As stigma against treatment lessens, population remains largely underserved.
A just-published survey of more than 100 Orthodox mental health professionals revealed that despite significant improvements in the past 25 years, the psychological needs of today’s Orthodox Jewish community are still far from being met.
“Unfortunately, even thought the mental health world spends a lot of energy studying diverse population minorities, it tends to be that religious minorities like Jews and Orthodox Jews have been omitted from that population,” said Eliezer Schnall, clinical assistant professor of psychology at Yeshiva College of Yeshiva University and the project’s lead researcher.
The study, called “Psychological Disorder and Stigma: A 25-Year Follow-up Study in the Orthodox Jewish Community,” follows up on an original study conducted in 1984 by Dr. Shalom Feinberg, clinical associate professor of psychiatry at YU’s Albert Einstein College of Medicine, and his wife Dr. Karyn Feinberg, school psychologist at Yeshiva Har Torah in Queens. Schnall and his team distributed the survey among a listserv of about 450 mental health professionals from Nefesh — an organization formed in 1992 to bring together Orthodox mental health professionals and rabbis. About 100 replies were received.
Respondents answered questions on topics such as the most prevalent psychological disorders within the Orthodox community, how well each segment of the community is being served and how much stigma is still associated with mental health conditions.
Schnall presented his team’s findings at the American Psychological Association convention in San Diego last week.
“On the one hand about 50 percent are telling us that [the Orthodox population is] at least somewhat underserved, and that’s a situation where we are not where we want to be,” Schnall told The Jewish Week. “But … the number of those who in 1984 said needs are adequately met was only 10 percent — now the number is 40 percent.”
The most common patient visits involve marital problems, followed by a combination of anxiety disorders, substance abuse and affective (mood) disorders like depression, according to responses in Schnall’s survey.
In the quarter-century between studies, the responding clinicians who felt that community members mistrust the mental health field has dropped from 87 to 59 percent; clinicians who felt that mental health patients are stigmatized fell from 93 to 70. Mental health visits are still perceived as relatively expensive, with 47 percent of doctors in 2009 responding that patients view psychological services as unaffordable; that figure was 57 percent in 1984.
“Clearly the needs are being met better now than back then,” Shalom Feinberg said. “It seems like there has been light years of progress. So how does one explain the numbers. Our take on this is that there’s a greater awareness of psychopathology now. There was so much more denial and so much less awareness of the existence of problems than there was back then. The bar has been raised now.”
Though much improvement still needs to occur, Schnall was encouraged to find that all of these results are statistically significant and that treatment has become much more acceptable to the community.
“Virtually every single [respondent] said [tolerance of medical treatment] is either somewhat greater or much greater,” Schnall said. “There is definitely greater acceptance within the community for illness and treatment of that illness.”
Both the chasidic and ultra-Orthodox segments of Orthodox Jewry remain particularly underserved, while the age group that needs the most attention includes children and adolescents. Eighty-five percent of responding clinicians identified the ultra-Orthodox as underserved in 1984, and 48 did so in 2009. Seventy-two percent of respondents in 1984 said chasidim were underserved, while 58 did so in 2009. In contrast, only 11 percent of those surveyed identified the Modern Orthodox as particularly underserved 25 years ago, and 4 percent did so now, Schnall said.
But according to both Schnall and the other Orthodox mental health professionals, both rabbis and community leaders can take active roles to reduce the stigma of mental health treatment.
“This is a community where I think a rabbi can play an important role; they do play an influential role and congregants may be turning to rabbis for advice and counseling,” Schnall said.
Nefesh, the group of Orthodox mental health professionals that distributed the survey, hopes to contribute to this effort “by providing ongoing professional development opportunities and seminars regarding mental health concerns and cultural sensitivity to professionals and community leaders such as rabbis and teachers,” according to its president and licensed clinical social worker, Rabbi Simcha Feuerman.
“The Orthodox Jewish community is growing, and along with it, the complex needs of its growing families,” he said.
From rabbinical schools and on, rabbis need to be trained to recognize disorders and know to whom they should refer congregants. Currently, rabbis do not play a significant role in patient referral, a passivity that Schnall laments. About 75 percent of Orthodox clinicians in New York and about 85 percent outside said that few, if any, clients are referred to their doctors by rabbis.
“We need to educate the community and rabbis about the nature of psychiatric illnesses and the availability of treatment. All emotional problems are not the same,” Feinberg added. “It’s not some homogenous bag of problems. Take shidduch anxiety for instance – I’m seeing people getting married now who never could’ve gotten a shidduch [match] 25 years ago. Yes, some people are on medicine, but they’re still capable of being good husbands and fathers, for instance.”
And this is a crucial detail that doctors like Schnall and Feinberg hope the entire community will soon understand.
“There has definitely been improvement, but we are not where we need to be,” Schnall said.
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