselves, fear of giving it to our own families, fears of not being able to save our own patients. And honestly, the fear that we were not cut out to do this, that we are not actually what people think we are, the fear of failure, the fear of being an imposter really. And then you add on, which is the study which was what really interested me in wanting to take part in this, then you add on who we are as human beings and how we, the different identities that we hold, whether they're gender identity as, you know, what does it mean to be a female physician or a male physician? What does it mean to be our racial identities in terms of what does it mean to be, you know, a black physician versus an Asian physician versus an Arab physician versus an immigrant physician, or an American one. There was so many different intersections. And then we had political intersections. And we had where we are in our own lives, such as our ages, that we were able to go over here. And all of these different things was, instead of, you know, allowing us to understand ourselves better, it really made the American physician experience more complicated. Because we had to learn how to navigate all of these different nuances of what made us us simultaneously. We had to not only be physicians and be the front line of this pandemic, but we had to continue being mothers. We had to continue being, you know, involved wives or, you know, or husbands. We had a lot of these kind of issues going on. And so what this did was it brought our reckoning for American physicians, where we had to decide now that, you know, who do we want to be? What did we find to be most important to us? And we had to, you know, we had to really own that. And now I hope that from all this experience of learning what we are, we're going to be more unapologetic and self-advocating in what we want. That includes in the system that we work in, that includes how we identify as not just being a cog in the healthcare system in America, but being an active member of it, of making decisions that affect patient outcomes, but also our own self-care and our own mental health, such as work hours, such as hazard pay, such as all of these different, you know, points that we really had to own and self-advocate for. So this is the beginning of a big conversation on what, you know, a physician or healthcare worker mental health is going to look like. But I'm thankful for the opportunity to kind of get our, you know, the discussion going and people talking about it more. So it's a fair for having me. Thank you so much, Dr. Mona. Incredibly unique and critical point of view that most of us didn't have to be able to listen in and hear and understand what people are going through. And you're right. I think so many of us look to physicians as being these, you know, indestructible humans that we can always look to to give us the answer. And yet they're just as afraid as we are in many cases. You mentioned in your remarks about, you know, coming, showing up as not only a physician, but you're a woman, you're a person of color. And I want to then turn to Marguerite to kind of help us understand the impact of all of these different identities as people are walking into the hospital trying to save lives. Between 19 and 25% of respondents said they experienced Islamophobia, racial or gender discrimination. Can you help us understand a little bit more about systemic discrimination? And what do you recommend to address these, especially in the healthcare system? Thank you. Yes, it's listening to the report and thinking about the discrimination that was reported in the study where, which aligns with other studies, like there is Seraphina et al, who talks about the discrimination that physicians of color experience where, and that's like kind of a qualitative data where the majority of the participants said that they experienced significant racism from parents, patients, colleagues and institutions, right? So, and that added stress, you know, so we could see the unhealthy responses, you know, because this is compounded, right? And, you know, the stress of the pandemic and experience experiencing discrimination. And with nurses, there's another study in Becker that says around 63% of survey respondents said that they had personally experienced an act of racism from a peer, a patient, a manager, a supervisor. So, so this is really significant as we think about healthcare, which already produces inequitable outcomes. And it's important for us as we think about like, what is systemic racism? How do we need to understand it? Systemic racism is synonymous with structural racism. But when we talk about structural, we're talking about more of the historical factors, like kind of like the laundry, like history, the historical forces, systemic can show up in different institutions, right? So as we think about structural racism, we're talking about the bias among institutions and across society. So it's very broad and it can be cumulative and compounding effects. So those daily microaggressions could actually lead to inequitable outcomes. So it could lead to aversions, it could lead to, say, for instance, like lower pay for people of color in a field or less opportunities, less prestigious positions that they may get from network bias. And typically when we teach anti-racism, we talk about the four eyes of racism, of ideological, which are like the kind of common tropes and the stereotypes. There's the internalized, which can also be that how individuals internalize racism themselves, but also the internal dimensions of those who've adopted racist norms. So those are the private beliefs. There's the interpersonal racism that we see. So that's where we kind of focus a lot on the microaggressions. There's a lot of focus on this interpersonal dimension. And institutional racism are the unfair policies, discriminatory practices, and unequal outcomes. And with that, you can still have racism existing in institutions without bad people, you know, where people aren't claiming to be racist or you can't identify a racist per se, but those outcomes, right, that can lead to extra pressures of those who are from targeted identities. Discrimination happens on a systemic level of targeting like gender-based discrimination, gender-based oppression, as we would say. Islamophobia is systemic. It is structural. And so you could see that across different fields of the, you know, from access to healthcare. And this can even include Muslim healthcare workers or Muslim healthcare workers who may now feel, you know, that they're trying to overcome so many obstacles that they may not want to address certain things that are leading to these inequitable outcomes. Some of the approaches, what I found was the study was very helpful in giving people coping strategies, especially when they're able to identify things now that we understand what microaggressions are. From a, on a broader level, and what we can do is start to think about creating anti-racism competencies within our institutions, which would create opportunities to address how Islamophobia shows up, how gender-based discrimination shows up, and how does that actually erode the working conditions for healthcare workers. My approach is multi-pronged in doing anti-racism. And I think it's definitely, it's really, it's not fair for Muslim healthcare workers and people of color to have the onus on them to be full advocates. It's important to have this, that the institutions take accountability and recognize that this is happening, right? And so even for those coping strategies, that the healthcare workers' peers should know that Muslim physicians, Muslim nurses are experiencing discrimination, so they should have outlets within their job place too, and not just kind of having to go upon like their own internal resources, but places where they can debrief and heal and that we can encourage our healthcare institutions to promote healthier environments and to counter discrimination. Obviously, we give, you know, healthcare workers provide care regardless of whether a patient is racist or an Islamophobe or not, but it does provide, it does cause a lot of stress on those who are trying to provide that care, and it's important for our workplaces to address that. So this study is so important that we can actually begin to advocate that our healthcare institutions include Islamophobia in their work on racial equity, because often that is left out. Absolutely. Thank you so much. Dr. Rania, back to you just to kind of sum up, as the primary investigator on this project, what would you like us to walk away with? So much of what both Dr. Mona and Marguerite said, both, both. I mean, honestly, this concept of, this very last point that you made is so powerful, which is now we can finally point to something and say, and hopefully there's, and there's more beyond our work here, but this is one really important piece of the puzzle to say, look, Islamophobia really needs to be part of, you know, our, I would say all institutions, right, to kind of hold them accountable, but certainly our medical institutions, absolutely. And I'm being part of one and part of parceling and actually very involved in our DEI work. It is a pill battle sometimes to say, hey, Islamophobia too, you know, but now you can actually point to something very concretely and say, this is why. Absolutely. Thank you. And we're going to now turn to questions from the audience. So please continue to submit your questions and we'll get to as many as we can. One question that came up from Dr. Awesome Hedela, he says, do you all perform predictive modeling? It seemed you suggest protective efforts of certain strategies against ill health outcomes. Did you see that association statistically? Happy to, happy to take that question. I would say everything that we put forward actually was in fact something we did kind of logistical regression, regression, thank you for trying to find the word to be able to make sure what it is that we included as part of the study. And yes, we were able to figure out, and actually I would point to the full survey, I might say this a few times here, because some of the questions are more fully answered in our full study. Yeah, and our report is now live online and does include the statistical analysis in an in an addendum at the end in the full table. In appendix, yeah, appendix. We're both fasting brain, I guess, but appendix at the end. Great. Another question that came up is from your research, it looked like racial discrimination in the workplace was more likely linked to less healthy coping behavior in Muslim healthcare workers. Can you speak to that? Just that that was a very interesting finding. And the challenge the Muslim community has in confronting racism within itself. The question is right on, and I would invite actually other panelists to share with me in answering this question, because, you know, we were able to really kind of tease that out and pull it out in the study, but it speaks to something I think we all know, I hope we all understand and know is kind of widely pervasive within our Muslim communities, as the questioner is asking. So absolutely. And I wonder if others want to speak to this as well. I think it's very, it seems hard for me to know like, you know, whether there's like correlation, you know, I mean, it's like, you know, there's a difference between correlation and causality. And so, you know, and that we can possibly guess like, why religious discrimination may actually kind of affirm like a solid like, like a positive self identity, or maybe even like some group boundaries of like, asserting one's Muslimness in that space. And then why, like, how would that be a little bit different for racial discrimination? So it's definitely, I think we'd have to do a kind of deeper dive and like kind of explore like, what does like Islamophobia does like, how does that help in the kind of formation around developing the Muslim identity? And then with the racial identity, which is something that one can't change, right? Like it's like, I can take off my scarf. And but then if somebody says, take off that scarf, I'm like, no way. But you know, like for, you know, my skin tone, it's like, this is something I can't change or assert. And so maybe there's like, you know, a different type of approach that that I would do, or maybe just the forms of discrimination that may occur because of race. So say if someone's pointing out an Arab identity, as opposed to a religious identity, because we can't necessarily just, you know, like even like with Asian South Asians, that, you know, they may experience racism in a particular way, which would be distinct from Islamophobia. So I mean, those are all things I'm so interested in exploring. And like, how does our, like those rough, like the disruptions that we may have when we encounter discrimination have us assert our identity in that space or find ways that we turn to those that I think it's maybe a little bit, I don't I mean, I have some theories, but I mean, I'm definitely interested in kind of exploring, exploring that and then possibly that I do think that for those who do have faith, it's always like that is always a great option to find strength within one's community. And then also, you know, like faith based practices actually bolster one's identity and give some resilience. So yeah, lots of questions left after that. Yeah. Yeah. And I'm also very interested, like you said, Margaret, in how people perceive discrimination and its cause when they are both Muslim and black or both Muslim and Arab or Asian, and how they how they interpret it as either racial or religiously based, I think is a really interesting question to delve into more as well. And right. And also, I mean, it's also who we show up for or what which intersection that we show up for in terms of, you know, defending or or being present about like, you know, are we going to show up if there's like, you know, there's Islamophobia versus if there's Islamophobia, and then there's also anti black racism. And is there are we going to show up for our own communities and our own cultures more than we would for other cultures and other communities? Because even though we can identify as all being Muslim, do we have implicit biases within ourselves that will, you know, make us rationalize against who we show up for within our own on our own religious groups. And so yeah, there's there's so many nuances. And the more you look at it, the more complicated the picture gets. But also, I think more telling the more you look into it. Yeah. And I I'd encourage everyone on, you know, listening to check out our toolkit on getting race right on looking at intran Muslim racism within our community. And I think we can put a link here in in the chat. So you can take a look at some of the resources and the research that we have compiled to address this very challenge within our community. I have a question now from someone who says they live in Sweden. And they said, and I live in Sweden and both systemic racism and interpersonal racism exist in our institutions, academia and health care. But our institutions somehow deny that there is existing that that racism exists in the workplace. So what is your advice on how we can start to raise awareness on both individual and group levels, ie health care providers? What can we also do on an individual level? So if you guys don't mind, I'd like to take this one on or at least start the conversation. It's been a kind of it's been a conversation topic amongst a lot of our physician activism and groups, specifically under this kind of broader category of, you know, of, you know, burnout versus, you know, systemic causes of burnout. And and I one of the dilemmas we've been finding and I think COVID has unearthed and enforced health care workers to talk about within their health care systems is that, you know, it's burnout being such a common topic or being, you know, being, you know, set used almost as a way to kind of blame the people going through it, such as, you know, if you say somebody's burnt out, then it kind of leads to this idea of, oh, well, there must be something wrong with you. Maybe you need to look into that. Maybe you need to be the one who takes care of that. And it kind of diverts the attention from, you know, the fact that that there's real systemic issues that are causing burnout. And so, you know, when I use the analogy that we don't say when a house is on fire, we don't say, you know, it was burnt out, we say, you know, what burned it down. And these are and it's forcing us to kind of, you know, rethink this. And I think Muslims and minorities, especially have a problem within these bigger systems, especially health care systems, which are multimillion dollar systems, and they're privatized in America, I'm not quite sure about Sweden, which leads to a whole another problem, is that, you know, when the bottom line is being prioritized, then health care workers are going to be just cogs in this bigger system. And if we see ourselves as that, or we internalize ourselves as being just cogs, rather than being, you know, important members of health care, then we're going to start, you know, blaming ourselves and seeing ourselves as being voiceless. And so to answer your question, the first thing that I would suggest is have more of these conversations amongst peers. And this is what Physician Support Line was really about, is about peers talking to peers, people who've had shared experience of these, of these outcomes of what it feels like to be a health care worker right now, and normalize and validate each other's experiences on how they're being treated, how their concerns are being dismissed or minimized. And really, you know, there is a power in the voice and when it goes from being one story to being a story of many. And then all of a sudden you have a movement. So you go from a narrative to a movement. And so, but it has to start with first giving yourself permission to talk about these things. And we tell ourselves as immigrants as minorities that we have to be quiet, we have to be, you know, well behaved, we have to be the model minority, we have to do all of these kind of like expectations and to our own detriment. And so the first step I would encourage is to start the conversation, start it somewhere, see who, what avenues that opens up, what networks people have, and then all of a sudden you have a movement. Thank you so much. Would anyone else like to add to that? Just really briefly to say that it's really important to have the data points. And I think we spoke to this a little bit before. But it's really hard into the questioner here. And though I can't speak directly to Sweden, here we are trying to do this in the American Muslim health care experience. But if something like this, if we could help that person, you know, that researcher can help replicate something similar in Sweden and other places to really have the data points to say, here is the evidence that we're finding, you know, and really start making it a push. Obviously, as as a researcher along with the clinician, I remember just really strong about collecting that data, because sometimes it's really hard to pinpoint. And you just talk from kind of anecdotal experience, like the questioner was saying, and not from hard data. So I hope that helps a little bit too. Music to my ears, collect the data. Absolutely. Okay, another question from Dr. Radehan. The study shows a large percentage of treatment seeking slash mental health support among mental Muslim health care workers. And it was mentioned that this is a growing trend among the Muslim population in general. Could you elaborate on this? I can start. And I know you have some data to to share as well. That's kind of newer data that's come through at the at the Stanford Muslim Mental Health and Islamic Psychology Lab. You know, the data we've been collecting over a decade now, it's been really interesting. When I look at one of the very first studies we did, which was MPAM, which turned out to be a you know, a validated psychometric skill, looking at attitudes and perceptions to mental health amongst Muslims. And it was so clear that the you know, you go to and it's almost always friends and family first, that eventually you get to the imams, the religious leaders, and very far, far, far down the line where the actual mental health care providers, people who are the professionals in the field, even primary care providers were before are the mental health care providers. That's what data about 10 years ago looked like. And in that, in the course of this decade, we've definitely been putting out that those questions out in our studies to find, is there a shifting trend? And we're actually finding that there is in fact a shifting trend. Some of our most recent research is on the topic, a difficult topic on the topic of suicide. But we asked that question there too, you know, who are people reaching out to? And we're definitely finding that there must be a generational difference, but also kind of an overall, even just across the entire nation, a more awareness and willingness to talk about mental health. And so that awareness is also kind of finding it's kind of trickled on effect, finding itself into its way into our Muslim communities as well. And then ISPs collected some recent data. I don't feel you want to talk about that. Yeah. And actually, I'm so glad you asked about it. We will be releasing it literally in the next few days. But I just finished kind of analyzing this data, which I'll go ahead and divulge here. Since you're all, you know, this is just a group of special friends, but don't tell anyone we're about to release it in a few days. But what we found is basically exactly what Dr. Rani just said, that to our surprise, Muslims were actually as likely as a general public to report seeking out mental health care support if they were in distress. So those who experienced distress during COVID, whether they were Muslim or of any other background, were equally likely to have sought out a mental health provider, a mental health care provider. Unfortunately, those in distress, and this was a great deal of distress that they said that it impacted their everyday life. Only a third sought out help, whether they were Muslim or any other background. So it's not that our community is worse, but it's just that there's an overall reluctance or inability. I mean, we've actually also asked questions about why aren't you seeking out help? And some of the top responses is affordability. So it's not, it's not, we actually don't hear about stigma anymore. We hear about other really basic obstacles to seeking help, like affordability, like finding culturally competent help. But Muslims are no worse and no better than anyone else, but it's still only a third of people who need support actually go out and get it or are able to find it. All right, great. Thank you so much. So I did have one question as a panelist. So I was actually surprised. I know it wasn't TikTok, but it was a YouTube video and then I just googled it, but it's like that one doctor was saying that they actually feared licensing. So there is like, you know, they're, they're, you know, that that actually creates a burden for them because they can actually request those records for them. So how much is that affecting Muslim health care workers? Oh, absolutely. I'm glad you brought that up, Margarine, because it's a common conversation that we have with callers on the support line, which is it's an anonymous support line. So of course, there's that kind of sense of safety there again. But it is a common thing where, you know, it's not even with Muslim health care workers either due to their insurance plans or their own affordability, they are able to afford going to health care, but then it becomes about reportability. Like, where is this information going to go? And there is an internal stigma amongst physicians, both culturally within just what we think of ourselves and that, you know, we have our own expectations of being healthy and not needing mental health support. But also from a licensing issue, there is a very big dilemma here, which is state by state. And each state medical licensing board has applications where they ask to disclose your mental health. And in that, there is, you know, of course, there's a violation of the American Disabilities Act, which is something that we're exploring and trying to deal with. But there's also the fact that, you know, if they do disclose, then will they be watched by, you know, either the hospitals, you know, HR, regarding their mental health? And will they be under a microscope? And will every action be kind of, you know, observed in that kind of way? Or will they have to report for mandatory kind of, you know, therapy sessions and etc. And so there does, it's a very big limit. And there's only a few states that are actually compliant with ADA regarding this. And that's a side project that I've been working on with other physician-led organizations to change that kind of punitive outcome. But yes, there is, as we know, with anything that has a stigma, there is systemic issues, there are individual issues. And all of these together are creating these barriers that we're seeing in mental health seeking. Thank you. Excellent question. Thank you, Marguerite. And I'll close out here just by asking this question one more. Well, actually, you know what, we only have three minutes. So I'm going to stop there with the Q&A and now ask you questions. Your feedback is incredibly important to us. So please take a few minutes to fill out the poll that we just launched. And as you do that, I just want to close out with a few other points. The full report is shared in the chat and will also be emailed in a follow-up email to everyone that registered. And I want you to, I want to also draw your attention to an early release of some data from our American Muslim poll, which is just in on vaccines and vaccine hesitancy among American Muslims. So please check that out. And please continue to be ambassadors for the facts and share our resources and our research with your network. You can do that by sending them a link even to this webinar.