 I think as we all know, suicide is one of the most difficult and heartbreaking topics to try to grapple with. And a recent study published in the prestigious journal, Jama Psychiatry, authored by some of our panelists here tonight, showed that Muslims in the United States have higher rates of suicide attempts than adults from other American faith groups. This study was based on data collected through ISPU's annual American Muslim poll. This is an annual survey and the data that contributed to this article was fielded throughout the month of January in 2019. So it was actually just pre-pandemic, right? It was definitely pre-pandemic. And the survey was fielded among a nationally representative survey, a nationally representative sample rather of American Muslims, as well as a sample of the general American public. If you want any further details on the methodology, I will drop a link into the chat so that you can see the methodology with all of its details. These results, which we'll talk about in a minute, have sparked a great deal of conversation, some confusion, and rightly a lot of concern. And today we're gonna discuss this important issue with those who authored the study, some of the leading experts in this field. I do wanna mention that this research was not solely an academic exercise. On the contrary, the authors and panelists that you're gonna hear from tonight, yes, they're academics and researchers, but they're also clinicians and public health practitioners, clinicians who see patients with mental health challenges every day, or people who oversee public health and for whom this type of data is really, really vital in their ability to effectively support not just their clients, but our communities. So without further ado, I wanna briefly introduce you to our amazing set of speakers here tonight. They really are experts in this field and so interested in learning from them here tonight. So let me first introduce you to Dr. Rania Awad. She is the Clinical Associate Professor of Psychiatry at the Stanford University School of Medicine, where she's also the director of the Stanford Muslim Mental Health and Islamic Psychology Lab and it's communitynonprofitmaristan.org. She's also the Associate Chief of the Division of Public Mental Health and Population Sciences and the Co-Chief of the Diversity and Cultural Mental Health Section at Stanford. Prior to studying medicine, she also pursued classical Islamic studies in Syria and holds certifications in the Quran, Islamic law and other branches of the Islamic sciences. So welcome, Dr. Rania Awad. We also have Dr. Hamada Hamid Al-Talib. He is the Associate Professor of Psychiatry, Neurology and Public Health at Yale University. He is an epidemiologist whose research focuses on mental health and neuropsychiatry. He's authored more than 50 academic publications in the field of neuropsychiatry and is the chief editor of the Journal of Muslim Mental Health. He's also the president of the Institute of Muslim Mental Health and he's dedicated much of his work focuses, focused on training mental health professionals about the needs of Muslim communities. In addition to this academic work, he provides direct clinical care for complex neuropsychiatric illnesses in the Yale University and VA healthcare systems. So welcome, Dr. Hamada. We also have Bilal Zia who's a PhD candidate in clinical psychology and he holds a master's degree in clinical psychology from the University of Manitoba. He's been researching issues related to Muslim mental health for more than five years, including topics related to suicide. He previously served as the co-lead for the Stanford Muslim Mental Health and Islamic Psychology Labs Suicide Response Team and he's the co-creator of Maristan Suicide Training Program for Muslim community and religious leaders. Welcome Bilal. And last but definitely not least, we have Ebony Jackson Shahid, also known as Bayan. She is the director of public health for the largest city in Connecticut. She has an MPH in epidemiology from SUNY and she completed a postgraduate fellowship at the Yale School of Medicine in neurology. She also has clinic experience as a behavioral analyst and she has research experience having served as a junior epidemiologist at the VA in West Haven, Connecticut and at Yale Epilepsy Research Center. Welcome Bayan. So thank you all so much. I wanna start this discussion with Dr. Ramia. Dr. Ramia, can you tell us a little bit about why you and your co-authors embarked on this study? Why was it important to look at this? Thank you so much, Mara and welcome everybody. I first wanted to just make sure that I let everybody know here that you're very welcome to be here. And before we really dive in any further, I also just wanted to let you know that the conversation may be heavy tonight. And so for that I want to just make sure that everyone here knows that if they need to take a moment to step back or even just leave and if they feel they can come back to come back because the topic is about suicide and it is a difficult one. And I guess that's a great place to start, Mara, why is it exactly that we decided to do this work? So I'll begin first, the Spindahar Akhman Akhman by saying that the group of us here that you were introduced, my very esteemed co-panelist and also one of my co-authors actually in this study, we decided to do this work as you said earlier, not as an academic exercise, but rather it was really to figure out what we were seeing clinically and anecdotally in the work we were doing in this community. So for me, this is not, and I wanna emphasize this because I know it's been on people's minds. Why publish something that actually shows the Muslim community in potentially a negative light? And that of course is not the intention in any way. Rather, it's because we were seeing in actual clinical practice, I'm a psychiatrist, for example, can have been the clinical director of clinics in which are predominantly for Muslims in mental health. And what we were seeing year after year was really an increase in suicide attempts. And in people talking about suicide actually being a very potential way out for them. And this is not for anyone who's listening to this and thinking to themselves, well, isn't that something that's, you know, how wrong it's done? It's not something that's permissible. Why is this even a point of conversation? You know, the religious belief system, which of course we're not going to delve into today's discussion per se, is not always, does not always translate into Muslims themselves, not feeling suicidal or attempting suicide, which is actually what we were finding. So I'll tell you, for me personally, what prompted this, a very large clinic that dealt with Muslim mental health, that I was part of, you know, what we were finding in the data we collected from thousands, literally thousands of Muslims was that one in three Muslims who came to the clinic said that in the two weeks prior to coming for actual health, clinical health, that they had suicidal ideation, meaning suicidal thinking. And when you look closer at those numbers, it actually looked as though, it actually not looked as though it actually was such that people had considered dying by suicide had actually some as much smaller number thankfully had attempted actually suicide. And there were those who had what we call a death wish, kind of a wish I was no longer here in alive, over 50%. So those numbers were very high and this is what we call clinical data as in to say people coming into the clinic and what we're observing as clinicians in order to really figure out was this really accurate across the US? Or was this only really for those who were coming in and seeking out mental health support is why we actually decided to partner with the ISPU, the Institute of Social Policy and Understanding which puts out of course every year something called the Muslim poll, the annual Muslim poll, which is a cross-sectional meaning it goes across the US and across different populations and not just looking at Muslim populations but actually comparative data that goes through all these different faith groups, Christians, Jews, atheists, agnostics, Hindus, Buddhists. The reason we were interested to look at the American Muslim population in comparison to other American communities was to really figure out how were we doing? Where the numbers and data we were seeing in our clinics similar to other faith groups was this more of an issue of spike? Was it because in the last many years things have been really difficult for the Muslim community? What was actually happening? So really to get a pulse, we decided to put these questions and I'll be the first to say it. I know that my esteemed panels will go into this much deeper that they'll talk about the limitations of our study but we just needed to get a sense of what was happening and that is why we decided to do this particular study. We didn't expect to the larger numbers because we saw things clinically and anecdotally that would prove this anyway but we certainly didn't expect exactly what we found and this is why we really needed to do this study because we needed to start somewhere and I can't emphasize enough how this is just a first step in really figuring out a whole lot more and a whole lot more of research and data that needs to be collected and studied in more detail to really come up with a more comprehensive story about what exactly is happening here in the US Muslim population issues. Thank you so much, Dr. Rania. It really is sobering to hear not only the sort of anecdotes but the numbers that you do have and I know that the data from this study was really sobering. So I wanna ask Dr. Hamada if you can actually tell the audience a little bit about the results from this study and how we might be able to understand them. Bismillah. I think it's fitting that we always start with in the name of Allah, most compassion and merciful and that really hopefully sets a tone for us that it's a very tough topic. It's sobering as Dr. Rania alluded to and in addition to us dealing with this clinically and academically, many of us are dealing with this personally with friends and family, even within the panel. And so what we discussed is let's keep in the tone of compassion and Rahman and mercy as some of this is difficult and triggering for many of us. And so to kind of discuss the nature of the data and the nature of the research. So one of the important factor that sets this study apart from much of the other research that's done in the American Muslim community is that it was a national survey. Much of the research that's done with American Muslim community is what we call a convenience sample. In other words, we wanna learn about in this community where we go, we go where Muslims are such as misogynist, mosques, Muslim organizations. And so we go to this serves MSAs, membership organizations and ask them what's your experiences and what's your opinion about X, Y and Z issue. What's unique about this is ISPU in their national poll are cold calling people across states asking what your faith is and then getting information. So this is really important because we don't have the same selection bias of having more religious or more Muslims who are more openly or actively Muslim. So that's a strength of the study is that it's much more representative of the general American Muslim community. As with any study, there's limitations. And one of the limitations is that in spite of the surveying over 800 Muslims and it's all done by phone interview, there's only 800 Muslims. And certainly that does not represent, 800 Muslims cannot possibly represent the entire landscape or fabric of the American Muslim community. It's just a sample, it's literally a sample. And so there's that limitation. In fact, from a suicide research perspective, we oftentimes in epidemiology report suicide rates in the unit of per thousand people. In other words, six per thousand people or we don't talk about it like percentages per hundred people. But because suicide itself is a relatively rare event in terms of deaths of suicide, oftentimes that's the unit. And so we only have 800 people and even within that those groups, obviously you have only a subset let's say African American or Arab or South Asian. And so comparing those subgroups is limited because of the numbers, that's one limitation. The other limitation is, this was a poll. It wasn't designed for a mental health study. And so the details of people's mental health situation we don't have. So we didn't ask people, do you have a history of depression or anxiety or are you actively drinking alcohol? We didn't ask that depth, those specific issues. And so we don't know what role we know from the general literature. And that is a major factor in terms of risk for suicide. But we don't know that about this population. And it could be that our sample happened to have a lot of people with severe mental illness. We don't know that. And so this is an important study because it really brings our attention to this very important and serious problem. And it will hopefully inspire the community to mobilize resources and think about it more deeply and develop interventions as a community to prevent this and deal with this. And as Dr. Rania said, all of us on this panel and our colleagues are already dealing with it. We already see it clinically, we see it in our communities. But this kind of gives you a broader perspective. So I guess I'll stop there. And then... Dr. Zalada, can I just ask one follow-up question? Thank you so much for outlining all of that. Can you talk just briefly about the actual data that what did you find through this methodology? What did the data tell you? Sure. I think the take-home message is that when we surveyed by 800 Muslims, around 8%, almost 8% reported, they try to kill themselves sometime in their life. And I would just pause there. And that is an astronomical number that almost one out of 10, if you're in a room with 10 people, one of them with Muslims, if you're in a message, for instance, Versace Jamal, and there's a couple hundred people, there's several people in that message that probably try to kill themselves sometime in their life. It's very, very concerning and that's very scary. Now, that's the take-home message. The where it got controversial is kind of that, where the media we picked up on it is when we compare different groups, there's different ways statistically to compare. So when we looked at, if you look at just number of people who reported, all right, 8% of Muslims reported that they were suicide, the suicide that they tried to kill themselves sometime in their life. And around 6%, 46% across the other groups reported that they try to kill themselves sometime in their life, any more than 36% depending on the group. And so the question is statistically, the wrong numbers suggest that the Muslims reported it at a higher proportion of their groups. But is that from random chance or is that a real number? And so one physical analysis we did, we found that there wasn't a difference that there was random chance. In other words, if you flip a coin 100 times, we know that the odds of getting heads and tails is 50%. But maybe out of random chance, you might hit 45 heads and 35 tails, for instance. And so this is random chance that you might not get exactly 50, 50, even though the probability is 50, 50. As the same thing with this, with any statistic or any survey, maybe that difference in 8% or 6% or 8% or 4% is this random chance. And so when we controlled for every factor such as socioeconomic class, education, race, gender, then that's when the Muslim, when you're trying for all those factors, it looked like the Muslims were at higher risk as much as double the risk of reporting having tried to kill themselves. Now again, this is one study, this is a sample. This is not the truth of the capital T. And so I don't think that's the take-home message. I think the take-home message is that this is a real serious issue that is not a marginal or a rare event. It's actually quite serious and we need to take it seriously. Larger studies need to be done. We need to do actually more in-depth statistical analysis. Because this was such a striking finding, we thought it was important to report these kind of preliminary findings, the major finding, which is the 8%, at a high impact journal such that we get attention from stakeholders, from public health experts, from mental health departments, from the community, from community leadership so we can have these conversations and then we will continue to analyze and see if there's any particular group that is in particular risk. And certainly this will help us think about what's the next study to see, A, where we need to focus our efforts and energy to prevent suicide and B, kind of developing programs such as what Maristat is doing in terms of training community leaders, imams, so forth and so on to deal with this tragic situation. Thank you so much, Dr. Hamada. Clearly this has enormous implications for all of us as individuals and families. And I wanna back up and see, look at the bigger, the big picture for a second and ask Bayan, in your capacity as a public health leader in a large city, what do you think the public health and the policy implications of these findings are? Where do we go from here when it comes to sort of community health and policy? So I wanna come everyone, how's everyone this evening? So I think I just wanna start with discussing exactly what the role of public health is because I think people don't really know what public health health is and how it benefits societies. So I think public health, it promotes the welfare of the entire population. Public health officials have been given this task of protecting populations by preventing disease, improving the quality of life through organized efforts, programming, education and enforcement. And I think that people really need to understand that that's what public health is. What is the role of public health in addressing suicide specifically? Really we need to learn more about what suicide is. We need to learn what the disease is or the condition just like any other disease in society. What is it? How it affects individuals? How is it diagnosed? How is it treated? How is it prevented? So studies like this are actually helping public health officials with diseases in community. We need to collect data and surveil suicide, find out the vulnerable population, who is it? And what are the risk factors? Analyze the data, communicate to stakeholders what the population's illnesses, what are potential threats to the population? And when I mean stakeholders, I'm talking about hospitals, nonprofit and profit organizations, local health departments, universities, et cetera. And then you need to basically discuss prevention and programming in terms of policies and how they contribute. Basically in doing this work, the study has fostered and I think brought awareness to the condition, suicide to the community. Public policy can further create things like regulatory measures, civil statutes, help delegate requirements and mandates, protecting populations at risk, foster direct support and create further opportunities and incentives for further research. Health policy can impact programs and services that influence our physical, social and our economic environments. And also impact the health behaviors of the community and the clinical care. So honestly, I just wanted to say, from a personal point of view, that I hope that this research and continued research will force the Muslim community to look at mental illness as a legitimate disease and not just a personal choice. I really hope that it fosters leaders to destigmatize individuals that are affected by many mental health disorders that can lead to suicidal behavior. I'm hoping that the Muslim community understands that there are drivers of health that can lead to this behavior. And through this work, we are helping to identify what some of those health drivers and risks as well as social determinants are and that this work is going to assist in creating intervention programs that benefit the community at large. And I just want to say that, a healthier community is a thriving community. And that's definitely something, a take home that I think, I hope everyone takes from this discussion. Thank you so much, Bayan. I'm so happy to know that there are people like you in leadership positions doing this really important work and that this data is helpful for elevating this conversation to the importance that it should have. I want to go back to the data a little bit. I know that Dr. Hamada talked a little bit about the limitations and some of the questions around why higher rates of attempted suicide might have been seen. And I was wondering Bilal, if there was anything you could add, I know that some people have wondered whether the results, these alarmingly high rates maybe reflect Muslim demographics just generally. We know from our research at ISPU from the American Muslim Surveys and other research that we've done that Muslims are more likely to be young. It's a very young community when you look at the American faith landscape. And the Muslim community also has higher rates of poverty than other American faith groups that we've studied. So there have been some questions about whether these, the suicide data perhaps reflects those demographics. Can you talk a little bit about that and add to what Dr. Hamada was discussing related to this? Yeah, thank you for the question. And I saw like, I appreciate everyone taking the time on a Sunday evening to be here and joining us for this really tough but really important conversation. To answer your question, it really is kind of challenging to go there necessarily. And the reason for that is when it comes to suicide in the Muslim community, there just isn't a lot of research. When it comes to suicide specifically in the Western Muslim populations or American Muslim community specifically, there's even less research. So we can borrow from other research literature and look at sort of the general American population and general global populations. And what we know in those populations is that youth do have higher rates of suicide attempt than adults but it's actually adults and older adults who generally have the highest rates of actual deaths by suicide. So I think one of the commonest conceptions that I often hear when we're working in suicide is, we must be worried about the youth only because the youth are the folks who will be at the highest risk. And I wanna point out that that may not be the case, that there may be other populations that in fact there are other populations who are just as equally at risk or maybe more at risk than the youth as well. So that's something to consider. But for our research, generally at this stage because there's not a lot of research out there, we came at it with a really broad focus and really the broad focus was asking the question, do American Muslims report more or less suicide attempts than other religious groups in America? And to answer this question, we essentially applied some statistical controls that Dr. Armando was talking about to remove the effects of demographic variables, things like age, gender, economic status, race and other factors. So we're essentially controlling from them, removing them from the equation. So in a nutshell, the results that we presented in our paper conclude that Muslims do report suicide attempts at a higher rate than other religious groups. And these are data that are essentially adjusting for the demographic factors. So again, that's not saying that younger people or older people or those who are struggling with poverty or specific racialized groups within the Muslim community are at greater risk or lesser risk. It's just saying at this stage, it's hard to tell. And like Dr. Hamad has pointed out and Dr. Rani has pointed out and Bayana has pointed out as well, we need to do a lot more finer detailed research to really elucidate what is going on in the data. And there are models that in childhood we're looking at doing to really get a sense of that a little bit better. But as all of that research will be for a little bit down the road in the future. Great, thank you so much Bilal. I wanna turn now, and I promise we'll get to, we're getting some great questions coming in, some really important questions. So keep putting your questions in the Q&A box. I promise we'll get to those very shortly. Before we do, I just wanna ask two questions, sort of the so what now what questions. So the first thing is, given this alarming data, and this is directed to you, Dr. Hamad, given this alarming data and the real and terrible impact that suicide has and suicidal ideation has on individuals and also on families, what can we do? What does the best science tell us about ways to prevent suicide and build resilience? Sure, the new answer, the complication to the complicated, way of thinking about this question is, who's we? When we say we as a society, and so there's certain societal issues, such as structural violence, access to care, how racism, economic oppression, there's kind of big issues that drive mental illness and even people to be suicidal. So there's kind of the big macro issues. There's kind of what we call the measles issues, which is more at a community level. And so how are our centers are either are massaged, our mosques or our third spaces, trying to help people with mental illness? What kind of, there are many massaged, there's many community centers who have, for instance, a social worker or a counselor or youth counselor that try to address this right there in the front lines. So there's kind of a measles level as a community. What can we do to help support whether it's our youth or the members of our community or our elders? So that's kind of the measles level. Then at a micro level, in terms of our own, as individuals, as families, there's kind of things we can do and there's very tangible concrete things we can do to hopefully prevent that. And some of this very cliche, as such as stuff such as diet and exercise and keep having healthy diets, watching caffeine, what you ingest, substances such as, whether it's weed or alcohol or so forth and so on. Exercise, as your stress hormones go up, it drives you to eat more carbs and that leads to heart disease, so forth and so on and it affects mood and as well as your sleep. As you exercise more, especially cardiovascular exercise that metabolizes your stress hormones, so that is very helpful. And then of course, as Muslims with the spiritual component and being particularly mindful and reflective and having techniques of reflecting on the Dean and engaging in the community, certainly that's part of it. The other part is support. So part of the support, so we talk about the basics, diner exercise and the spiritual perspective, there's seeking support. So seeking support is if you're feeling stressed, if you're feeling a little overwhelmed, burning out from work, so forth and so on, where do you get help? Support from family members, asking family members, going to therapy, finding a therapist counselor, which is still quite taboo in some subgroups within our community. But we are six to 10 million Muslims in this country and there's truly the dollars of resources for healthcare, including mental healthcare. We shouldn't, this is not only our problem, we're not on the island. And so we really should use the resources available to us from public health, the public health system, including mental health system. And so seeking support is very important for our community and individuals and then providing support. And so whether you're a parent or just a member of the community, provide support in a non-judgment white way, be more curious and prescriptive. Don't just give advice, but ask people like, what's going on? How are things going? And how can I help you and really reach out to people? So that's how I'd kind of summarize kind of things we can do. We talk about macro, meso, individual, individual that exercise the spirituality, support, and even developing the language. Just talking, one thing we're not very good at is just talking about emotions. Whenever you say, how are you? How are you? Everybody says, fine, good, Alhamdulillah. And do we do what we have much? We don't use emotional language. I actually learned that from the Muslim, the Black Muslim Psychology Conference. One of the things I took home from that conference is how Muslims, we lack that emotional language in our day to day. And so we should start shifting that culture and use emotional language to express kind of our needs to our loved ones and to our support systems. And Dr. Rania, I wanna close the discussion question out before we answer some audience questions with you. You know, what now? So we see this concerning data. We've talked a little bit about the policy implications and sort of public health implications and then some ideas about how we can deal with this issue. But what else is being done now that we know something more, now that we know these results? What is being done about this? What further is being done? Absolutely. And I think that's really the right way to think about this because this entire conversation we've been having tonight is I can't emphasize enough how much it's a really a starting point. I believe it was that who said earlier, there's very little data about the topic of Muslims and suicide, particularly when we look at Western Muslims. If we look at the US, which is our population we're talking about today since that has been the focus of our study, even less so. And so for that reason, I wanna say that there's a number of things that we ourselves, this group here is really dedicated to making sure we do. I'm gonna just mention again, I know we mentioned it before, but this work is really a partnership, a partnership between the Stanford Muslim Mental Health and Islamic Psychology Lab and the researchers like myself, Bilad who's here tonight, Dr. Asama who's not here but was with us in the study. And then of course, Dr. Hamadah, who was at Yale and the Institute of Muslim Mental Health where he and Bayan had worked together at Yale. And then of course, you know, Sister Dadya who's not with us tonight, so go ahead and yourself, Myra, from the ISPU, the Institute of Social Assault Policy and Understanding. Why am I mentioning all of this? Because it takes a collaborative effort to really make sure we're looking at this properly and looking at it from so many different lenses and different types of disciplines. Now in terms of next steps, I can tell you that this group here is dedicated to making sure we figure out follow up steps. So one of the first things we intend on doing is figuring out, well, the data was from 2019 pre-pandemic. What's happened since? Because apparently we have no idea actually if things even got even worse, perhaps after the pandemic, because we know in general, mental health of all people after the pandemic has really taken a hit. So for all we know, this could actually be even more of a problematic number or it could be like some of the other data we have in the lab that actually says that many Muslims turn to faith and really try to cope through faith in the pandemic a little on it. We really don't know. So my saying all of that is to say that one of the first steps we're planning on doing is follow up steps. Figuring out asking these very same questions again and asking even deeper questions because so many people are asking why. We understand the numbers and the percentages now, but why is this the case? So that's our first point. I also wanna say that at the lab at the Stanford Muslim Mental Health and Islamic Psychology Lab and how did you know we were very blessed actually to receive an important grant that started just this month. And it's from the Templeton Foundation for those who are familiar with that foundation and what looks at the intersection between science and religion. And what we're looking at here is what we're calling Islam inspired preventative measures against suicide. What are the moral and character traits that Islam inspires and protects against suicide? Because I don't wanna just deliver bad news. I wanna make sure we look at what is it from Islam that's actually preventative and resiliency factors that allows Muslims to actually not die by suicide. Even if they have attempted to prevent our survivors of suicide attempts and even if this is a consideration, what do we do next? So we're pulling this out and literally building out an entire model what we call a psychological model on this topic. And that study is going to run for the next year and a half. So we asked for you to do us for Tophil in that for success in it. Now, in terms of that's more research and academic on a more practical, personal day to day what are we actually doing here? Since I mentioned to you that we embarked on this work several years ago when we started to realize that clinically in our clinics, we were seeing a third of Muslims coming in reporting suicidal ideation and some reporting suicidal attempts very similar to the 8% actually found in this study. We decided in the lab at the Stanford lab to really put together a concerted effort to make sure that we have materials to teach and educate our community. One of the very first steps in suicide prevention is education. It's awareness and education. But there was no manual like a go-to guidebook on what to do. So the lab actually spent the last three years working on and creating a very up to date scientifically evidence-based research backed guidebook on suicide prevention, suicide intervention and suicide postvention which is basically a fancy word to say what do you do in the unfortunate afternought after a suicide has happened in a Muslim community? And we took all of that scientific data but this is where it's very uniquely integrated in with Islamic ethics, Islamic morals and principles. And that guidebook from Maniwal, Insha'Allah will be available and made to the public free of charge for everybody to use and download off of our website at Maristand.org. Insha'Allah in due time. And it's nearly a hundred pages and heavily cited in order to be able to say, look, this is the cutting edge research on this topic and this is what you can do. Now, I realized that so many people, here are the hundred pages in an academic manual and go, no, that's just too much, right? So what do we do as a step after that? We took that manual and developed off of it training, trainings for communities. So these are different modules that are part of a larger what we call certification training on suicide prevention, intervention and postvention for Muslim communities specifically. And this kind of certification training is what we're calling the 500 Imam Campaign. And Insha'Allah, you'll have links here in the chat box very soon for you to be able to take a look at that yourself. The reason we called it that, people wonder why we're calling it 500 Imam Campaign. The reason we called it that was because we have this hope that in 2022 next year that we would have trained and certified at least 500 Imams, Mustadahs, religious and community leaders, youth directors, youth leaders. And the goal is, and this is actually a study that came out of the ISPU actually on how many Massajid or Mosques are there in the US and it's 3,000, is the last account. So our five year goal at Maristam is actually to train all 3,000 Massajid, Insha'Allah, with your support and help and your du'as. The reason we're doing this is because we need to make sure that all of this education isn't just brushed under the topic of suicide, isn't just brushed under the Massajid love. It's actually there, it's discussed, it's part of the prevention and education that we do. And I wanna tell you, if you go to the website, themaristam.org, suicide response link, which will be here shortly for you, if not already there, it actually, you have a number of things you can already use beyond the certification trainings. For example, we have Khutbas, prepared for our Khutibs of the Friday prayers and summons that they can download on suicide prevention. And I hope every single person here who does a Khutba or is in touch with their Imam or Khutib of their Friday prayer that they attend, please give them a copy of this. Please send them the link, it's fully written. And we have one for prevention, we have one for postvention and we have steps in what do you do in the aftermath of the crisis and what do you do to prevent suicide? All of these materials and trainings and manuals and certifications are there because we believe this is the next step, we have identified an issue in our community, communities with us, right? All these different Muslim communities. And it is not, it is indifferent to cultures, to ages, to ethnicities. And even for those who are wondering, our study also showed that it was indifferent to how much a person was religious. And when I realized that's shocking to people sometimes through that, and you have to understand mental illness does not discriminate. And when somebody reaches a point where they do not see the light at the end of the tunnel any further, they might consider suicide as an option, even if they are someone who's actually a practicing Muslim. This is really important to understand, but suicide and please take nothing home from this whole conversation tonight, please take home this one fact, that suicide is 100% preventable. So if we were actually able to do our work in educating and in making awareness and making sure that there was prevention efforts, we could all actually make a really key difference. So I hope that's at least the beginning of a conversation. And again, there's so many resources we're able to access on our own website at Maristan, but also in the many other partner organizations that are hoping and adding to this, kind of nascent or beginning work on the topic of suiciding. Thank you, Dr. Aranya. It's so helpful to understand where to go from here and there's clearly so much work being done to prevent suicide. I'm looking at all the questions and there are a number of questions relating to the very specific and unique needs of Muslim communities and the ways that Muslim communities might be the same or different from other communities. So I'm gonna throw this sort of larger question out to the panel for anyone who'd like to answer, but the questions really revolve around both from the care side of things, are the psychiatric needs of Muslims different from non-Muslims when it comes to suicide? In what ways or is it the same or different and is there a difference in efficacy when it comes to treatment for Muslims? But then there are also questions on the other side of things from an individual's perspective and some of the challenges that Muslims may face in accessing mental health services and care, both related to stigma and maybe not seeking services, but also maybe not finding them. So it's sort of part of the same question but two sides of that coin a little bit. So I'd like to throw that out to anyone who'd like to start to answer that. Sure, maybe I'll give you a go. So first thing is, again, it's a complicated question, but I would say that in general, that the needs are the same, that the factors that affect people are the same. I mean, we are all human. The difference oftentimes is trust. And do you trust a non-Muslim therapist? Do you trust a non-Muslim psychiatrist? Do you even trust a Muslim psychiatrist? Believe me, there are many Muslims but you don't trust Muslim mental professionals because they feel that they're gonna be either judged by the Muslim mental professional or that somehow that the Muslim mental health professional is less professional and we'll talk to their spouses or people in the community about that. And so they actually prefer going to non-Muslim mental professional. So a big factor, a big difference in terms of the Muslim needs versus other people is do they trust, and Muslims have plenty of reasons not to trust the system and whatnot. And so the question is, that's a barrier that Muslims have. I mean, whether it's the Muslim ban or Islamophobia or whatnot, there's many barriers or inclusive access. So one thing is trust, the other thing is understanding. When I can tell them, say you share many anecdotes where a person, just a mental professional, I mean, they're also human, they're Americans, they may not know anything about Islam. Yeah, I've had one joke I've had among my colleagues that a therapist's colleague of mine asked a Muslim, are you Islam? Now they don't even know the language of are you Muslim? They say, are you Islam? And so a Muslim having to explain whether it's hijab or prayer or whatnot is, might be tiresome and they might not want to have to explain what their Dean means to them or their religion means to them, why they do what they do or they presumably would not have to do that to a Muslim. Of course that varies. So I think trust and feeling understood are the two major factors that distinguishes the Muslim, American Muslims' needs versus the general population. I can jump in on the stigma piece, Insha'Allah. There's really interesting findings and these are a couple of different studies have started to show this, but generally speaking Muslims, both in America and Canada and in several other Western countries have generally favorable attitudes towards seeking help. So actually when they think about going to seek help or others going to seek help, they generally have this positive idea of, you know what, it would be a good thing if I seek help. But for some reason what there's a disconnect between this idea of help seeking is good versus should I actually seek help? And what we're starting to find is that there is this idea of stigma. So Muslims do believe that if they were to go seek help, others in the community would look at them negatively, others would look at them shamefully and sort of there's this mentality of you don't spread sort of the family business outside of the family. And so there's this concern that, a therapist will take that information if they're a Muslim therapist and go spreading it around Muslim circles or concern that the information won't necessarily be confidential that you are spreading your family's business out. And it's important to know a couple of things. So the first thing is, you know, from my experience working with individuals who have come to treatment, when they end up going and sharing that with other people that they are in treatment, they end up having some fairly good responses. So people don't necessarily shut them down. They don't necessarily say, oh my God, you must be crazy. You must be, you know, there must be so much wrong with you. They're usually kind of like, oh, okay, you're in therapy. And then that's that. The other piece is you don't have to tell anyone if you go to therapy, you can do it quietly. And so you can sort of sidestep that shame piece if it's a big concern. And then the other piece is when it comes to our communities, one of the things that we have to understand is we often think of therapy as a process where, you know, people will think about it critically and reason through it critically and say, well, you know what, I need treatment. There's this treatment available and I'll go. What the research actually shows is that this process of actually going to therapy isn't really very often a critically thought out process. Often what sort of supports people going to treatment is their friends and family. And so what will end up happening for most people who have emotional concerns or psychological concerns or concerns about suicide is that they will tell someone beforehand. They'll talk to a family member or they'll talk to a friend. They'll talk to their parents, their brothers or sisters, and folks of that in sort of any of their support group. And so that message will come out somewhere that I am struggling. I have some problems. And it's important for us as community members to hear that message and hear what's being said that I need support and then understand our limitations. So most people in the community are not suited to responding to suicide, but they are sort of integral members of that help seeking chain. So when you hear someone say, I'm thinking about killing myself or I'd be better off dead, that should be a cue right away, a trigger in one's mind to say, whoa, this is serious. And have you thought about going to seek treatment? There are treatments available. And that's sort of a way for us to sidestep the stigma in the community. If everyone is talking about the availability of resources where the resources are and that it's okay to access the resources as a whole will end up actually communicating this compassionate environment where seeking treatment is not a bad thing. And it actually is a courageous act that should be commended rather than looked down upon. Thank you. I just want to... George, go ahead. Go ahead, Diane. I'm sorry. I just wanted to just address the access to care. So I know that a lot of people right away when they're thinking about access to care immediately mental health, they're assuming that they have to find a psychiatrist or a mental health counselor immediately to address their issue. But in terms of access to care, you may be in some cities or towns that may not have social services available to you. So there are other resources. So I know that we have a lot of individuals here within Bridgeport and other different urban epicenters where there may not be a social service organization. So speaking to any type of healthcare provider, going to your primary care physician, there are urgent care centers where there are healthcare providers, going to see someone who is a medical healthcare provider is better than not seeing anyone. So just from a public health standpoint, you don't necessarily have to see a mental healthcare provider immediately if you don't have access to one. Most cities and towns do have, however, resources such as urgent care centers and some sort of hospital ER or someone that you can talk to before being referred to a counselor or a psychiatrist. So just wanted to let people know that there is access somewhere. Thank you, Bayan. That's really, really helpful concrete suggestions. I'm gonna move on to another question. We still have quite a few, but I'm sort of grouping them. And one set of questions is around protective and compounding factors. It doesn't sound like this study itself looked necessarily that it was beyond the scope of this study, but is there anything we know or can surmise about protective and compounding factors? I think the two things that keep coming up are number one, is Islamophobia and sort of the unique challenges that Muslims face in America, could that be a compounding factor and that may be different to other faith communities and could faith, could Islam itself be a protective factor? Do we know anything about this and sort of what's the thinking around that? Yeah, that's a really good question and it has a very complicated answer. So really understand this question and the answer to, we have to really understand a little bit about sort of the main theories of suicide right now. And there are a number sort of competing theories that are out there in the psychological literature, but all of them have among the components two sort of important factors. One is a perceived sense of burdensomeness that you feel like a burden to others. And the other piece is a perceived sense that you don't fit in with others. Now, Islamophobia is sort of a direct sort of most observable piece of not fitting in, right? It's an observable piece of the puzzle where you're actively hated on. We've seen some really heinous attacks against Muslims in the West in the last few years, which really put the Muslim community on edge and signaled to a lot of people that we don't belong. So that can actually be a contributing factor to the sense of not belonging in the American community, not belonging in the American narrative or the Canadian narrative or whatever Western narrative country you're from. So that can actually compound suicide risk for sure. There's not a lot of studies that show that. There's not any studies specifically on suicide that show that, but there are sort of consistent studies on Islamophobia that show that it is related to negative psychological outcomes. It is related to mental health problems. So that being said, direct Islamophobia may not be the actual sort of the worst problem that a lot of folks face. I think a lot of young adults and a lot of youth and actually adults in general face the same problem of not necessarily being able to reconcile their identities, right? There are some issues such as consuming alcohol which are sort of fundamentally irreconcilable. If you have sort of Western friends, if you're going to university, if you're even in academia and you're going to social gatherings, chances are that you'll be going out for drinks, right? That's sort of like the social currency that happens these days. And as a Muslim, you may believe, well, I can't do that. I can't even go out, let alone drink. I can't be in the presence of alcohol. And so all of a sudden, you can find yourself marginalized, socially excluded. And so a lot of people find themselves that way. And it's this issue of marginalization, this issue of not necessarily fitting in very well that at least I think maybe one of the root causes in our community that really we need to look into a lot more. As for resiliency factors, there are actually quite a few as well, right? Islam actually has built into it a number of different mechanisms by which we can become resilient to suicide. There are things like Salah, there are things like Thikr, all of these pieces are essentially mindfulness components. And what we know about mindfulness from the psychological literature, rather than maybe the specific Islamic forms of mindfulness is that these forms of practice can actually bring us into contact with hard emotions. And one of the ways that we deal with suicide in therapy and in a person's personal life is to come into contact with your tough emotions and really face them, allow them in. It's actually the avoidance of these hard emotions that can actually compound these issues. So Islam offers a lot of different pathways. And inshallah in the project that Dr. Ranio is alluding to the Templeton project, inshallah we'll be able to find out a little bit more about how Muslims use these resiliency factors to actually improve their likelihood of being protected from suicide down the line. Would anyone else like to add to that or if not I can move on to another question. I think Bilal summarized that really well. I'll just add one thing in terms of, in addition to the individual practices of Thikr and Salah and reflection meditation that Islam offers also that social network and whether it's Juma or Eid or whatever or just activism, connecting to other people across faiths has shown to be resilient factor, a protective factor for suicide and depression and anxiety in general. Thank you, Dr. Hamada. I wanna ask a sort of related but different question. We've talked a lot tonight about suicide before suicide. So suicidal ideation, how to help people or help communities. I'd like to ask in the tragic event that a suicide occurs, what is something that you can share about how a family or a community can approach the tragedy of a death by suicide where there may be a lot of stigma, there may be a lot of questions about the role of faith and all kinds of issues that come up. So I'd like to ask about that side of things. I think those are great questions. And I think if we really look back to some of the key points we were saying here today which is that the frontline or first responders to anything related to suicide or really anything related to mental health are actually friends and family which is everyone here. Not everyone here necessarily is a psychiatrist or a therapist or a physician or even public health worker but everybody is family or friends to other people. And I think that's what's important and it keeps on repeating itself in every study that we do related to mental health and we ask who would you go to first if you felt that there was a mental health concern that you were dealing with, it always comes out to be friends and family first. Why am I emphasizing that? Because there's so much all of us can be doing. And I would like to draw your attention to a summary actually article, kind of a brief hopeful, I hope the Chaldeh article that we wrote actually on this topic whether it relates to suicide prevention we kind of did a list of like six things friends and family can do to help with suicide prevention. It was just published just some days ago actually because this is September suicide awareness and prevention month. So it was just published earlier last week in Muslim Matters and we'll put that link for you here just very shortly. We had a link to an article also on Muslim Matters on the topic of suicide postvention what happens in the tragedy and in the aftermath of a tragedy in your community of what can you do to really help and support those who are lost survivors those who lost a person to suicide or whole community that lost somebody in this way and how do you really do things well so you don't further cause harm sometimes we inadvertently cause harm sometimes our leaders and religious leaders meaning very well, inadvertently we'll say things that actually could be more triggering or traumatizing to those that have had this loss. So we also prepare this article for all of you and it's 10 do's and don'ts related to tragedy after the tragedy of the suicide that we can say and do and I wanna draw your attention again to what Dr. Hamad was talking about the importance of social networks and community the importance of what happens so much about healing has to do with how the community responds and for their lack of response it's really, really important and this comes down to everybody as family, as friends but especially our leaders our imams and our status and our youth leaders and so on and this is why we have the trainings that we have but also the steps this is why we've written the hookahs away we've written them, we've written the do's and don'ts to really help guide the community in what to do exactly because there was an earlier question that was asked about what is it that is different about Muslims and suicide? Like what is the need here? And some of the things that are very unique that we focused on in this manual of ours is really focusing on things that are specific to the faith like the fact that all Muslims need to have a Janazah prayer, a funeral prayer for them regardless of cause of death they need to have the last rites of a Muslim the washing of the body and the burial of the body and the prayer for the person and then there's all these questions about can we pray for them after their death and all of these things that come up this is why we tackled the manual the way we did because there were so many faith specific questions that needed to be addressed and even our imams had questions about how do we handle this exact thing, right? And how do we help the community breathe? So I hope and Shala you find that this work has been official work very much open to your feedback if you look through the resources we told you about on the website and through the articles you're reading here and you find that there's actually more that you want, you know, that will pop up this topic or we're missing this or how do we address this, let us know because that's what the whole point of the lab is we're here to actually create resources for you and Shala and that Marathon can then provide them to the general community. The manual sounds like just an incredible resource along with the hood buzz and everything else that's been described. So I do hope that people joining us here tonight will in fact take a look at all of those resources and I know that some people have very specific questions about how to best serve their patients, their communities, their friends and family and I hope that there are a lot of answers it sounds like there's a lot of good answers in all these resources in addition to what's been shared here tonight. Did anyone else want to add to that question on how to support in the aftermath of a tragedy like that? I think one of the things that has come up a couple of times when we've jumped into support different communities are things about balancing sort of faith versus compassion. And I think that's one of the things that Dr. Rania has said but I really want to emphasize that a little bit more right after someone has died by suicide is not really the time to bring up questions of faith that just does more damage to the bereaved people who are grieving their losses. But it's also not the time to shy away from discussions of suicide, including discussions that suicide is haram. One of the things that we know in the aftermath of suicides is that there is something called a contagion effect that particularly people who are vulnerable and youth can actually act once they see that suicide has been done that it sort of opens the door for them to ponder suicide, to attempt suicide or to actually take their own life. So this is actually a time where it's a sensitive time for the community and one that requires sort of tactful navigation so that we discuss suicide in a very, very frank discussion but at the same time maintaining a lot of compassion for the family members and for the deceased so that we don't unnecessarily harm someone more than protecting other people. Wonderful. I think I'd like to sort of pose a final question to each of the panelists at this point. And we've talked so much today about so many ways that we can help people as an individual or as a service provider or as a community leader when it comes to this topic of suicide. And I'd like to ask each of the panelists for some final thoughts as we wrap up on what you think the most important or what is an important key takeaway from this research and what can we all listening to you take forward with us into our lives as we move on from this discussion. And maybe I can start with, well I can start with whoever would like to jump in. Sure, I'll start out sort of soft today. I think I really two key takeaways. The first one, and this is probably the strongest one and as Dr. Ronnie said before, if you take nothing away from the talk, take this away that suicide is 100% treatable. There are effective treatments out there and there are a number of resources. And also if you go to one therapist and it doesn't work, that doesn't mean that treatment won't work for you, try a second therapist, try a third therapist. Chances are that you will eventually find someone who will be able to work with you. And again, they will help you resolve that issue. And the second key takeaway for me is sort of a message of hope in the face of this conversation about stigma. So we do have this prevailing attitude of our communities that no one wants to talk about mental health, that it's taboo and it's never gonna change. And five years ago, when I started research on suicide in the Muslim community, I remember going to messages and community leaders and saying, based on my research, Muslims are probably at risk for suicide. We haven't been on the data, but maybe we should do something to either get the data or talk about this. And basically at that time, five years ago, no one was interested. No one wanted to touch the topic with a 10 foot pole. But look where we are five years from now. We are actually having open community conversations about suicide. We're having conversations again and again about stigma in the Muslim community about mental health. And so that's something that I want us to take away is it may seem like there's a long way to go and there is a long way to go on eradicating the entire stigma, but we've also come a really long way. And so I want us all to just take a moment and reflect on that that our conversations about stigma and mental health are effective and they're continuing to be effective. And the more we have these conversations, the more effective they will be. And consistency when it comes to talking about mental health is absolutely key. I think I'll go next. So I just have two very brief points. And I think the first one is that I hope everyone understands that interventions should include numerous support therapeutics and education sessions over an extended period of time. And I believe that that's what we're doing here. And then I think the other point is is that no one is exempt from suicide. And I think that a lot of times when people in their minds, they have this image of a person that is affected by suicide. So this person looks a certain way. This person acts a certain way. This person comes from a specific socioeconomic background. This person lives in a certain location. And so this is the prototype for someone who commits suicide. And so I think that the last takeaway that I would say is that no one is exempt from this permanent decision of suicide. Yeah, I mean, my final guess to take a whole message is not so much from the research, but just to encourage people with my clinical experience and activism is get help early. Do not wait till it's too late. When you're feeling stressed, well, I posted psychologytoday.com. You can look for Muslim mental professionals there. You can look for any mental professional there. That's a really excellent resource. It's mainly US and actually not sure if it's Canada as well. And so I would go start with that. Also, if you want to be active in your community, so you can certainly support Maristan and other organizations as individuals who want to do something more local and you're worried about, you don't have to jump on the topic of suicide right away. You can do something with less stigma and talk about promoting wellness, promoting happiness and go from a more positive perspective as opposed to the hard, the more taboo, more difficult topics to touch. So if you want to organize it, whether it's in your mosque community or your third space or your college or your youth group, whatever it is, continue this discussion. Things, as what I said, have really shifted in the last five, 10, even 20 years. And so you can continue that conversation in your local community. I'll add to that that I very much agree with everything that was actually stated. And the work, as we mentioned earlier, it's really something that we're all going to have to pitch in and do. When we talk about stakeholders, which really means people who are responsible for certain things in the community, that this topic here of suicide and the more broader topic of mental health is actually something where each and every one of us is a stakeholder. It's not something that just the professionals need to work on. In fact, like I mentioned earlier, when we ask who is a person more likely to go to and it's friends and families, the answer, you should also know that the answer for the professionals is a little bit lower down on the list. And we're hoping that it gets a little bit higher in time, but it's really important to understand that every person here is what we call a stakeholder in mental health of our communities and our families and our loved ones. So when people say, you know, what can I do to help? One of the first things to know is that you can always inspire change in someone else. And sometimes that's all about role modeling. So when we talk about other people of your friends and family, maybe your own children, or maybe there are people in your community that you serve like youth and others, one day you see that you yourself are role modeling, good and positive health and really taking care of your well-being, but they too are likely to do the same. I have often talked to in our trainings and trainings with imams, for example, they'll say things to me like, yes, we're starting to say to families, you should go to see the mental health professional when they come to the imam and clearly the issue is more of a mental health issue, not a religious spiritual issue. And there are lines drawn about who should be counseling about what, for example, right? However, I've often said to our dear imams that imagine how much stronger it is if you said to that family or the person coming to ask you the question, and I too see a therapist because I have a heavy load to carry here in the community. And therefore it helps and therefore you should as well imagine how much stronger that message would be. And I know there's people smiling here, but trust me, there are more and more imams and leaders every day who are actually seeking out this kind of support because they do carry a lot, masha'Allah. But this all goes to just say, start with yourself first. And then your inner circle next. And then after that, the broader community, preferably your local community before we talk about the very national kind of and the global umma type of situations. I'll also say this, having really, having been in the after that unfortunate aftermath of helping communities pick up pieces after the loss, very tragic loss by suicide. I've done a number of what we call postvention trainings after a suicide training of how to help the community help and grieve, a number of these, masha'Allah. And what I could tell you from my experience from that, from all that work is really to know that often people when a tragedy or crisis strikes, it's just they freeze. Like it's really hard to figure out what to do next. And this is why I hope we're not sounding redundant, but this is why we're saying, come to the resources that have been developed because it is really hard in that moment to know exactly what to do. So reach out for the kind of help. We hope, inshallah, in time that the whole big group that's part of Marathon, all of our partner collaborators, we wanna actually come to your communities and help train your leaders so that they know what to do in the moment where they need to intervene, so suicide intervention or even just mental health intervention, or of course, unfortunate aftermath of a crisis as well. So please do know that there are resources out there, part of education and awareness is that you play that part too. And letting folks know where to turn, where to go and you yourself role modeling that kind of self-care, which is not in people hear the word self that they think of the word nefs, you know, you know, or the word Anna in Arabic, like Anna, Anna, this is, you know, what do you mean I should focus on myself? This is actually part of our very, so not of taking care of ourselves first and foremost so that we can take care of others. They're very beautiful. And I'll end with this very beautiful Islamic saying is that, you know, what the scholars often say is that you can't actually give what you don't have and a container can only pour out what it contains. So if you yourself don't have that kind of ability to give self, to help others, how are you going to do so if you haven't helped yourself, right? So this is where we start with ourselves first then the ripple effect of our, you know, circles of our local and then our more national and then our own kind of communities and show. That's a perfect way to end this conversation tonight. I wanna thank all of our incredible panelists here tonight for imparting such wisdom and some really important tips and tools that I think we can all take back to our families, to our communities and also for ourselves, things that we individually need to think about too. So thank you all so much, not just for tonight and your incredible wisdom but also for the really important work that you do every single day. So thank you all. I wanna thank everybody so much for joining us here tonight. I hope that this is the start of a conversation and more importantly, a start to solving this really tragic challenge that we all face and hopefully, you know, you've been given some tools and tips tonight that can help us start down that path. So thank you all. I hope you enjoy the rest of your evening. Assalamu alaikum.