Unveiling mental health seeking through transnational religious healing practices among Bangladeshi migrants in the UK

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Data were collected during the Covid-19 pandemic through online semi-structured interviews in Eastbourne, UK, as no previous research has been conducted in this location where a group of Bangladeshi migrants reside. Bangladeshi migrants voluntarily relocated to the UK for economic or familial reasons, and their descendants continue to reside in the country. Upon migration, they retain their beliefs and values, including their practice of medical pluralism. The most prevalent mental health treatment-seeking behaviours include religious healing practices, obtaining preferred medications from different suitable sources, and travelling to holy sites for remedies while simultaneously utilising UK psychiatric care. The findings of this article demonstrate that the mental health-seeking behaviour of Bangladeshi migrants is deeply rooted in religious or faith healing practices that are transported from Bangladesh to the UK through the lenses of medical pluralism resulting in a unique phenomenon of travelling medicine and travelling treatment. Bangladeshi migrants first-generation mental health transnational religious healing medical pluralism travelling medicine Introduction The phenomenon of global migration is currently seeing unprecedented levels, and the process of migration induces stress, anxiety, and depression which have an impact on one's mental well-being 1 . The study of the impact of migration on health has gained attraction in recent years despite the research on mental health of migrants is relatively scarce 2 . In many Western countries, migrants are more vulnerable to mental illnesses than host communities and have varying rates of psychiatric service use owing to the significant differential in economic status, linguistic challenges, and/or sociocultural issues 3 . In the UK, migrant groups represent a growing percentage of the overall population where they have a higher rate of first admission for schizophrenia than the overall population 4 . Individuals from ethnic minority communities are more prone to being sectioned under the Mental Health Act than their white counterpart 5 . This study focuses on Bangladeshi migrants who came to the UK voluntarily for economic or family reasons and their descendants who continues to live in the UK. Most of the study of Bangladeshi migrants are in East London based. There is no prior study in Eastbourne, UK where a large proportion of Bangladeshi migrants live. This study will understand Eastbourne Bangladeshi migrants’ mental health seeking behaviour through the lenses of medical pluralism. Medical Pluralism and Religious Healing Medical pluralism defines circumstances in which individuals can select from a wide variety of treatment options or selection is made for them from existing therapeutic alternatives in the event of mental incapacity to take decisions. A large proportion of mental health visits do not take place with biomedical physicians and related specialists, but with traditional healers, herbalists, religious figures and so on 6 . Fernando 7 has argued that in Britain psychiatric services are predominantly biomedical and the diagnosis of psychosis and treatment provided to ethnic minority groups is often perceived as a way of control. Several authors have discussed the issue of institutional racism and cultural misunderstandings in the British mental health service in relation to high incidence of schizophrenia among Black communities resulting in stress and feeling powerlessness 7 . On this background, migrant communities might find themselves uncomfortable with seeking help from the existing biomedical services and opt for multiple religious healing options. As western biomedical categorizations of mental illnesses are different from that of the local ethnic groups’, treatments are also failing to meet their expectations 8 . Moreover, the biomedical system assumes local understanding as ‘folk’ and ‘personalistic’ 9 . In Western cultures, mental disorders are mostly described in biological or psychological terms, whereas the interpretation often includes cultural or spiritual traditions in non-Western communities. Kleinman 10 argued that it is necessary to study the explanatory illness model to better understand patients and their family members. An overall lack of understanding of the patient’s religion and cultural beliefs among health care professionals could negatively affect diagnostic efficacy and may lead to inadequate management 11 . Thus, understanding how patients' explanatory models affect mental health practice and could influence treatment outcomes and satisfaction is important 12 . It is evident in different literatures 4,13–14,15− 21 that cultural values, religious beliefs, stigma, shame, fear, communication play an important role for the presentation of mental illness and the barriers to approach psychiatric service and resort for pluralistic coping strategy. Among the Muslim community, religious beliefs, and supernatural interpretations of mental health impact individuals to seek help and cope in different ways, yet these issues might not always be recognized or incorporated into therapeutic practices 22 . According to Alhomaizi and his colleagues 23 , Islamic religious beliefs can either support or obstruct the pursuit of help among Arabic-American individuals. Those experiencing mental health issues might be criticized for having insufficient faith and advised to pray to enhance their relationship with God. On the special issue on mental health, religion, and culture, Dein 17 has focused on the psychological effect of religious healing and found that religious healing is the most common coping strategy for mental illness among the migrant communities in the UK that they practice with biomedical treatment. Furthermore, a survey of Muslims in the UK by the Lantern Initiative found that 84% of respondents expressed the desire for faith informed counselling service 24 . When accessing NHS talking therapies, Muslim experiences a lower recovery rate compared with Christian and Jewes 25 . According to studies conducted among Muslims in Europe, mental illness is widely believed to be brought on by jinn spirits. As a result, many Muslims resort to religious healers who recite verses from the Qur'an in an effort to drive these evil spirits away 26 . Dein and Illaiee 20 have also found that jinn are frequently mentioned as the cause of insanity and epilepsy. However, Gunson and his colleagues 27 studied among the Glasgow Muslim women and found that their strong belief on spirit possession hindrance seeking treatment from medical services. In a similar vein, Linney and his colleagues 16 found the preference of religious coping among the Somali migrants and travelling to different holy places for their treatment of mental illness. Demographic data on South Asian migrants in the UK suggests less mental health service utilization among them as compared to other ethnic groups and the general population 28 . Many studies 19 – 20 among different South Asian Muslim communities observed that they are strongly belief about the evil effects of being possessed by spirits, and as a result, their preferred place to seek treatment from Qur’anic healers from different sources by travelling many places. Bangladeshi Migrants in the UK and Religious Healing Practices Bangladeshis are the third largest and one of the UK's earliest South Asian ethnic minorities, constituting 1.15% of the population 13 . Approximately 95% are from Sylhet district in Bangladesh and are predominantly patrilineal. The majority (65%) are living in East London, while the rest live all over England 29 . They experience strikingly high poverty rates (65% below the poverty line) and educational disparities (49% of women, 40% of men lack qualifications) 30 and 42% lacked regular income and 22.5% residing overcrowded houses in contrast to the lowest rate of 1.7% observed in white British households 31 . Kirkbride 32 found first episode psychosis elevated risk was 2.1 (incidence rate ratios [IRR] 1.4–3.1) among the Bangladeshi communities in Tower Hamlets, London. Nazroo and Illey 33 reported that 1.6% of Bangladeshi males and 2.2% of females face CMD (Common Mental Disorder) in a UK community survey. As it is mentioned earlier that ethnic minorities are more likely to be detained under the Mental Health Act than white counterparts, but it is also reported that detentions among Bangladeshi migrants is significantly low, and the rates are reducing each year 34 . Bangladeshi migrants are least likely to use mental health services (4550 adults per 100,00 population and lowest number of referrals to the service of talking therapy (10,468) compared to white British (1,157,582) 35 . Bhui and his colleagues 36 conducted a study among six ethnic groups in Britain and argued that religious exercises among Bangladeshis were important for their coping practice compared to other ethnic groups and White British respondents. Effective coping methods were praying, using amulets, talking to God, and having faith in God. Despite addressing Bangladeshi migrant women’s mental health seeking behaviour, a recent literature focused on the British Bangladeshi men and their limited uses of formal psychiatric service due to stigma, cultural barrier and linked Islam with mental wellbeing. It is also reported that Bangladeshi migrant men feel comfort, solace in religion practices namaaz or (salah), Quran recitation led to improve their wellbeing 14 . Littlewood and Dein 18 found that Bangladeshi psychiatric patients in London had confidence in psychiatrists whilst also using healing tabij (amulets). Dein and colleagues 37 described the dissatisfaction with GP treatment in their study in Tower Hamlet, London, and the preference for long-distance travelling to find suitable Hakim (religious healers), having Zamzam water, Quranic recitation, prescription of tabij , foo (blowing over the patient) is the possible treatment seeking behaviour for mental illness. In addition, they also elaborated a story of a mute women in Manchester taken by her parents to a mullah in Stephany Green and visiting different faith healers in different places within the UK for her treatment. Given these contexts, this study explores how first-generation Muslim Bangladeshi migrants interact with existing mental health facilities and how they navigate alternative therapeutic coping based on their religious ideologies. Methods and Materials Selecting Participants The process of respondent selection started before Covid-19 and interviews were conducted during the pandemic period around July 2020 to September 2020. To conduct this study, the snowball sampling method was used to facilitate in-depth and semi-structured qualitative interviews as the researcher was unfamiliar with Eastbourne and the UK. The snowball sampling method assisted the researcher in gaining trust as the researcher was introduced to participants by community members. The researcher was acquainted with two key informants who provided assistance during the initial period of settling in the UK at Eastbourne. Two follow-up interviews were conducted with two key informants. Prior to the pandemic, meetings were arranged at the informants' residences or the researcher's home. The informants' referrals facilitated the process of earning the trust of other research candidates who consented to participate. Through these connections, access was obtained to the mobile numbers of some Bangladeshi families for communication purposes. During the pandemic, contact was maintained via mobile calls or text messages. Eight families were contacted who expressed willingness to share their perceptions of mental illness and health-seeking behaviour. From these groups, three first-generation and three child migrants were purposively selected for in-depth online interviews. Data were gathered from individuals who migrated either as spouses, as an employer, as a student or as children. Child migrants were included as part of the first generation to facilitate a more accurate comparison between those who received education in the UK and those who did not or those who raised in the UK and those who did not. Data collection and Analysis Data were collected through in-depth interview in Eastbourne at Hyde Park(pseudonym) Area where many Bangladeshi families are living. Interviews were conducted mostly using telephone interview, sometimes using the Facebook messenger video call and What’s App video call. With informants’ permission, interviews were recorded using a digital audio recorder. All interviews were conducted in Bengali Sylheti dialect or in English and mostly lasted between 20 to 40 minutes. The longest interview took one and half hours. These interviews allowed to engage in deep conversation with informants. The researcher contacted potential participants to inquire about their availability for interviews. A structured interview guide was utilised to ensure a systematic approach. Each interview typically commenced with a series of questions pertaining to participants' knowledge and understanding of mental illness, treatment modalities experienced during periods of mental illness, satisfaction with the UK health system, and religious perspectives on mental health treatment. Follow-up questions were tailored according to individual informant responses. Interview data were subsequently coded and analysed manually. Ethics : This study adhered to the guidelines and research ethics framework provided by the Research Ethics Committee of the School of Global Studies, University of Sussex. The research proposal was submitted to the Social Science and Arts Research Committee of Sussex for ethical approval ER/FH260/2. Upon receiving ethical approval, the research commenced. The names of interlocutors were kept anonymous in the writing to ensure anonymity and present the overall picture of the research in a sensitive manner. Prior to conducting the interviews, a consent form and an information sheet were sent to the participants. The fieldwork began after obtaining proper consent. It is noteworthy that written consent alone may not be sufficient for building trust and developing a personal connection with participants. Engaging in regular telephone communications and informal conversations prior to interviews with informants facilitated the acquisition of in-depth data. The audio recordings are currently retained for future research purposes. They are stored on a password-protected personal computer with USB backup kept in a secure location at the researcher's residence. The decision was made not to upload the recordings to an online platform such as iCloud due to the perceived high privacy risks associated with such platforms. Results Eastbourne Bangladeshi migrants, religious healing and travelling medicine Bangladeshi migrants arrived in Eastbourne in 1965 seeking employment. Nazim is 75 years old, a retired person from restaurant job, completed his GCSE after coming to the UK, one of the earliest residents in Eastbourne, reported that his father relocated to Eastbourne from London and purchased a house in the 1970s. Currently, approximately 100 to 150 Bangladeshi families reside in Eastbourne, with the majority originating from the Sylhet district. There is one Bangladeshi association named "Sunar Bangla Association", and there were two councillors of Bangladeshi origin in Eastbourne Borough Council. The majority of first-generation and child migrant males in Eastbourne are restaurant proprietors, co-owners of restaurants, or grocery shop owners. Some are employed as taxi drivers. The first-generation and child migrant females are predominantly homemakers, particularly those with lower levels of education. Some are employed as food delivery drivers or care workers. When questioned about mental illness, all respondents associated feelings of stigma with the subject. For them, having a mental illness is considered a social stigma and a matter not to be discussed openly. Romija is a homemaker and mother of three children. She immigrated to the UK following her marriage. When asked about her perceptions of mental illness, she recounted another individual's narrative without initially disclosing her own experience of mental illness. Amr eta hoice na. Eastbourne e mathat dukko paise emon ekjon ase. Taine konsomoy vala feel korena. Taine bujena kon jaigar moddhe kon kotha allowed. Taine depression er problem achena ni. Taine majhe modde matat ghuri pori jai. Amr shamne eta bohubar hoice. Hafiza mota hoitese gum na howa ar depression er karone I do not have such kind of illness. I know one lady in Eastbourne who has got mental illness (mathat dush or mathat dukko). She (Hafiza) does not feel okay. She feels sleepy all the time. She does not understand what to say (taine bujhuen na kon jaigar moddhe kon kotha allowed) on different occasions. She (Hafiza) has a depression problem. She sometimes got fainting attacks and it happened on many occasions in front of me. Hafiza is getting fat because of her depression and sleeping excessively. Following the recounting of Hafiza's narrative, Romija inquired about potential interventions and pharmacological treatments for anger and obstinacy, presuming that I might be able to offer recommendations. This initial reluctance to discuss mental health issues was observed among my interlocutors during the preliminary phase of my interviews. In terms of the question about jinn possession and mental illness, one of the interlocutors Hasina elucidated that jinn possession can happen if someone does not follow religious practices such as praying, fasting, and reciting Quran. They perceived that for the jinn possession or sudden behavioural change, a mullah or a religious healer has a power to treat it. Mullah can treat jinn possession what they termed as upri. They believed there are two types of disease one is dactory (biomedical ) disease and the other is upri. One has to go to a doctor when they have dactory disease like diabetes blood pressure and cholesterol. But upri , which is linked to Jinn inflection, must be treated by a mullah or a religious scholar. According to Romija, Eta luv hoito na jodi keo daktor dekhat jai tar upri problem nia. Mullah shahed etar jonnw bala. Diabetes, pressure, cancer hoile daktor decani vala. There will be no benefit if someone goes to a doctor with an upri problem. Those who have an upri problem need to go to a mullah for the treatment and those who have dactory problem like diabetics, bloods pressure, cancer they need to go to see a biomedical doctor. When questioned about their belief in tabij (an amulet containing Islamic verses) and Panipora (a form of treatment administered by a mullah , involving the recitation of an Islamic verse over water, which is then considered blessed) for the treatment of anxiety and depression, all interlocutors expressed belief in panipora and denied the use of tabij . They reported observing its use by grandparents, parents, or relatives while in Bangladesh. Although the interlocutors expressed scepticism regarding tabij , it was observed that many individuals wore copper bracelets to alleviate pain, headaches, and various other ailments during initial meetings prior to the commencement of the Covid-19 lockdown. Regarding the question about NHS mental health service, interlocutors Hasina, who came in the UK when she was twelve years old and started her secondary school. She was suffering from headache for the long time and had her check-ups on different occasions. But GP did not find anything and then prescribed her anxiolytics. She was not satisfied with that. She said that she did not get chance to share his experience properly. GP did not want to listen to her. She also thought that only NHS mental health service cannot solve her problems. According to her, This is my own problem; I have to solve it by myself. They (GP service) did not want to understand me. They only wanted to listen to my life history. Sometimes I feel that instead of going to seek help from GP, seeking help from Allah by praying nofol namaz (optional prayer which is not mandatory for Muslims) helps me a lot. Shimul was a restaurant owner who came to the UK as a student. He got his UK passport after marrying a British passport holder woman. He was suffering from doctor phobia few years back due to his misdiagnosis of kidney disease. Then he went to GP for that. The general physician (GP) suggested him to go to Health in Mind Service. He went there and noticed no changes on him. According to him, I think Bangladeshi medicine and Bangladeshi treatment are better than UK health system especially for Phobia what happened to me few years before. I think doctor did not understand what I wanted to say. Whatever, according to their recommendation, I went three times to GP Health in Mind counselling service for my Phobia. It was not effective. I did not feel any change in myself after taking it. For me, it is my own problem. I need to solve it by my own. I took so many medicines for that, but it did not work. At last, I ordered medicine from Bangladesh. After taking those, I felt better. I also do not feel comfortable to see a doctor here, especially GP are not good in the UK. I cannot understand what doctor says. Doctor does not want to listen to me and does not give any medicine. I think UK health system is good for the treatment of blood pressure, diabetics, cancer, kidney and so many physical problems not for the illness like my problem.” Upon question of the resort for religious healers, one of the interlocutors (Usman), who served as an Imam (religious priest) in a mosque, asserted that he utilised panipora for his and his family members' illnesses, obtained from a mullah in Eastbourne. He typically travels to London for this purpose, as the mullah no longer resides in Eastbourne. He also reported experiencing discomfort due to his inability to travel to London to procure panipora for his family during the lockdown period. All the study respondents believed staying pure and being obedient to God by performing religious activities can save them from being ill or give them early recovery, help them to lead a stress-free life. Performing Hajj (an annual pilgrimage to Mecca undertaken each year), Umrah Hajj (a pilgrimage that can be completed any time of the year) and drinking Zamzam water (holy drinking water found in Mecca during pilgrimage) were all possible means by which Bangladeshi migrants in Eastbourne tried to stay closer to God to remain free from illnesses. The first generation and child migrants both are deeply involved with performing Hajj and Umrah Hajj . Many Sylheti migrant families in Eastbourne went to Saudi Arabia several times to perform Hajj and Umrah Hajj . They saved and invested a lot of money for this. When any of their relatives or any familiar person come from Saudi Arabia after performing Hajj or Umrah Hajj , they ask them to bring Zamzam water . Nazim came in the UK when he was twelve years old. He mostly concerned about performing Umrah Hajj. He unfortunately had a failed attempt of kidney transplant which made him dialysis dependent for life. That is why he had to retire early from his restaurant business. He stayed depressed all the time due to his illness. Along with his kidney failure medicine, he had to take antidepressant. According to him, I used to love travelling. It gave me relief from my monotonous life. Now I cannot go anywhere due to my illness. I know Allah is everywhere. Only Allah can save me. That is why I prefer to go for performing Umrah Hajj although I have travel restrictions. I think it is my high time to seek help from Allah for my diseases and many issues. Allah can do anything, so we always need to seek help from Allah when we have difficulties. I think performing Umrah Hajj and drinking Zamzam water are the main source of my mental satisfaction. However, People were seeking help from Allah by reciting Islamic verses ( dua ). After reciting these, they practiced foo , a ritual blowing of air over the body and head and feel stress free. Romija, recited dua when she went outside, when her husband went for work or when her children had exams and health difficulties. She also tried to practice foo by reciting Islamic verse while drinking zamzam water. She kept water in her refrigerator all the time so that she can use it whenever needed. According to her, We drink Zamzam water by reciting Islamic verse and blow over it as we feel that it is a kind of medicine for our illnesses. After drinking it we feel really stress free. In addition, all the study interlocutors preferred praying, fasting during their anxiety or depression time. They also thought that sending their children for Quran teaching also helped them to remove their worry or anxiety. Aleya, who came in the UK when she was thirteen years old and started her secondary school in the UK. She was a healthcare assistant in NHS. She preferred to send her children for Quran learning. She inspired them to pray every day five times and fast. She used to send her children to Eastbourne Mosque. She kept an online tutor for her children because of Covid-19. She stated that Hmmm.... Whenever I feel pain in my mind, I recite Quran to feel refresh. I pray five times. I think reciting Quran also helps me a lot. I also think Quran learning is necessary for all the Muslims. Not only that I think it is one of the best ways to acquire knowledge about Islam and people can connect themselves with God this way... It is my responsibility to send my child for Quran learning so when they will grow up, they can have some Islamic knowledge at least as you know this western culture is different from us. If they learn Quran and they have got some knowledge about Islam, then they also won’t be fall in a big trouble in their life, they will be mentally strong and could find a right way of their life in future...... Discussion and Conclusion This study draws on qualitative online in-depth interview with three first generation and three child migrants from the Bangladeshi migrant’s community in Eastbourne. Its focus was on how the first-generation migrants explain their aetiology of mental illness and how they navigate their treatment. The aetiology of first-generation Bangladeshi migrants in Eastbourne is similar to Littlewood and Dein 18 who stated that the aetiology of mental illness is dependent on Bangladeshi migrants’ own understanding related to the biomedical diagnosis as well as their subjective day to day understandings. Some of their explanations are psychological, some are somatic, or some are religious. This study has found that most of the first-generation Bangladeshi migrants cannot differentiate their common mental disorder with their physical illness. They feel discomfort, shy to talk about their mental illness. In addition, their explanation of psychosis or madness is different from the explanations of common mental disorders. Their explanation of common mental disorder is only related to “ pereshani ” (worry, anxiety). Lawrence and colleagues 38 explored conceptualisations of depression among older adults using a multicultural approach where depression was described as ‘low mood’ and ‘hopelessness’ by White British and Black Caribbean patients whilst South Asian and Black Caribbean people commonly explained depression as ‘worry’. In other words, sometimes most of the first-generation who came as a spouse or as an employer in Eastbourne confused their explanation of common mental disorder with matha batha (“headache”) or sleeping problem ( ghum hoi na ) and many more times they cannot understand that they are suffering from anxiety or depression specially who are female. Similar to previous studies who also revealed that the social understanding of depression is more relevant as there is a low rate of common mental disorder patient is found among the female Bangladeshi migrants in the UK 38 . In this study, the majority of respondents demonstrated limited understanding of their experiences with anxiety or depression, or in some instances, attempted to disregard these conditions. They often neglected these issues until the symptoms worsened, a phenomenon Linney and colleagues 16 observed among Somali migrants in the UK. Furthermore, analogous to Alam 14 findings, my respondents exhibited reluctance to disclose their experiences to others due to feelings of shame and stigma, as evidenced in Romija's account. Similarly, child migrants who grew up in the UK also are not aware the symptoms of common mental disorders like depression or anxiety until the symptoms get severe. However, both first-generation migrants who did not receive education in the UK and child migrants who were educated in the UK shared similar beliefs in jinn , which are common in Muslim faith. Most of the interlocutors who have limited education and practicing Muslims, they associated psychosis with jinn possession or upri . They cannot differentiate mental illness and jinn possession. Especially they perceived that jinn possession is related to good or bad people and Jinn may affect mostly those who are bad. They also explained that after a Jinn infliction people cannot behave normally, a similar belief consistent among migrant Muslims Like Arabic-Americans 23 . Within these communities, mental illness is widely attributed to jinn spirits. Consequently, many Muslims seek assistance from religious healers who recite verses from the Qur'an in an attempt to exorcise these perceived evil spirits 26 . Moreover, this study is based on those who came as a spouse, as an employer or as a student and those who came as a child migrant and their mental health seeking pattern. regarding their perception of GP service and NHS mental health treatment this study found no difference between those who came to the UK as grown up from Bangladesh, and those who came as a child from Bangladesh and raised in the UK. Both were dissatisfied and reluctant to seek treatment from the existing health services. However, first generation migrants who are not born and not grown up in the UK are especially dissatisfied with “Health in Mind” service which is evident in Shimul’s case. They showed their trust on Bangladeshi medicine rather than UK medicine resulting to bring medicine from Bangladesh indicated travelling medicine from their home country. On the other hand, child migrants who are raised in the UK were also dissatisfied with UK mental health service. They thought that only NHS mental health service cannot solve their problems of anxiety and depression. It is noted that all the study interlocutors who were not grown up in the UK and elderly child migrants were prescribed by different anxiolytics. Still, they sought help from different sources from the plural medical landscape which suited them best. Research findings also indicated that religious leaders, including mullahs or measabs , played a significant role in the treatment of worry, pereshani , or mathat dukkho . Both groups believe panipora or holy water from a religious leader is the treatment of common mental disorders such as worries, anxiety and sleepiness. They bring panipora either from London or elsewhere in the UK. All the interlocutors go to holy places like Makkah to perform Hajj or Umrah Hajj and drink Zamzam water for their mental satisfaction. They request someone to bring Zamzam water from Saudi Arabia when any of their relatives or friends go to perform their Hajj or Umrah Hajj and drink it for any kind of “pereshani” which also indicated seeking treatment for mental dissatisfaction by travelling holy places or bringing suitable medicines like holy water from holy places or elsewhere within the UK. They do fast, they try to pray more than five times recite Quran if they feel ‘worry’ or ‘pereshani’ which are all possible means of seeking help from Allah and direct connection to God and having stress free life for them, which was also evident in Littlewood and Dein 18 and Dein and his colleagues’ studies 37 studies. Unlike the above following author’s study, current study population did not believe in use of tabij as means of remedy for mental health issue what the study interlocutors interpreted that their parents used to bring it from Bangladesh a few years ago. In response to their mistrust in the UK health system and the availability of alternative sources of treatment, Bangladeshi migrants in the UK practice a complex medical pluralism as their health-seeking pattern to deal with their mental health issues. Historically Bangladeshi people believe in traditional and faith healing and seeking help from biomedical as well as a traditional system simultaneously in the event of mental illnesses 39 – 40 . Bangladeshi migrant families maintain a very close transnational relationship with their loved ones back home through financial support or marriage 41 . As a result, they carry their beliefs and tradition across Britain, from Sylhet 42 . In addition, religious figures and faith healers remain a significant source of care for people with mental wellbeing problems in Islamic societies 43 . Since Bangladeshi Islam significantly relates to Sufiism and lead by Islamic priests called Pirs, Pirs play a major role in certain part of Bangladeshi people who are suffering from mental illness because of their ability to do ‘miracles’. Therefore, they are often appealed to during sickness. This kind of Islamic priests are prominent figures on the village scene in Bangladesh and sometimes this kind of sanctuary are numerous than the mosque. Female seclusion, traditional religious rituals, obtaining religious and/or secular education is commonly observed among their inhabitants. Gardner 44 described how religious myths are constructed by local people about pirs and their miracles. Migration has not changed their instinctive inclination towards spiritual healing although Eade and Garbin 45 argued that Bangladeshi community in the UK are going through Islamic revivalism under the auspice of mosques. As the study interlocutors were Muslims and have different options available, they prefer to practice religious healing along with biomedical practices. Holding the same consensus with Dein and colleagues 37 study, this research has demonstrated that migrant communities from Sylhet whether they are inhabitants in East London or Eastbourne in the UK have maintained their transnational characters and have reinforced traditional beliefs related to causation of illnesses. It is also argued with Dein and his colleagues 37 that Sufism in Bengal led to the fusion of sunni (orthodox) Islam with Bangladeshi indigenous culture creating a syncretistic Islam that is prone to the reverence of saints ( pirs ) and faith in spiritual healers. The traditional appeal of miracle healers did not disappear after migration and is widespread among Bangladeshi first-generation migrants in the UK in whether they are grown up in the UK or not. This study aimed to provide knowledge about mental illness and health-seeking behaviour among the first-generation Bangladeshi migrants in Eastbourne. As most of the research is based on East London, this study has added extra knowledge about Bangladeshi migrants in the UK. As this study has explained the two-way travelling pattern of Bangladeshi migrants. In one hand, their beliefs and values are travelling from Bangladesh to UK and on the other hand, they are travelling to many places within the UK and to the holy places abroad for embracing the resort of religious healers for their mental illness. As the surge of migration escalating day by day, the exponential growth of first-generation migrants’ is increasing all over the world. Thus, it is necessary to understand their understanding of mental health seeking pattern. Appreciating the concept of Close and his colleagues 2 , who worked among the first-generation migrants in the UK, suggested that more research is needed for this group to understand their subjective experience to set up culturally specific measurement tools. Simkhada 15 suggested cross-cultural perspective would be priority in practice in mental health settings. In addition, understanding faith based or religious healing is also important. Therefore, to support the mental well-being of Bangladeshi migrants effectively, it is important to consider the cultural and religious contexts that influence their help-seeking behaviour. As migration continues to grow, mental health services must adapt by incorporating culturally and spiritually informed practices that truly reflect the lived experiences of these communities. Limitations: This study acknowledges its limitations as an initial exploration into this research area, as the conclusions are based on a limited number of respondents. Future research may investigate the evolving perceptions of mental illness and health-seeking behaviour among subsequent generations of Bangladeshi minority groups in the UK, as well as examine the relationship between medical tourism and migrants' mental health, as indicated by this study. Furthermore, it is important to note that the data for this study was collected during the COVID-19 pandemic, which may have influenced the findings. Subsequent in-depth research will be necessary to gain insights into the health-seeking behaviour related to mental illness in the post-pandemic period. Declarations Author Information Authors and Affiliations Department of Anthropology, Jagannath University, Dhaka. Contributions The author herself is designed the study, conducted the literature review, and analysed data, drafted and wrote the manuscript. The author also critically revised the content and approved the final version for submission. Contributors Correspondence to Farzana Habib Ethics Declarations Ethical Approval and Consent Ethical approval for this study was granted by the University of Sussex Social Science and Arts Cross-School Research Ethics Committee(C-REC). All procedures were conducted in accordance with institutional guidelines and relevant ethical regulations as outlined by the committee. Consent for Publication Not applicable Consent to Participate All study participants participated voluntarily, and data were collected anonymously following written informed consent by maintaining confidentiality throughout the entire data collection process. Competing Interests The authors declare no competing interests. Funding The author received no financial support for the research, authorship or publication of this article. Author Contribution F. H. wrote the whole manuscript, reviewed, edited, and conduct the whole research such as literature search, data collection, data analysis. This paper is based on her master's thesis. Acknowledgement I would like to express my heartfelt gratitude to my second master’s supervisor, Dr Rebecca Prentice, at the University of Sussex, who has provided immense support and guidance throughout my fieldwork and final manuscript writing. This study would not have been possible without expressing my gratitude towards my study interlocutors. Many thanks to all who generously gave me their invaluable time and provided a space for me to talk to them, share their stories, and witness both their sorrows and joys. I would also like to convey my regards to my respected parents, beloved husband and lovely daughter. Their sacrifice, encouragement and unwavering support have been invaluable in the successful completion of this work. Data Availability This manuscript is based on qualitative data and will be available upon requests. References Butler M, Warfa N, Khatib Y, Bhui K. Migration and common mental disorder: an improvement in mental health over time?. International Review of Psychiatry. 2015 Jan 2;27(1):51-63. Close C, Kouvonen A, Bosqui T, Patel K, O’Reilly D, Donnelly M. The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews. Globalization and health. 2016 Dec;12:1-3. Patel K, Kouvonen A, Close C, Väänänen A, O’Reilly D, Donnelly M. What do register-based studies tell us about migrant mental health? A scoping review. Systematic reviews. 2017 Dec;6:1-1. Memon A, Taylor K, Mohebati LM, Sundin J, Cooper M, Scanlon T, De Visser R. Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England. BMJ open. 2016 Nov 1;6(11):e012337. NHS Digital (2024) Mental Health Services Monthly Statistics, Performance January 2024 Orr DM, Bindi S. Medical pluralism and global mental health. The Palgrave handbook of sociocultural perspectives on global mental health. 2017:307-28. Fernando S. DSM‐5 and the ‘Psychosis Risk Syndrome’. Psychosis. 2010 Oct 1;2(3):196-8. Callan A, Littlewood R. Patient satisfaction: ethnic origin or explanatory model?. International Journal of Social Psychiatry. 1998 Mar;44(1):1-1. Littlewood R, editor. On knowing and not knowing in the anthropology of medicine. Left Coast Press; 2007 Feb 15. Kleinman A. Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Univ of California Press; 1980. Kirmayer LJ. Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism. Social science & medicine. 2012 Jul 1;75(2):249-56. Bhui K, Black T. Identity, idioms and inequalities: Providing psychotherapies for South Asian women. Migration and mental health. 2010:128-38. Hussain N, Clark A, Innes A. Cultural myths, superstitions, and stigma surrounding dementia in a UK Bangladeshi community. Health & Social Care in the Community. 2024;2024(1):8823063. Alam S. British-Bangladeshi Muslim men: Removing barriers to mental health support and effectively supporting our community. The Cognitive Behaviour Therapist. 2023 Jan;16:e38. Simkhada B, Vahdaninia M, van Teijlingen E, Blunt H. Cultural issues on accessing mental health services in Nepali and Iranian migrants communities in the UK. International Journal of Mental Health Nursing. 2021 Dec;30(6):1610-9. Linney C, Ye S, Redwood S, Mohamed A, Farah A, Biddle L, Crawley E. “Crazy person is crazy person. It doesn’t differentiate”: an exploration into Somali views of mental health and access to healthcare in an established UK Somali community. International Journal for Equity in Health. 2020 Dec;19:1-5. Dein S. Religious healing and mental health. Mental Health, Religion & Culture. 2020 Sep 13;23(8):657-65. Littlewood R, Dein S. The doctor's medicine and the ambiguity of amulets: life and suffering among Bangladeshi psychiatric patients and their families in London–an interview study–1. Anthropology & medicine. 2013 Dec 1;20(3):244-63. Littlewood R, Dein S. ‘Islamic fatalism’: life and suffering among Bangladeshi psychiatric patients and their families in London–an interview study 2. Anthropology & Medicine. 2013 Dec 1;20(3):264-77. Dein S, Illaiee AS. Jinn and mental health: looking at jinn possession in modern psychiatric practice. The Psychiatrist. 2013 Sep;37(9):290-3. Loewenthal D, Mohamed A, Mukhopadhyay S, Ganesh K, Thomas R. Reducing the barriers to accessing psychological therapies for Bengali, Urdu, Tamil and Somali communities in the UK: some implications for training, policy and practice. British Journal of Guidance & Counselling. 2012 Feb 1;40(1):43-66. Faheem A. ‘It’s been quite a poor show’–exploring whether practitioners working for Improving Access to Psychological Therapies (IAPT) services are culturally competent to deal with the needs of Black, Asian and Minority Ethnic (BAME) communities. The Cognitive Behaviour Therapist. 2023 Jan;16:e6. Alhomaizi D, Alsaidi S, Moalie A, Muradwij N, Borba CP, Lincoln AK. An exploration of the help-seeking behaviors of Arab-Muslims in the US: A socio-ecological approach. Journal of Muslim Mental Health. 2018 Aug 2;12(1). Lantern Initiative CIC, Civil Society Counsulting CIC, Shaikh, A. Chowdhury, R., (2021) Muslim Mental Health Matters: “Understanding Barriers to accessing Mental Health Support Services and Gaps in Provision for the UK Muslim Community.” alHarbi H, Farrand P, Laidlaw K. Understanding the beliefs and attitudes towards mental health problems held by Muslim communities and acceptability of Cognitive Behavioral Therapy as a treatment: systematic review and thematic synthesis. Discover Mental Health. 2023 Nov 23;3(1):26. Gaw A. Culture, ethnicity, and mental illness. (No Title). 1993 Jan. Gunson D, Nuttall L, Akhtar S, Khan A, Avian G, Thomas L. Spiritual beliefs and mental health: a study of Muslim women in Glasgow. UWS-Oxfam Partnership: Collaborative Research Reports Series. 2019 Jan 15;4:1-32. Sheikh S, Furnham A. A cross-cultural study of mental health beliefs and attitudes towards seeking professional help. Social psychiatry and psychiatric epidemiology. 2000 Aug;35:326-34. Ahmed AA, Ali M. In search of sylhet—The fultoli tradition in britain. Religions. 2019 Oct 12;10(10):572. Alexander C, Firoz S, Rashid N. The Bengali Diaspora in Britain: A review of the literature. London, UK. 2010. Population of England and Wales, 2022, Available from: https://www.ethnicity-facts-figures.service.go.uk/housing Kirkbride JB, Barker D, Cowden F, Stamps R, Yang M, Jones PB, Coid JW. Psychoses, ethnicity and socio-economic status. The British Journal of Psychiatry. 2008 Jul;193(1):18-24. Nazroo J, Iley K. Ethnicity, race and mental disorder in the UK. The SAGE Handbook of Mental Health and Illness. London: Sage Publications. 2011:80-102. Detentions Under the Mental Health Act, 2024, Available from: https://www.ethnicity-facts-figures.service.gov.uk/health/mental-health/detentions-under-the-mental-health-act/latest/). Health Matters: reducing Health Inequalities in Mental Illness, Public Health England (2018). https://www.gov.uk/government/publications/health-matters-reducing-health-inequalities-in-mental-illness/health-matters-reducing-health-inequalities-in-mental-illness Bhui K, King M, Dein S, O'Connor W. Ethnicity and religious coping with mental distress. Journal of mental health. 2008 Jan 1;17(2):141-51. Dein S, Alexander M, Napier AD. Jinn, psychiatry and contested notions of misfortune among east London Bangladeshis. Transcultural Psychiatry. 2008 Mar;45(1):31-55. Lawrence V, Murray J, Banerjee S, Turner S, Sangha K, Byng R, Bhugra D, Huxley P, Tylee A, Macdonald A. Concepts and causation of depression: A cross-cultural study of the beliefs of older adults. The Gerontologist. 2006 Feb 1;46(1):23-32. Callan A. Patients and agents: Mental illness, modernity and Islam in Sylhet, Bangladesh. Berghahn Books; 2012 Aug 1. Wilce JM. Eloquence in trouble: The poetics and politics of complaint in rural Bangladesh. Oxford University Press; 2003 Oct 16. Samuel G. Islam and the family in Bangladesh and the UK: The background to our study. Culture and Religion. 2012 Jun 1;13(2):141-58. Bose R. Psychiatry and the popular conception of possession among the Bangladeshis in London. International Journal of Social Psychiatry. 1997 Mar;43(1):1-5. Khalifa N, Hardie T, Latif S, Jamil I, Walker DM. Beliefs about Jinn, black magic and the evil eye among Muslims: age, gender and first language influences. International Journal of Culture and Mental Health. 2011 Jun 1;4(1):68-77. Gardner K. Age, narrative and migration: The life course and life histories of Bengali elders in London. Routledge; 2020 Dec 7. Eade J, Garbin D. Changing narratives of violence, struggle and resistance: Bangladeshis and the competition for resources in the global city. Oxford Development Studies. 2002 Jun 1;30(2):137-49. Additional Declarations No competing interests reported. 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The study of the impact of migration on health has gained attraction in recent years despite the research on mental health of migrants is relatively scarce\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. In many Western countries, migrants are more vulnerable to mental illnesses than host communities and have varying rates of psychiatric service use owing to the significant differential in economic status, linguistic challenges, and/or sociocultural issues\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. In the UK, migrant groups represent a growing percentage of the overall population where they have a higher rate of first admission for schizophrenia than the overall population\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Individuals from ethnic minority communities are more prone to being sectioned under the Mental Health Act than their white counterpart\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. This study focuses on Bangladeshi migrants who came to the UK voluntarily for economic or family reasons and their descendants who continues to live in the UK. Most of the study of Bangladeshi migrants are in East London based. There is no prior study in Eastbourne, UK where a large proportion of Bangladeshi migrants live. This study will understand Eastbourne Bangladeshi migrants\u0026rsquo; mental health seeking behaviour through the lenses of medical pluralism.\u003c/p\u003e\n\u003ch3\u003eMedical Pluralism and Religious Healing\u003c/h3\u003e\n\u003cp\u003eMedical pluralism defines circumstances in which individuals can select from a wide variety of treatment options or selection is made for them from existing therapeutic alternatives in the event of mental incapacity to take decisions. A large proportion of mental health visits do not take place with biomedical physicians and related specialists, but with traditional healers, herbalists, religious figures and so on\u003csup\u003e6\u003c/sup\u003e. Fernando\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e has argued that in Britain psychiatric services are predominantly biomedical and the diagnosis of psychosis and treatment provided to ethnic minority groups is often perceived as a way of control. Several authors have discussed the issue of institutional racism and cultural misunderstandings in the British mental health service in relation to high incidence of schizophrenia among Black communities resulting in stress and feeling powerlessness\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOn this background, migrant communities might find themselves uncomfortable with seeking help from the existing biomedical services and opt for multiple religious healing options. As western biomedical categorizations of mental illnesses are different from that of the local ethnic groups\u0026rsquo;, treatments are also failing to meet their expectations\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Moreover, the biomedical system assumes local understanding as \u0026lsquo;folk\u0026rsquo; and \u0026lsquo;personalistic\u0026rsquo;\u003csup\u003e9\u003c/sup\u003e. In Western cultures, mental disorders are mostly described in biological or psychological terms, whereas the interpretation often includes cultural or spiritual traditions in non-Western communities. Kleinman\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e argued that it is necessary to study the explanatory illness model to better understand patients and their family members. An overall lack of understanding of the patient\u0026rsquo;s religion and cultural beliefs among health care professionals could negatively affect diagnostic efficacy and may lead to inadequate management\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Thus, understanding how patients' explanatory models affect mental health practice and could influence treatment outcomes and satisfaction is important\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIt is evident in different literatures \u003csup\u003e4,13\u0026ndash;14,15\u0026minus; 21\u003c/sup\u003e that cultural values, religious beliefs, stigma, shame, fear, communication play an important role for the presentation of mental illness and the barriers to approach psychiatric service and resort for pluralistic coping strategy. Among the Muslim community, religious beliefs, and supernatural interpretations of mental health impact individuals to seek help and cope in different ways, yet these issues might not always be recognized or incorporated into therapeutic practices\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. According to Alhomaizi and his colleagues\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e, Islamic religious beliefs can either support or obstruct the pursuit of help among Arabic-American individuals. Those experiencing mental health issues might be criticized for having insufficient faith and advised to pray to enhance their relationship with God. On the special issue on mental health, religion, and culture, Dein\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e has focused on the psychological effect of religious healing and found that religious healing is the most common coping strategy for mental illness among the migrant communities in the UK that they practice with biomedical treatment. Furthermore, a survey of Muslims in the UK by the Lantern Initiative found that 84% of respondents expressed the desire for faith informed counselling service\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. When accessing NHS talking therapies, Muslim experiences a lower recovery rate compared with Christian and Jewes\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. According to studies conducted among Muslims in Europe, mental illness is widely believed to be brought on by jinn spirits. As a result, many Muslims resort to religious healers who recite verses from the Qur'an in an effort to drive these evil spirits away\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Dein and Illaiee\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e have also found that jinn are frequently mentioned as the cause of insanity and epilepsy. However, Gunson and his colleagues\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e studied among the Glasgow Muslim women and found that their strong belief on spirit possession hindrance seeking treatment from medical services. In a similar vein, Linney and his colleagues\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e found the preference of religious coping among the Somali migrants and travelling to different holy places for their treatment of mental illness. Demographic data on South Asian migrants in the UK suggests less mental health service utilization among them as compared to other ethnic groups and the general population\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Many studies\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e among different South Asian Muslim communities observed that they are strongly belief about the evil effects of being possessed by spirits, and as a result, their preferred place to seek treatment from Qur\u0026rsquo;anic healers from different sources by travelling many places.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eBangladeshi Migrants in the UK and Religious Healing Practices\u003c/h2\u003e\u003cp\u003eBangladeshis are the third largest and one of the UK's earliest South Asian ethnic minorities, constituting 1.15% of the population\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Approximately 95% are from Sylhet district in Bangladesh and are predominantly patrilineal. The majority (65%) are living in East London, while the rest live all over England\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. They experience strikingly high poverty rates (65% below the poverty line) and educational disparities (49% of women, 40% of men lack qualifications)\u003csup\u003e30\u003c/sup\u003e and 42% lacked regular income and 22.5% residing overcrowded houses in contrast to the lowest rate of 1.7% observed in white British households\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Kirkbride\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e found first episode psychosis elevated risk was 2.1 (incidence rate ratios [IRR] 1.4\u0026ndash;3.1) among the Bangladeshi communities in Tower Hamlets, London. Nazroo and Illey\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e reported that 1.6% of Bangladeshi males and 2.2% of females face CMD (Common Mental Disorder) in a UK community survey. As it is mentioned earlier that ethnic minorities are more likely to be detained under the Mental Health Act than white counterparts, but it is also reported that detentions among Bangladeshi migrants is significantly low, and the rates are reducing each year\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Bangladeshi migrants are least likely to use mental health services (4550 adults per 100,00 population and lowest number of referrals to the service of talking therapy (10,468) compared to white British (1,157,582)\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Bhui and his colleagues\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e conducted a study among six ethnic groups in Britain and argued that religious exercises among Bangladeshis were important for their coping practice compared to other ethnic groups and White British respondents. Effective coping methods were praying, using amulets, talking to God, and having faith in God. Despite addressing Bangladeshi migrant women\u0026rsquo;s mental health seeking behaviour, a recent literature focused on the British Bangladeshi men and their limited uses of formal psychiatric service due to stigma, cultural barrier and linked Islam with mental wellbeing. It is also reported that Bangladeshi migrant men feel comfort, solace in religion practices \u003cem\u003enamaaz\u003c/em\u003e or (salah), Quran recitation led to improve their wellbeing\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Littlewood and Dein\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e found that Bangladeshi psychiatric patients in London had confidence in psychiatrists whilst also using healing \u003cem\u003etabij\u003c/em\u003e (amulets). Dein and colleagues\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e described the dissatisfaction with GP treatment in their study in Tower Hamlet, London, and the preference for long-distance travelling to find suitable \u003cem\u003eHakim\u003c/em\u003e (religious healers), having Zamzam water, Quranic recitation, prescription of \u003cem\u003etabij\u003c/em\u003e, \u003cem\u003efoo\u003c/em\u003e (blowing over the patient) is the possible treatment seeking behaviour for mental illness. In addition, they also elaborated a story of a mute women in Manchester taken by her parents to a mullah in Stephany Green and visiting different faith healers in different places within the UK for her treatment. Given these contexts, this study explores how first-generation Muslim Bangladeshi migrants interact with existing mental health facilities and how they navigate alternative therapeutic coping based on their religious ideologies.\u003c/p\u003e\u003c/div\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eSelecting Participants\u003c/h2\u003e\u003cp\u003eThe process of respondent selection started before Covid-19 and interviews were conducted during the pandemic period around July 2020 to September 2020. To conduct this study, the snowball sampling method was used to facilitate in-depth and semi-structured qualitative interviews as the researcher was unfamiliar with Eastbourne and the UK. The snowball sampling method assisted the researcher in gaining trust as the researcher was introduced to participants by community members. The researcher was acquainted with two key informants who provided assistance during the initial period of settling in the UK at Eastbourne. Two follow-up interviews were conducted with two key informants. Prior to the pandemic, meetings were arranged at the informants' residences or the researcher's home. The informants' referrals facilitated the process of earning the trust of other research candidates who consented to participate. Through these connections, access was obtained to the mobile numbers of some Bangladeshi families for communication purposes. During the pandemic, contact was maintained via mobile calls or text messages. Eight families were contacted who expressed willingness to share their perceptions of mental illness and health-seeking behaviour. From these groups, three first-generation and three child migrants were purposively selected for in-depth online interviews. Data were gathered from individuals who migrated either as spouses, as an employer, as a student or as children. Child migrants were included as part of the first generation to facilitate a more accurate comparison between those who received education in the UK and those who did not or those who raised in the UK and those who did not.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection and Analysis\u003c/h3\u003e\n\u003cp\u003eData were collected through in-depth interview in Eastbourne at Hyde Park(pseudonym) Area where many Bangladeshi families are living. Interviews were conducted mostly using telephone interview, sometimes using the Facebook messenger video call and What\u0026rsquo;s App video call. With informants\u0026rsquo; permission, interviews were recorded using a digital audio recorder. All interviews were conducted in Bengali Sylheti dialect or in English and mostly lasted between 20 to 40 minutes. The longest interview took one and half hours. These interviews allowed to engage in deep conversation with informants. The researcher contacted potential participants to inquire about their availability for interviews. A structured interview guide was utilised to ensure a systematic approach. Each interview typically commenced with a series of questions pertaining to participants' knowledge and understanding of mental illness, treatment modalities experienced during periods of mental illness, satisfaction with the UK health system, and religious perspectives on mental health treatment. Follow-up questions were tailored according to individual informant responses. Interview data were subsequently coded and analysed manually.\u003c/p\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cb\u003eEthics\u003c/b\u003e:\u003c/div\u003e\u003cp\u003e This study adhered to the guidelines and research ethics framework provided by the Research Ethics Committee of the School of Global Studies, University of Sussex. The research proposal was submitted to the Social Science and Arts Research Committee of Sussex for ethical approval ER/FH260/2. Upon receiving ethical approval, the research commenced. The names of interlocutors were kept anonymous in the writing to ensure anonymity and present the overall picture of the research in a sensitive manner. Prior to conducting the interviews, a consent form and an information sheet were sent to the participants. The fieldwork began after obtaining proper consent. It is noteworthy that written consent alone may not be sufficient for building trust and developing a personal connection with participants. Engaging in regular telephone communications and informal conversations prior to interviews with informants facilitated the acquisition of in-depth data. The audio recordings are currently retained for future research purposes. They are stored on a password-protected personal computer with USB backup kept in a secure location at the researcher's residence. The decision was made not to upload the recordings to an online platform such as iCloud due to the perceived high privacy risks associated with such platforms.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eEastbourne Bangladeshi migrants, religious healing and travelling medicine\u003c/h2\u003e\u003cp\u003eBangladeshi migrants arrived in Eastbourne in 1965 seeking employment. Nazim is 75 years old, a retired person from restaurant job, completed his GCSE after coming to the UK, one of the earliest residents in Eastbourne, reported that his father relocated to Eastbourne from London and purchased a house in the 1970s. Currently, approximately 100 to 150 Bangladeshi families reside in Eastbourne, with the majority originating from the Sylhet district. There is one Bangladeshi association named \"Sunar Bangla Association\", and there were two councillors of Bangladeshi origin in Eastbourne Borough Council. The majority of first-generation and child migrant males in Eastbourne are restaurant proprietors, co-owners of restaurants, or grocery shop owners. Some are employed as taxi drivers. The first-generation and child migrant females are predominantly homemakers, particularly those with lower levels of education. Some are employed as food delivery drivers or care workers. When questioned about mental illness, all respondents associated feelings of stigma with the subject. For them, having a mental illness is considered a social stigma and a matter not to be discussed openly. Romija is a homemaker and mother of three children. She immigrated to the UK following her marriage. When asked about her perceptions of mental illness, she recounted another individual's narrative without initially disclosing her own experience of mental illness.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eAmr eta hoice na. Eastbourne e mathat dukko paise emon ekjon ase. Taine konsomoy vala feel korena. Taine bujena kon jaigar moddhe kon kotha allowed. Taine depression er problem achena ni. Taine majhe modde matat ghuri pori jai. Amr shamne eta bohubar hoice. Hafiza mota hoitese gum na howa ar depression er karone\u003c/em\u003e\u003c/p\u003e\u003cp\u003eI do not have such kind of illness. I know one lady in Eastbourne who has got mental illness (mathat dush or mathat dukko). She (Hafiza) does not feel okay. She feels sleepy all the time. She does not understand what to say (taine bujhuen na kon jaigar moddhe kon kotha allowed) on different occasions. She (Hafiza) has a depression problem. She sometimes got fainting attacks and it happened on many occasions in front of me. Hafiza is getting fat because of her depression and sleeping excessively.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFollowing the recounting of Hafiza's narrative, Romija inquired about potential interventions and pharmacological treatments for anger and obstinacy, presuming that I might be able to offer recommendations. This initial reluctance to discuss mental health issues was observed among my interlocutors during the preliminary phase of my interviews.\u003c/p\u003e\u003cp\u003eIn terms of the question about \u003cem\u003ejinn\u003c/em\u003e possession and mental illness, one of the interlocutors Hasina elucidated that \u003cem\u003ejinn\u003c/em\u003e possession can happen if someone does not follow religious practices such as praying, fasting, and reciting Quran. They perceived that for the \u003cem\u003ejinn\u003c/em\u003e possession or sudden behavioural change, a \u003cem\u003emullah\u003c/em\u003e or a religious healer has a power to treat it. \u003cem\u003eMullah\u003c/em\u003e can treat \u003cem\u003ejinn\u003c/em\u003e possession what they termed as \u003cem\u003eupri.\u003c/em\u003e They believed there are two types of disease one is \u003cem\u003edactory\u003c/em\u003e (biomedical\u003cem\u003e)\u003c/em\u003e disease and the other is \u003cem\u003eupri.\u003c/em\u003e One has to go to a doctor when they have \u003cem\u003edactory\u003c/em\u003e disease like diabetes blood pressure and cholesterol. But \u003cem\u003eupri\u003c/em\u003e, which is linked to \u003cem\u003eJinn\u003c/em\u003e inflection, must be treated by a \u003cem\u003emullah\u003c/em\u003e or a religious scholar. According to Romija,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eEta luv hoito na jodi keo daktor dekhat jai tar upri problem nia. Mullah shahed etar jonnw bala. Diabetes, pressure, cancer hoile daktor decani vala.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThere will be no benefit if someone goes to a doctor with an \u003cem\u003eupri\u003c/em\u003e problem. Those who have an \u003cem\u003eupri\u003c/em\u003e problem need to go to a mullah for the treatment and those who have dactory problem like diabetics, bloods pressure, cancer they need to go to see a biomedical doctor.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhen questioned about their belief in \u003cem\u003etabij\u003c/em\u003e (an amulet containing Islamic verses) and \u003cem\u003ePanipora\u003c/em\u003e (a form of treatment administered by a \u003cem\u003emullah\u003c/em\u003e, involving the recitation of an Islamic verse over water, which is then considered blessed) for the treatment of anxiety and depression, all interlocutors expressed belief in \u003cem\u003epanipora\u003c/em\u003e and denied the use of \u003cem\u003etabij\u003c/em\u003e. They reported observing its use by grandparents, parents, or relatives while in Bangladesh. Although the interlocutors expressed scepticism regarding \u003cem\u003etabij\u003c/em\u003e, it was observed that many individuals wore copper bracelets to alleviate pain, headaches, and various other ailments during initial meetings prior to the commencement of the Covid-19 lockdown.\u003c/p\u003e\u003cp\u003eRegarding the question about NHS mental health service, interlocutors Hasina, who came in the UK when she was twelve years old and started her secondary school. She was suffering from headache for the long time and had her check-ups on different occasions. But GP did not find anything and then prescribed her anxiolytics. She was not satisfied with that. She said that she did not get chance to share his experience properly. GP did not want to listen to her. She also thought that only NHS mental health service cannot solve her problems. According to her,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThis is my own problem; I have to solve it by myself. They (GP service) did not want to understand me. They only wanted to listen to my life history. Sometimes I feel that instead of going to seek help from GP, seeking help from Allah by praying nofol namaz (optional prayer which is not mandatory for Muslims) helps me a lot.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eShimul was a restaurant owner who came to the UK as a student. He got his UK passport after marrying a British passport holder woman. He was suffering from doctor phobia few years back due to his misdiagnosis of kidney disease. Then he went to GP for that. The general physician (GP) suggested him to go to Health in Mind Service. He went there and noticed no changes on him. According to him,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI think Bangladeshi medicine and Bangladeshi treatment are better than UK health system especially for Phobia what happened to me few years before. I think doctor did not understand what I wanted to say. Whatever, according to their recommendation, I went three times to GP Health in Mind counselling service for my Phobia. It was not effective. I did not feel any change in myself after taking it. For me, it is my own problem. I need to solve it by my own. I took so many medicines for that, but it did not work. At last, I ordered medicine from Bangladesh. After taking those, I felt better. I also do not feel comfortable to see a doctor here, especially GP are not good in the UK. I cannot understand what doctor says. Doctor does not want to listen to me and does not give any medicine. I think UK health system is good for the treatment of blood pressure, diabetics, cancer, kidney and so many physical problems not for the illness like my problem.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eUpon question of the resort for religious healers, one of the interlocutors (Usman), who served as an Imam (religious priest) in a mosque, asserted that he utilised \u003cem\u003epanipora\u003c/em\u003e for his and his family members' illnesses, obtained from a mullah in Eastbourne. He typically travels to London for this purpose, as the mullah no longer resides in Eastbourne. He also reported experiencing discomfort due to his inability to travel to London to procure \u003cem\u003epanipora\u003c/em\u003e for his family during the lockdown period.\u003c/p\u003e\u003cp\u003eAll the study respondents believed staying pure and being obedient to God by performing religious activities can save them from being ill or give them early recovery, help them to lead a stress-free life. Performing \u003cem\u003eHajj\u003c/em\u003e (an annual pilgrimage to Mecca undertaken each year), \u003cem\u003eUmrah Hajj\u003c/em\u003e (a pilgrimage that can be completed any time of the year) and drinking \u003cem\u003eZamzam\u003c/em\u003e water (holy drinking water found in Mecca during pilgrimage) were all possible means by which Bangladeshi migrants in Eastbourne tried to stay closer to God to remain free from illnesses. The first generation and child migrants both are deeply involved with performing \u003cem\u003eHajj\u003c/em\u003e and \u003cem\u003eUmrah Hajj\u003c/em\u003e. Many Sylheti migrant families in Eastbourne went to Saudi Arabia several times to perform \u003cem\u003eHajj\u003c/em\u003e and \u003cem\u003eUmrah Hajj\u003c/em\u003e. They saved and invested a lot of money for this. When any of their relatives or any familiar person come from Saudi Arabia after performing \u003cem\u003eHajj or Umrah Hajj\u003c/em\u003e, they ask them to bring \u003cem\u003eZamzam water\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eNazim came in the UK when he was twelve years old. He mostly concerned about performing \u003cem\u003eUmrah Hajj.\u003c/em\u003e He unfortunately had a failed attempt of kidney transplant which made him dialysis dependent for life. That is why he had to retire early from his restaurant business. He stayed depressed all the time due to his illness. Along with his kidney failure medicine, he had to take antidepressant. According to him,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI used to love travelling. It gave me relief from my monotonous life. Now I cannot go anywhere due to my illness. I know Allah is everywhere. Only Allah can save me. That is why I prefer to go for performing Umrah Hajj although I have travel restrictions. I think it is my high time to seek help from Allah for my diseases and many issues. Allah can do anything, so we always need to seek help from Allah when we have difficulties. I think performing Umrah Hajj and drinking Zamzam water are the main source of my mental satisfaction.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHowever, People were seeking help from Allah by reciting Islamic verses (\u003cem\u003edua\u003c/em\u003e). After reciting these, they practiced \u003cem\u003efoo\u003c/em\u003e, a ritual blowing of air over the body and head and feel stress free. Romija, recited \u003cem\u003edua\u003c/em\u003e when she went outside, when her husband went for work or when her children had exams and health difficulties. She also tried to practice foo by reciting Islamic verse while drinking \u003cem\u003ezamzam\u003c/em\u003e water. She kept water in her refrigerator all the time so that she can use it whenever needed. According to her,\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe drink Zamzam water by reciting Islamic verse and blow over it as we feel that it is a kind of medicine for our illnesses. After drinking it we feel really stress free.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn addition, all the study interlocutors preferred praying, fasting during their anxiety or depression time. They also thought that sending their children for Quran teaching also helped them to remove their worry or anxiety. Aleya, who came in the UK when she was thirteen years old and started her secondary school in the UK. She was a healthcare assistant in NHS. She preferred to send her children for Quran learning. She inspired them to pray every day five times and fast. She used to send her children to Eastbourne Mosque. She kept an online tutor for her children because of Covid-19. She stated that\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHmmm.... Whenever I feel pain in my mind, I recite Quran to feel refresh. I pray five times. I think reciting Quran also helps me a lot. I also think Quran learning is necessary for all the Muslims. Not only that I think it is one of the best ways to acquire knowledge about Islam and people can connect themselves with God this way... It is my responsibility to send my child for Quran learning so when they will grow up, they can have some Islamic knowledge at least as you know this western culture is different from us. If they learn Quran and they have got some knowledge about Islam, then they also won\u0026rsquo;t be fall in a big trouble in their life, they will be mentally strong and could find a right way of their life in future......\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion and Conclusion","content":"\u003cp\u003eThis study draws on qualitative online in-depth interview with three first generation and three child migrants from the Bangladeshi migrant\u0026rsquo;s community in Eastbourne. Its focus was on how the first-generation migrants explain their aetiology of mental illness and how they navigate their treatment. The aetiology of first-generation Bangladeshi migrants in Eastbourne is similar to Littlewood and Dein\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e who stated that the aetiology of mental illness is dependent on Bangladeshi migrants\u0026rsquo; own understanding related to the biomedical diagnosis as well as their subjective day to day understandings. Some of their explanations are psychological, some are somatic, or some are religious.\u003c/p\u003e\u003cp\u003eThis study has found that most of the first-generation Bangladeshi migrants cannot differentiate their common mental disorder with their physical illness. They feel discomfort, shy to talk about their mental illness. In addition, their explanation of psychosis or madness is different from the explanations of common mental disorders. Their explanation of common mental disorder is only related to \u0026ldquo;\u003cem\u003epereshani\u003c/em\u003e\u0026rdquo; (worry, anxiety). Lawrence and colleagues\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e explored conceptualisations of depression among older adults using a multicultural approach where depression was described as \u0026lsquo;low mood\u0026rsquo; and \u0026lsquo;hopelessness\u0026rsquo; by White British and Black Caribbean patients whilst South Asian and Black Caribbean people commonly explained depression as \u0026lsquo;worry\u0026rsquo;. In other words, sometimes most of the first-generation who came as a spouse or as an employer in Eastbourne confused their explanation of common mental disorder with \u003cem\u003ematha batha\u003c/em\u003e (\u0026ldquo;headache\u0026rdquo;) or sleeping problem (\u003cem\u003eghum hoi na\u003c/em\u003e) and many more times they cannot understand that they are suffering from anxiety or depression specially who are female. Similar to previous studies who also revealed that the social understanding of depression is more relevant as there is a low rate of common mental disorder patient is found among the female Bangladeshi migrants in the UK\u003csup\u003e38\u003c/sup\u003e. In this study, the majority of respondents demonstrated limited understanding of their experiences with anxiety or depression, or in some instances, attempted to disregard these conditions. They often neglected these issues until the symptoms worsened, a phenomenon Linney and colleagues\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e observed among Somali migrants in the UK. Furthermore, analogous to Alam\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e findings, my respondents exhibited reluctance to disclose their experiences to others due to feelings of shame and stigma, as evidenced in Romija's account. Similarly, child migrants who grew up in the UK also are not aware the symptoms of common mental disorders like depression or anxiety until the symptoms get severe.\u003c/p\u003e\u003cp\u003eHowever, both first-generation migrants who did not receive education in the UK and child migrants who were educated in the UK shared similar beliefs in \u003cem\u003ejinn\u003c/em\u003e, which are common in Muslim faith. Most of the interlocutors who have limited education and practicing Muslims, they associated psychosis with \u003cem\u003ejinn\u003c/em\u003e possession or \u003cem\u003eupri\u003c/em\u003e. They cannot differentiate mental illness and \u003cem\u003ejinn\u003c/em\u003e possession. Especially they perceived that \u003cem\u003ejinn\u003c/em\u003e possession is related to good or bad people and \u003cem\u003eJinn\u003c/em\u003e may affect mostly those who are bad. They also explained that after a \u003cem\u003eJinn\u003c/em\u003e infliction people cannot behave normally, a similar belief consistent among migrant Muslims Like Arabic-Americans\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Within these communities, mental illness is widely attributed to \u003cem\u003ejinn\u003c/em\u003e spirits. Consequently, many Muslims seek assistance from religious healers who recite verses from the Qur'an in an attempt to exorcise these perceived evil spirits\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMoreover, this study is based on those who came as a spouse, as an employer or as a student and those who came as a child migrant and their mental health seeking pattern. regarding their perception of GP service and NHS mental health treatment this study found no difference between those who came to the UK as grown up from Bangladesh, and those who came as a child from Bangladesh and raised in the UK. Both were dissatisfied and reluctant to seek treatment from the existing health services. However, first generation migrants who are not born and not grown up in the UK are especially dissatisfied with \u0026ldquo;Health in Mind\u0026rdquo; service which is evident in Shimul\u0026rsquo;s case. They showed their trust on Bangladeshi medicine rather than UK medicine resulting to bring medicine from Bangladesh indicated travelling medicine from their home country. On the other hand, child migrants who are raised in the UK were also dissatisfied with UK mental health service. They thought that only NHS mental health service cannot solve their problems of anxiety and depression. It is noted that all the study interlocutors who were not grown up in the UK and elderly child migrants were prescribed by different anxiolytics. Still, they sought help from different sources from the plural medical landscape which suited them best. Research findings also indicated that religious leaders, including mullahs or \u003cem\u003emeasabs\u003c/em\u003e, played a significant role in the treatment of worry, \u003cem\u003epereshani\u003c/em\u003e, or \u003cem\u003emathat dukkho\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eBoth groups believe \u003cem\u003epanipora or holy water\u003c/em\u003e from a religious leader is the treatment of common mental disorders such as worries, anxiety and sleepiness. They bring \u003cem\u003epanipora\u003c/em\u003e either from London or elsewhere in the UK. All the interlocutors go to holy places like Makkah to perform \u003cem\u003eHajj\u003c/em\u003e or \u003cem\u003eUmrah Hajj\u003c/em\u003e and drink \u003cem\u003eZamzam\u003c/em\u003e water for their mental satisfaction. They request someone to bring Zamzam water from Saudi Arabia when any of their relatives or friends go to perform their \u003cem\u003eHajj\u003c/em\u003e or \u003cem\u003eUmrah Hajj\u003c/em\u003e and drink it for any kind of \u003cem\u003e\u0026ldquo;pereshani\u0026rdquo;\u003c/em\u003e which also indicated seeking treatment for mental dissatisfaction by travelling holy places or bringing suitable medicines like holy water from holy places or elsewhere within the UK. They do fast, they try to pray more than five times recite Quran if they feel \u0026lsquo;worry\u0026rsquo; or \u0026lsquo;pereshani\u0026rsquo; which are all possible means of seeking help from Allah and direct connection to God and having stress free life for them, which was also evident in Littlewood and Dein\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e and Dein and his colleagues\u0026rsquo; studies\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e studies. Unlike the above following author\u0026rsquo;s study, current study population did not believe in use of \u003cem\u003etabij\u003c/em\u003e as means of remedy for mental health issue what the study interlocutors interpreted that their parents used to bring it from Bangladesh a few years ago.\u003c/p\u003e\u003cp\u003eIn response to their mistrust in the UK health system and the availability of alternative sources of treatment, Bangladeshi migrants in the UK practice a complex medical pluralism as their health-seeking pattern to deal with their mental health issues. Historically Bangladeshi people believe in traditional and faith healing and seeking help from biomedical as well as a traditional system simultaneously in the event of mental illnesses\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Bangladeshi migrant families maintain a very close transnational relationship with their loved ones back home through financial support or marriage\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. As a result, they carry their beliefs and tradition across Britain, from Sylhet\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. In addition, religious figures and faith healers remain a significant source of care for people with mental wellbeing problems in Islamic societies\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. Since Bangladeshi Islam significantly relates to Sufiism and lead by Islamic priests called \u003cem\u003ePirs, Pirs\u003c/em\u003e play a major role in certain part of Bangladeshi people who are suffering from mental illness because of their ability to do \u0026lsquo;miracles\u0026rsquo;. Therefore, they are often appealed to during sickness. This kind of Islamic priests are prominent figures on the village scene in Bangladesh and sometimes this kind of sanctuary are numerous than the mosque. Female seclusion, traditional religious rituals, obtaining religious and/or secular education is commonly observed among their inhabitants. Gardner \u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e described how religious myths are constructed by local people about \u003cem\u003epirs\u003c/em\u003e and their miracles. Migration has not changed their instinctive inclination towards spiritual healing although Eade and Garbin\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e argued that Bangladeshi community in the UK are going through Islamic revivalism under the auspice of mosques. As the study interlocutors were Muslims and have different options available, they prefer to practice religious healing along with biomedical practices. Holding the same consensus with Dein and colleagues\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e study, this research has demonstrated that migrant communities from Sylhet whether they are inhabitants in East London or Eastbourne in the UK have maintained their transnational characters and have reinforced traditional beliefs related to causation of illnesses. It is also argued with Dein and his colleagues\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e that Sufism in Bengal led to the fusion of \u003cem\u003esunni\u003c/em\u003e (orthodox) Islam with Bangladeshi indigenous culture creating a syncretistic Islam that is prone to the reverence of saints (\u003cem\u003epirs\u003c/em\u003e) and faith in spiritual healers. The traditional appeal of miracle healers did not disappear after migration and is widespread among Bangladeshi first-generation migrants in the UK in whether they are grown up in the UK or not.\u003c/p\u003e\u003cp\u003eThis study aimed to provide knowledge about mental illness and health-seeking behaviour among the first-generation Bangladeshi migrants in Eastbourne. As most of the research is based on East London, this study has added extra knowledge about Bangladeshi migrants in the UK. As this study has explained the two-way travelling pattern of Bangladeshi migrants. In one hand, their beliefs and values are travelling from Bangladesh to UK and on the other hand, they are travelling to many places within the UK and to the holy places abroad for embracing the resort of religious healers for their mental illness. As the surge of migration escalating day by day, the exponential growth of first-generation migrants\u0026rsquo; is increasing all over the world. Thus, it is necessary to understand their understanding of mental health seeking pattern. Appreciating the concept of Close and his colleagues\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, who worked among the first-generation migrants in the UK, suggested that more research is needed for this group to understand their subjective experience to set up culturally specific measurement tools. Simkhada\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e suggested cross-cultural perspective would be priority in practice in mental health settings. In addition, understanding faith based or religious healing is also important. Therefore, to support the mental well-being of Bangladeshi migrants effectively, it is important to consider the cultural and religious contexts that influence their help-seeking behaviour. As migration continues to grow, mental health services must adapt by incorporating culturally and spiritually informed practices that truly reflect the lived experiences of these communities.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eLimitations:\u003c/h2\u003e\u003cp\u003eThis study acknowledges its limitations as an initial exploration into this research area, as the conclusions are based on a limited number of respondents. Future research may investigate the evolving perceptions of mental illness and health-seeking behaviour among subsequent generations of Bangladeshi minority groups in the UK, as well as examine the relationship between medical tourism and migrants' mental health, as indicated by this study. Furthermore, it is important to note that the data for this study was collected during the COVID-19 pandemic, which may have influenced the findings. Subsequent in-depth research will be necessary to gain insights into the health-seeking behaviour related to mental illness in the post-pandemic period.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cb\u003eAuthor Information\u003c/b\u003e\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003cp\u003eDepartment of Anthropology, Jagannath University, Dhaka.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003cp\u003e The author herself is designed the study, conducted the literature review, and analysed data, drafted and wrote the manuscript. The author also critically revised the content and approved the final version for submission.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eContributors\u003c/strong\u003e\u003cp\u003eCorrespondence to Farzana Habib\u003c/p\u003e\u003c/p\u003e\u003ch2\u003e\u003cb\u003eEthics Declarations\u003c/b\u003e\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent\u003c/strong\u003e\u003cp\u003e Ethical approval for this study was granted by the University of Sussex Social Science and Arts Cross-School Research Ethics Committee(C-REC). All procedures were conducted in accordance with institutional guidelines and relevant ethical regulations as outlined by the committee.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003cp\u003e All study participants participated voluntarily, and data were collected anonymously following written informed consent by maintaining confidentiality throughout the entire data collection process.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe author received no financial support for the research, authorship or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eF. H. wrote the whole manuscript, reviewed, edited, and conduct the whole research such as literature search, data collection, data analysis. This paper is based on her master's thesis.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e I would like to express my heartfelt gratitude to my second master\u0026rsquo;s supervisor, Dr Rebecca Prentice, at the University of Sussex, who has provided immense support and guidance throughout my fieldwork and final manuscript writing. This study would not have been possible without expressing my gratitude towards my study interlocutors. Many thanks to all who generously gave me their invaluable time and provided a space for me to talk to them, share their stories, and witness both their sorrows and joys. I would also like to convey my regards to my respected parents, beloved husband and lovely daughter. Their sacrifice, encouragement and unwavering support have been invaluable in the successful completion of this work.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThis manuscript is based on qualitative data and will be available upon requests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eButler M, Warfa N, Khatib Y, Bhui K. Migration and common mental disorder: an improvement in mental health over time?. International Review of Psychiatry. 2015 Jan 2;27(1):51-63.\u003c/li\u003e\n\u003cli\u003eClose C, Kouvonen A, Bosqui T, Patel K, O\u0026rsquo;Reilly D, Donnelly M. The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews. Globalization and health. 2016 Dec;12:1-3.\u003c/li\u003e\n\u003cli\u003ePatel K, Kouvonen A, Close C, V\u0026auml;\u0026auml;n\u0026auml;nen A, O\u0026rsquo;Reilly D, Donnelly M. What do register-based studies tell us about migrant mental health? 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Transcultural Psychiatry. 2008 Mar;45(1):31-55.\u003c/li\u003e\n\u003cli\u003eLawrence V, Murray J, Banerjee S, Turner S, Sangha K, Byng R, Bhugra D, Huxley P, Tylee A, Macdonald A. Concepts and causation of depression: A cross-cultural study of the beliefs of older adults. The Gerontologist. 2006 Feb 1;46(1):23-32.\u003c/li\u003e\n\u003cli\u003eCallan A. Patients and agents: Mental illness, modernity and Islam in Sylhet, Bangladesh. Berghahn Books; 2012 Aug 1.\u003c/li\u003e\n\u003cli\u003eWilce JM. Eloquence in trouble: The poetics and politics of complaint in rural Bangladesh. Oxford University Press; 2003 Oct 16.\u003c/li\u003e\n\u003cli\u003eSamuel G. Islam and the family in Bangladesh and the UK: The background to our study. Culture and Religion. 2012 Jun 1;13(2):141-58.\u003c/li\u003e\n\u003cli\u003eBose R. Psychiatry and the popular conception of possession among the Bangladeshis in London. International Journal of Social Psychiatry. 1997 Mar;43(1):1-5.\u003c/li\u003e\n\u003cli\u003eKhalifa N, Hardie T, Latif S, Jamil I, Walker DM. Beliefs about Jinn, black magic and the evil eye among Muslims: age, gender and first language influences. International Journal of Culture and Mental Health. 2011 Jun 1;4(1):68-77.\u003c/li\u003e\n\u003cli\u003eGardner K. Age, narrative and migration: The life course and life histories of Bengali elders in London. Routledge; 2020 Dec 7.\u003c/li\u003e\n\u003cli\u003eEade J, Garbin D. Changing narratives of violence, struggle and resistance: Bangladeshis and the competition for resources in the global city. Oxford Development Studies. 2002 Jun 1;30(2):137-49.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-social-science-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diss","sideBox":"Learn more about [Discover Social Science and Health](https://www.springer.com/journal/44155)","snPcode":"","submissionUrl":"","title":"Discover Social Science and Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Bangladeshi migrants, first-generation, mental health, transnational, religious healing, medical pluralism, travelling medicine","lastPublishedDoi":"10.21203/rs.3.rs-7652521/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7652521/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study focuses on the treatment-seeking patterns of first-generation Bangladeshi migrants for mental health conditions. Data were collected during the Covid-19 pandemic through online semi-structured interviews in Eastbourne, UK, as no previous research has been conducted in this location where a group of Bangladeshi migrants reside. Bangladeshi migrants voluntarily relocated to the UK for economic or familial reasons, and their descendants continue to reside in the country. Upon migration, they retain their beliefs and values, including their practice of medical pluralism. The most prevalent mental health treatment-seeking behaviours include religious healing practices, obtaining preferred medications from different suitable sources, and travelling to holy sites for remedies while simultaneously utilising UK psychiatric care. The findings of this article demonstrate that the mental health-seeking behaviour of Bangladeshi migrants is deeply rooted in religious or faith healing practices that are transported from Bangladesh to the UK through the lenses of medical pluralism resulting in a unique phenomenon of travelling medicine and travelling treatment.\u003c/p\u003e","manuscriptTitle":"Unveiling mental health seeking through transnational religious healing practices among Bangladeshi migrants in the UK","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-25 05:09:36","doi":"10.21203/rs.3.rs-7652521/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-14T11:05:21+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"70566500804236101047355990889109990957","date":"2025-11-14T10:06:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-12T15:02:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174270618181024753204272313987874932016","date":"2025-10-26T21:40:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-23T11:18:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222832856051096990395074123534049076144","date":"2025-10-16T15:34:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149472538113061101656890260755955972459","date":"2025-10-16T10:15:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-16T09:08:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-29T11:32:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-29T11:32:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Social Science and Health","date":"2025-09-22T22:53:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-social-science-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diss","sideBox":"Learn more about [Discover Social Science and Health](https://www.springer.com/journal/44155)","snPcode":"","submissionUrl":"","title":"Discover Social Science and Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"03ca6e27-cb91-4686-af16-ac7a4ae246ab","owner":[],"postedDate":"September 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T11:11:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-25 05:09:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7652521","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7652521","identity":"rs-7652521","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}