Muslim spiritual care offers comfort — and improves patient outcomes — at HCMC

In her 15 years as a psychiatric nurse practitioner at Hennepin County Medical Center, Hawa Ali has often provided Qurans for her Muslim patients. She said having the holy text brings patients relief while they suffer through the worst of their mental health crises.

For the last three years, patients had an additional resource: three Muslim spiritual care providers hired by Hennepin Healthcare. The care providers not only ease patients’ minds, but they have also helped reduce readmission rates for Muslim patients — by more than two-thirds in the hospital’s inpatient psychiatry department.

“There’s mistrust of Western treatment, but I see people when they have a spiritual care member approach them, they can face their challenges and regulate their behaviors,” Hawa said. “Seeing someone you can relate to spiritually, that makes a difference.”

In 2021, Hennepin Healthcare partnered with Open Path Resources, a nonprofit based in the Cedar-Riverside neighborhood, to integrate spiritual care as part of the medical care plan for patients by request. Now, the Muslim spiritual care providers cover a third of all spiritual care at the hospital.

The initiative at HCMC was funded through a $1 million investment at Hennepin Health into eight programs to improve outcomes and care experiences for community members.

“We’ve seen a large increase of individuals who practice Islam,” said Christine Hauschildt, a spokeswoman for Hennepin Health. “The entire patient population has changed over the past decade and there’s been more demand in serving, especially, the Somali community.”

At least 7% of patients in the hospital system identify as Muslim, according to Hennepin Healthcare and 10% of psychiatric patients are Muslim.

Tracking impact

The most profound impact has been in the psychiatry department. Health care providers found that patients who identify as Muslim were more likely to be rehospitalized within 30 days of being discharged, according to Dr. Stamatis Zeris, a psychiatrist at HCMC and psychiatry residency program director.

The hospital tracked readmission rates for patients in the inpatient psychiatry department and found that, after introducing Muslim spiritual care, the hospital reduced readmission rates for Muslim patients from 24% in 2019 to 9% in 2023.

“This is an intervention that focuses on how we as caregivers think about the different cultural languages that people use to describe their distress,” Zeris said. “Spiritual care providers have really helped us integrate that theme more into our overall comprehensive treatment plan.”

One goal of the hospital system’s partnership with Open Path Resources was to target high readmission rates. OPR was founded by Michael Van Keulen and Imam Sharif Mohamed to improve relationships between public institutions and Minnesota’s Muslim communities. The organization is based at Dar Al-Hijrah, Minnesota’s oldest Somali-run mosque.

OPR has interviewed over 500 individuals and conducted surveys since 2013 to better understand the critical needs of the local Muslim community.

“The most complex place is where there is stigma, where there are challenges, and where there is mistrust,” Van Keulen said. “Those were places we wanted to dig in deeper.”

The group found that Muslim patients were ending up back in the hospital because of the stigma around taking medication often perpetuated by family and community.

“There’s a perspective of, ‘God is punishing me because I’m far from my religion,’” Sharif said. He added that spiritual care providers help patients and their family members see that medication is not against the religion of Islam and that mental illness is not spiritual illness.

At the same time, Van Keulen said, they don’t pressure patients to take medication but rather build the trust needed to accept care.

A new model of spiritual care

Van Keulen explained that the spiritual care provider program developed by OPR is different from chaplaincy. The providers focus on care for Muslims. They also follow up with patients after they’re discharged. Spiritual care providers are OPR employees, but are part of hospital care teams.

Spiritual care providers at HCMC sit and talk with patients, pray with them, and bring them Qurans, prayer rugs, and a schedule of prayer times.

Van Keulen and Sharif found that by simply having a conversation with someone who looks like them and understands their faith, patients were more likely to accept care and trust providers. Sharif himself was formerly a Muslim chaplain.

OPR also hosts community education events to combat the stigma around mental health treatment, so that patients can feel supported when they return home.

Sharif said they are trained to recognize the symptoms of mental illness, especially anxiety and psychosis. They are also skilled at listening without judgment and meeting the patients where they are.

“A lot of what the psych patient needs is belonging. You are part of the community, you are not alone,” Sharif said. “All of those elements are very important.”

One challenge OPR is still discussing is how to provide hijabs for Muslim women in inpatient psychiatric care.

Inpatient psychiatric care is, by design, restrictive while patients recover from a mental health crisis. For example, a patient who is exhibiting extreme distress may not be able to wear a hijab because it could be used as a self-harm device. If a psychiatric patient requests a hijab, the answer isn’t so simple, Van Keulen said.

“Hospital rules used to be very rigid, that is no longer the case. There’s much more conversation. Our spiritual care team has been involved in de-escalation, resolution and in some cases a hijab was provided,” Van Keulen said. “It’s just control over your own dignity that’s so missing in health care.”

While the rigid rules are less prevalent at HCMC surrounding hijab, the safety of the patient is still top priority, Van Keulen said. He added that now there is a respect towards the safety Muslim women feel in hijab, especially when they are suffering a mental health crisis.

Hennepin Health and OPR recommend integrating a similar model for spiritual care providers to benefit Muslims who are pregnant, have a chronic health condition, those suffering substance use disorders, and hospice patients, as well as their families.

Spiritual care model is not yet the norm

While HCMC has made strides in improving mental health treatment for Muslim patients, Dr. Farha Abbasi, the director of the annual Muslim Mental Health Conference and Consortium in Michigan, said that such initiatives are not yet the norm nationwide.

“Physicians are contributing to health disparities by not being culturally sensible. That’s becoming a big barrier in good care of the patient,” Abbasi said. “Cultural competency training that’s based on implicit bias, that’s good, but it’s falling short for a fast-growing diverse population.”

Abbasi said she continues to observe practices at inpatient psychiatric facilities where there are limited language interpretation services, a lack of halal food available for Muslim patients, and strict rules around hijab for safety concerns. In addition to mental illness, the trauma some Muslim immigrants experience during migration is also an added burden for patients.

“Are the hospitals doing enough? I would suggest we’re failing badly,” Abbasi said. “Cultural sensitivity training needs to be taken to a deeper level.” She said she encourages other hospital systems to hire cultural and spiritual liaisons for their diverse patient populations.

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