British government initiatives and the National Health Service (NHS) frameworks highlight the mental health needs of ethnic minority groups as a priority in the provision of appropriate mental health services in the United Kingdom (UK; Department of Health [DoH], 2005; Hamid & Furnham, 2013). Evidence suggests that Muslim communities are under-referred and under-represented in therapy services and have considerably poorer recovery rates compared to the general population (Mir, Ghani, Meer, & Hussain, 2019). Similar patterns were found for ethnic and religious minority groups nationally (Carter, 2017, cited in Mir et al. 2019), who also report higher levels of dissatisfaction with mental health services, and are more likely to disengage from mainstream mental health services possibly leading to deterioration in their mental health (Arday, 2018; Naz, Gregory, & Bahu, 2019).

Studies have found the following were barriers for ethnic minority individuals to accessing mental health services in Western countries: lack of culturally sensitive services (Arday, 2018; Grey, Sewell, Shapiro, & Ashraf, 2013; Mind 2013a); inadequate recognition of or response to the mental health needs of ethnic minority groups, cultural naivety (Arday, 2018; Grey et al., 2013; Memon et al., 2016; Mind, 2013a; Woods-Giscombe, Robinson, Carthon, Devane-Johnson, & Corbie-Smith, 2016); therapists not taking into account how therapy interacted with the client’s religion/spirituality (Mind, 2013a); language barriers and poor knowledge of mental health and available services (Abu-Ras, 2003; Arday, 2018; Memon et al., 2016); confidentiality concerns (Hamid & Furnham, 2013; Youseff & Deane, 2006); lack of trust, cultural mistrust of institutions, hierarchical relationships between service users and healthcare providers, and fears of disclosure due to concerns of being misunderstood or misinterpreted by healthcare providers (Arday, 2018; Keating & Robertson 2004); experiences of discrimination from healthcare providers (Arday, 2018; Keating & Robertson 2004; Memon et al., 2016); and shame and stigma associated with mental health problems (Alhomaizi et al., 2017; Arday, 2018; Pilkington, Msetfi, & Watson, 2011; Woods-Giscombe et al., 2016).

Shame and stigma associated with mental health problems were found to be a major barrier to accessing mental health services for those with Muslim Middle Eastern and North African (MENA) origins in Western countries (Abu-Ras, 2003; Alhomaizi et al., 2017; Aloud & Rathur, 2009; Youssef & Deane, 2006) and in the Middle East and North Africa (Gearing et al., 2013; Kadri et al., 2004; Rayan & Jaradat, 2016). Research has found that British Arabs and Muslims have a more negative attitude toward seeking professional psychological help compared to British Caucasians (Hamid & Furnham, 2013). Arabs (Abu-Ras, 2003; Al-Krenawi & Graham, 2011; Youssef & Deane, 2006) and Muslims (Pilkington et al., 2011) were found to have high levels of shame and stigma. This increased stigma was related to a lessened intention to accessing help or services for mental health difficulties, which Youssef and Deane (2006) found was attributed to strong cultural prohibitions on exposing any personal or family matters to outsiders.

Culture and faith are intrinsic to the formation of beliefs and ways of healing concerning mental health and illness (Fernando, 2010, 2014). This has been found to define acceptable responses to mental health problems and appropriate coping mechanisms, which influences minority groups accessing mental health services (e.g., Hamid & Furnham, 2013; Memon et al., 2016), and may directly lead to individuals preferring alternative means of coping.

Cultural traditions and religious rituals can provide a protective function, and in the context of collective trauma have been found to restore community resilience and reduce distress (Kirmayer et al., 2009; Somasundaram & Sivayokan, 2013; Wilson, 2007). This includes the use of traditional healing practices, such as the following examples in particular communities: ancient Tamil folk arts (Koothu; Somasundaram & Sivayokan, 2013), Opari (lament; Duran, 2011) in Sri Lanka, oral storytelling among Aboriginal communities (Kirmayer et al., 2009), and sweat lodge purification ceremonies among Native Americans (Wilson, 2007).

Religion and spirituality have been found to be associated with better mental health, improved wellbeing, recovery, and coping with stress (e.g., Bonelli & Koenig, 2013; Bonelli, Dew, Koenig, Rosmarin, & Vasegh 2012; Koenig, 2012; Webb, Charbonneau, McCann, & Gayle, 2011). It is important to distinguish between types of religious coping: ‘negative religious coping’ is when a person feels punished or abandoned by God or unsupported by their religious community, and this coping is associated with increased depression, anxiety, and psychological distress (e.g., Ano & Vasconcellas, 2005; Dein, 2018; Dew, Daniel, Goldston, & Koenig, 2008; Pargament, Tarakeshwar, Ellison, & Wulff, 2001). In comparison, ‘positive religious coping’ (e.g., benevolent religious appraisals) is the use of an internalized spiritual belief system to provide strategies that promote hope and resilience, and is associated with positive psychological adjustments to stress, reduced levels of depression, anxiety, distress, and improved mental health (Ano & Vasconcellas, 2005; Dein, 2018; Koenig et al., 2001; Pargament et al., 2001).

Religion is a central component of many people’s lives; it can provide a cognitive framework that individuals use to interpret and cope with traumatic events and reduce distress by engendering a sense of purpose and meaning (Hammad & Tribe, 2020a; Peres, Moreira-Almeida, Nasello, & Koenig, 2007). Meaning-making can be a component of trauma recovery and aids adaptive coping with traumatic events (Hammad & Tribe, 2020b; Weathers, Aiena, Blackwell, & Schulenberg, 2016). Indeed, religion has been found to foster resilience and aided coping with collective trauma and loss such as war and protracted political conflict in studies of Arabs and Muslims (e.g., Hammad & Tribe, 2020a; Nuwayhida, Zurayka, Yamouta & Cortas, 2011; Salem-Pickartz, 2009; Thabet, Dajani & Vostanis, 2013; Thabet, Elhelou & Vostanis, 2015). Spirituality and positive religious coping have been associated with reduced psychological distress among survivors of war, community violence, sexual violence, child abuse, domestic abuse (Bryant-Davis & Wong, 2013), and natural disasters (MHum, Bell, Pyles, & Runnels, 2011). Religion was found to be a protective factor for deleterious psychological effects, and a resource that aided coping, meaning-making, acceptance of loss and the grieving process for bereaved Malay Muslim parents whose children had been killed in a traumatic manner (Hussin, Guàrdia-Olmos, & Aho, 2018).

Culturally sensitive interventions can enhance engagement and retention of service users (Cardemil, Kim, Pinedo, & Miller, 2005). It can help address the multiple and complex interplay of barriers that ethnic minority and faith groups encounter in accessing psychological support. Culturally appropriate interventions for mental health are promoted by policy bodies internationally (National Institute for Health and Care Excellence [NICE], 2011; World Health Organization, 2013). The Inter-Agency Standing Committee (IASC, 2007) Guidelines on Mental Health and Psychosocial Support in Emergency Settings, developed by the United Nations (UN) and over 200 non-UN humanitarian organizations, encourage the use of culturally appropriate interventions and utilizing cultural and spiritual/faith-based resources that promote wellbeing and help people to cope and recover from disasters. The United Nations High Commissioner for Refugees (UNHCR) incorporated religion/spirituality into their assessments and interventions as part of their mental health and psychosocial support programme (Quosh, 2013). Yet, trauma-informed psychological interventions incorporating religion and indigenous forms of healing are few (e.g., Akinsulure-Smith et al., 2009; Stepakoff, 2007).

Incorporating religious beliefs into psychological therapy is associated with positive outcomes (Mir et al., 2015). A meta-analytic review of 31 studies demonstrated that spiritual or religious adapted psychotherapy can effectively benefit clients with psychological problems such as stress, anxiety, depression and eating disorders (Smith, Bartz, & Richards, 2007). Religious-based psychological interventions for depression were found to result in faster symptom improvement compared with non-religious based psychological interventions or control groups, in five out of eight randomized controlled trials (Koenig, 2009). Randomized controlled trials have found that religious or spiritually informed mental health interventions reduced anxiety more than a standard intervention or control condition (Koenig, 2012).

Meta-analyses show that culturally adapted psychological interventions are typically more effective in improving mental health outcomes (e.g., Benish, Quintana, & Wampold, 2011; Griner & Smith, 2006; Hall, Ibaraki, Huang, Marti, & Stice, 2016; Smith, Domenech Rodríguez, & Bernal, 2011; Soto, Smith, Griner, Domenech Rodríguez, & Bernal, 2018). Similarly systematic reviews found that culturally adapted psychological interventions were effective for ethnic minority groups (e.g., Bhui et al., 2015; van Loon et al., 2013). A recent meta-analytic review of 99 studies, comprising 13,813 ethnic minority participants, found that when interventions are specifically aligned with the client’s culture, there is greater client engagement in therapy and better mental health outcomes and that the efficacy of an intervention increased as more cultural adaptations were applied (Soto et al., 2018). Similar findings are noted in other meta-analyses (Griner & Smith, 2006; Smith et al., 2011); mental health interventions tailored to a specific ethnic/racial group were four times more effective than interventions targeting a variety of cultural groups (Griner & Smith, 2006).

Rathod and colleagues (2018) conducted a review of meta-analyses on culturally adapted mental health interventions. The review highlighted that there is value in cultural adaptations. However, the review highlighted various issues with the meta-analyses including a lack of methodological rigor, small sample sizes, mixed ethnic and diagnostic samples, limited description of the adaptation process, a lack of systematic approach to cultural adaptation, and incomplete data. Their review also highlighted a lack of standardized universally accepted frameworks for cultural adaptation of interventions and difficulties in identifying which component of cultural adaptation is effective and for which population.

A study in Malaysia on depression outcomes found that highly religious Malay Muslim clients affected by bereavement and grief who received psychotherapy with a religious perspective demonstrated faster and significant improvements which were maintained at six months follow-up in comparison to the control group who received secular psychotherapy (Azhar & Varma, 1995). The religious psychotherapy included discussions of religious issues specific to the clients (e.g., reading of verses from the Qur’an and Hadith, encouragement of prayers) in a collaborative cognitive behavioral approach. Other studies in Malaysia also found that religious-based psychotherapy rapidly improved symptoms of depression and generalized anxiety (Razali, Hasanah, Aminah, & Subramaniam, 1998; Razali, Aminah, & Khan, 2002). Azhar, Varma, and Dharap (1994) found Malay Muslim clients with generalized anxiety disorder had faster symptom improvement compared to individuals who only received medication or secular psychotherapy (Azhar, Varma, & Dharap, 1994). Hook and colleagues (2010) found spiritually/religious-informed psychological interventions as an additional intervention can help improve depression outcomes for Muslim clients.

Walpole, McMillan, House, Cottrell, and Mir’s (2013) systematic review of interventions for Muslims experiencing depression indicated the lack of published research in this area and the poor quality of available research studies. Their review highlights a wide range of factors to consider when providing interventions for depression for Muslims: causal beliefs, the role of faith in interventions, and the potential need to make adaptations in terms of therapeutic style. Mir and colleagues (Mir, Kanter, & Meer, 2013; Mir et al., 2015, 2019) culturally adapted a behavioral activation (BA) intervention for depression for Muslims; the intervention focused on utilizing positive religious coping as a resource for clients and integrating religious scriptures to enhance BA concepts and strategies. The study found that it improved access to psychological services and reduced depression for Muslim service users in the UK (Mir et al., 2019). Integrating Islamic teachings that promoted physical activity, compassion, self-management, and dispelling cultural myths into a culturally adapted pain management intervention was found to improve depression, anxiety, and self-efficacy in the UK (Bradford Teaching Hospitals, NHS Foundation Trust, and In Health Pain Management Solutions, 2018).

There is a lack of research on evaluating interventions that involve community engagement, partnership working with communities (Thompson et al., 2018), culturally sensitive interventions focused on coping skills and wellbeing (Hall et al., 2016), and faith-sensitive therapies for religious minority groups (Mir et al., 2015). There is a paucity of research on identifying the barriers encountered in accessing mental health services and culturally appropriate psychological interventions for MENA populations, as well as Muslim populations from these ethnic groups in the UK. There is also a lack of research on culturally adapting therapy for the Muslim community in general (Mir et al., 2019). The service evaluations were conducted to help address the gap in the literature for this client group. Two Hand of Hope therapeutic groups were coproduced at different time periods to reflect the different stages and difficulties clients encountered post-Grenfell. A service evaluation is provided for each Hand of Hope therapeutic group intervention.

The aims of the Hand of Hope groups and service evaluations were:

In this paper, we discuss two Hand of Hope therapeutic group interventions which were piloted at different time frames—10 months and 22 months after the fire. In this section, we discuss adaptations we made to address the reported barriers and the framework and approaches we used to coproduce a culturally appropriate intervention. The Hand of Hope therapeutic group interventions adopted an integrative therapeutic approach utilizing community psychology, cognitive-behavioral aspects, relational/interpersonal, narrative, expressive/humanistic therapies, and Western group therapy principles. A combination of bottom-up (Hwang, 2009) and top-down (Bernal, Bonilla, & Bellido, 1995) approaches were used to create a culturally appropriate intervention. Hwang’s (2009) formative method for adapting psychotherapy (FMAP) utilizes a bottom-up approach consisting of collaborating with community stakeholders to develop ideas to adapt the therapy, and involves five phases that target developing, testing, and reformulating therapy modifications. Bernal and colleagues (1995) outline an Ecological Validity Model consisting of eight dimensions of culturally adapting interventions for ethnic minority groups using a top-down approach: a) language (e.g., offering therapy in the client’s preferred language); b) persons (e.g., matching client and therapist on salient variables to enhance therapeutic alliance, such as culture/race/language); c) metaphors (e.g., use of cultural expressions and concepts); d) content (e.g., applying cultural knowledge about traditions, customs, and values); e) concepts (e.g., intervention concepts consistent with culture); f) goals (e.g., support of client’s desired outcomes); g) methods (e.g., cultural enhancement of intervention methods); and h) context of the intervention/services (e.g., considering impact of client’s socio-political economic context).

The Hand of Hope therapeutic group interventions were informed by Herman’s (1992) three phase (non-linear) model of trauma recovery. The first phase of recovery involves safety and stabilization (e.g., stabilizing symptoms and building trusting relationships). The second phase involves remembrance and mourning (e.g., expressing emotional impact of and processing trauma and loss). The third phase focuses on reconnection (e.g., reintegration and reconnecting with people, meaningful activities, and other aspects of life). A community psychology approach was adopted that aimed to meet the mental health needs of ethnic minority and faith groups that were not engaging with mental health services by trying to address the reported barriers to improve access, and improve service user experience by coproducing and tailoring therapeutic interventions to meet their cultural and faith needs following collective trauma and loss. The IASC (2007) Guidelines on Mental Health and Psychosocial Support in Emergency Settings endorse community consultation in the development and delivery of services, the activation and strengthening of social support networks, and the use of cultural and faith-based healing practices; these recommendations informed the development and delivery of the Hand of Hope therapeutic group interventions.

In many cultures, food and social connectedness is central to the grieving process. Following the initial stages of bereavement in MENA cultures, the bereaved generally do not cook for themselves, people will visit to offer their condolences and bring cooked dishes to feed the bereaved family. In the MENA cultures, feeding others is a deeply symbolic gesture of care and love. Cultural healing practices and collective cultural coping strategies in many MENA cultures include oral storytelling—‘hikaya’ (Atallah, 2017; Zarifi, 2015), hospitality and communal gatherings over food (Abi-Hashem, 2006; Hammad & Hamid, in press; Zarifi, 2015), and traditional arts connected to cultural heritage such as communal embroidery (Zarifi, 2015). These cultural healing practices are used during times of collective trauma and loss. Hikaya involves people bearing witness to each other’s stories in a supportive environment where the sharing of tales of sorrow, joys, life, memories, and linking their past to their future takes place (Zarifi, 2015). In many MENA cultures, the processing of collective trauma and loss and distress is typically done collectively in an informal supportive manner focused on a concrete shared activity connected to cultural heritage (Hammad & Hamid, in press). Cultural healing practices were central features of the Hand of Hope therapeutic group interventions and were used to (1) promote stabilization; (2) support remembrance and mourning; and (3) promote reconnection—reconnecting with people, meaningful activities, and other ordinary aspects of life, as per Herman’s (1992) trauma recovery model.

Supporting cultural healing practices can increase psychosocial wellbeing for many disaster-affected people (IASC, 2007). Ignoring such healing practices, on the other hand, can prolong distress and potentially cause harm by marginalizing helpful cultural ways of coping (IASC, 2007). Rituals build the capacity for social connection and emotional self-regulation (Hobson, Schroeder, Risen, Xygalatas, & Inzlicht, 2018). Coproducing culturally appropriate interventions with community organizations that utilize rituals, creative arts connected to cultural heritage, faith-based rituals, and collective coping strategies like storytelling (e.g., Qur’anic stories about coping with trials and tribulations) is encouraged as it can support the development of culturally informed resilience (Hammad & Tribe, 2020a). Social support and religion are primary sources of resilience for people affected by collective trauma and loss (e.g., Hammad & Tribe, 2020a, 2020b; Somasundaram & Sivayokan, 2013).

In most disasters, family and community networks can be significantly disrupted; even if family and community networks remain undamaged, disaster-affected people will benefit from assistance with activating and strengthening social support networks (IASC, 2007). IASC (2007) recommends these networks be facilitated by women’s and activity groups and incorporate concrete common interest activities such as cooking. Social support helps promote wellbeing, better mental health, and community resilience, and has been found to reduce mental health problems (e.g., Fowler et al., 2003; Friedli, 2009; Tse & Liew, 2004).

The first three authors coproduced and cofacilitated the Hand of Hope therapeutic group; the fourth author provided consultation, supervision, and support. All four authors are experienced in offering culturally appropriate and faith-informed therapeutic interventions.

The first author is a Middle Eastern (Levantine) Muslim counselling psychologist and integrative psychotherapist, specializing in complex trauma, traumatic bereavement, and culturally sensitive therapy; she works at NHS GHWS (adults service) and has trained in Islamic counselling. She has conducted research on Arab mental health and how Arabs cope with ongoing collective trauma and loss and has developed culturally appropriate therapy services for Muslims.

The second author is a key community member and a Moroccan Muslim Arabic-speaking family systemic practitioner at NHS GHWS (children and young people’s service); she has trained in Islamic counselling. She specializes in the development and delivery of trauma-informed, culturally sensitive and faith-informed family, group, and youth interventions as well as community engagement.

The third author is Moroccan, Muslim and Arabic-speaking, and works as a child, adolescent and family psychodynamic psychotherapist and adult integrative counsellor at Al-Hasaniya Moroccan Women’s Centre.

The fourth author is a key community member, psychotherapist, Islamic counsellor, CNWL community collaborations service manager and NHS cultural consultant. She developed and managed the Arabic Families Service at CNWL, a service for Muslim Arabic-speaking families who would not engage in mainstream mental health services. Part of her role also involves specialist consultation, training, and supervision to the NHS, local authority and government organizations, and enhancing wellbeing as part of an integrated health approach where spirituality, faith, and culture are a core resource. Since the Grenfell tragedy she has played a key role in facilitating discussions and opportunities for organizations to develop relationships and capabilities with local communities that are necessary for moving beyond Grenfell and ensuring that the community voice is amplified at decision-making levels. She also developed the Together for Grenfell collaborations model which connects the local authority, local community organizations, and the NHS to develop and provide culturally appropriate interventions for the community that support existing ways of coping with trauma and loss. She is Muslim and of Moroccan heritage.

The process of how the Hand of Hope therapeutic group (a project of Together For Grenfell) was established and coproduced was organic. The phases involved community mapping, community consultation, establishing partnership work between services and organizations, coproduction, delivery and evaluation of the interventions. As part of outreach efforts for the Together For Grenfell project, the third author spent time over a period of a few months building relationships with community members in the local community center. This involved her taking part in community activities and informal support and discussions with community members over tea and coffee. She attended the community center twice a week. The community members were aware she was a psychotherapist. During this period there was mass displacement, therefore some people would spend time in community venues, as they were living in hotels at the time. The third author reported that the community members she was engaging with did not understand what therapy was and assumed it was for ‘crazy’ people, and that the women who had engaged in mainstream mental health services reported a lack of culturally appropriate mental health care. The other authors were also involved in community consultation and similarly received feedback from some sections of the MENA-origin Muslim community regarding the lack of culturally appropriate mental health care.

First, community consultation and partnership working between services was established, recognizing that local community organizations hold valuable knowledge and cultural expertise (e.g., Lane & Tribe, 2010). Through the Together For Grenfell project a partnership was established to work collaboratively to address the psychological needs of the MENA Muslim community who were not engaging with mental health services. We discussed the importance of offering collective interventions and restoring cultural healing practices (e.g., communal gatherings over food are central to the grieving process), as this had been disrupted in part because of the mass displacement that had taken place. We also discussed the importance of working systemically to engage families, as the women were not consenting for their children to access mental health services following the fire. This was why it was also important to have a collaboration between health services serving adults, children, and young people.

Second, during her outreach efforts described earlier, the third author approached the women who seemed most in need and wanted more structured support. The women were asked what their needs were and what type of activities they would like. They requested to focus on their religion, cooking and sharing a meal together, and connecting with other bereaved women. The intervention was introduced as the ‘Hand of Hope’ group, which involved cooking activities and a space to talk including talking about trauma and grief they have experienced. The intervention was not labelled as a mental health intervention due to the stigma and shame associated with accessing mental health care.

Third, the women were invited to the first session, where we hosted lunch for them. We introduced ourselves as therapists and where we worked, but we did not emphasize and draw attention to our professional roles. During our lunch, these women were consulted to: (1) understand what barriers/difficulties they encountered in accessing mental health services, so that we could try to address these barriers and improve access to services; and (2) establish their needs and what type of support they would like, to better inform service provision offered to them. Table 1 outlines the reported barriers and difficulties reported by the women and the adaptations made to address these. During our meal, we discussed in greater detail what activities and topics they would like to focus on in the group. The group requested to cook and share meals together, focus on their religion, access faith-informed culturally appropriate therapeutic support, and connect with other bereaved women. The group members decided what we would cook in the next session and we made a list of ingredients for the group facilitators to purchase. We created a group contract asking them what they needed for the space to feel safe and comfortable. We then started running the group weekly.

Fourth, at various intervals, we checked in with the group regarding whether the group was meeting their needs, topics to focus on, etc.

Table 1. Reported barriers and adaptations made to improve access to mental health services

- Shame and stigma attached to mental health and seeking therapy

- Formal delivery of therapy1

1Formal delivery of therapy refers to how therapy is commonly delivered in mental health services—individual therapy in a consulting room, where the clinician adopts a formal position as the mental health professional.

The interventions focused on utilizing positive religious coping as a resource for clients by integrating religious scriptures to reduce distress, to enhance positive coping strategies and resilience, and to aid therapeutic concepts and strategies relating to facilitating emotional expression, the mourning process, and processing of trauma and loss.

In this section, we discuss an example of how we integrated religious scriptures into both Hand of Hope therapeutic group interventions to normalize crying/grief and mourning responses following bereavement.

In terms of the context, some group members reported cultural beliefs conceptualized as religious prohibitions regarding expressing distress and crying following any longer than three days after a bereavement. The group members reported this was causing additional distress and impeding on their mourning process, and similar observations were made by the group facilitators. Some group members also reported experiencing distress due to negative religious coping, for example in feeling punished or abandoned by God.

The aims/goals of integrating religious scriptures were to normalize grief responses and crying following bereavement and to reduce distress connected to negative religious coping. Using religious scriptures could promote balanced thinking regarding beliefs held by some group members that loss and hardship is an indication of God’s punishment toward them and that expressing distress/crying is an indication of being discontent with God’s decree, or that it indicates low iman (religious faith). Muslims endeavor to follow Prophet Muhammad’s sunnah (behaviors and sayings in various life situations). In Islam, prophets are considered the most beloved by God and it is considered that believers including prophets are tried in proportion to their faith. These concepts were used to help address the aims/goals mentioned above.

The method utilized sayings from Hadith and Qur’anic examples from the life of the prophets to illustrate how the prophets were afflicted with trials, tribulations, hardship, multiple losses, and traumatic events. For instance, when the Prophet Muhammad’s 18-month-old son Ibrahim died, the Prophet cried. Abdur Rahman bin `Auf said, “O Allah’s Apostle, even you are weeping!” He said, “O Ibn `Auf, this is mercy.” Then he wept more and said, “The eyes are shedding tears and the heart is grieved, and we will not say except what pleases our Lord, O Ibrahim! Indeed we are grieved by your separation.” (Saheeh Al-Bukhari). This Hadith highlights how grieving and feeling sadness following bereavement is a prophetic tradition and an expression of compassion; thus reframing this as beneficial to the individual to allow for sadness and grieving (note: mercy (rahma) holds a different meaning in Islam and is akin to compassion). The Prophet Muhammad experienced multiple bereavements and was orphaned by the age of six; in adulthood, the loss of his wife Khadija and uncle within a short period is referred to as the ‘year of sorrow’. In another example, Prophet Yaqub was informed that his son Prophet Yusuf had been killed. Over an extended period of time, Prophet Yaqub grieved deeply and cried so extensively that it affected his eye sight. His intense grief is expressed in the Qur’an, “And he (Yaqub) said “Oh, my sorrow over Yusuf,” and his eyes became white from grief…” (Surah Yusuf, 12:84).

Collaboration between services and third-sector organizations and coproduction was key to the success of the interventions. It was a challenge to build a trusting relationship because the group members had difficulty in trusting us as therapists, the community, and the other group members; we had to work really hard to build trust. For example, some service users did not want to complete basic information sheets to register their attendance. Their lack of understanding of therapy and how it works was also a challenge; they automatically brought in their own negative experiences of therapy and doubts about whether therapy would work, especially when touching on trauma and loss. We managed this by adopting a gentle and warm approach and focusing on restoring cultural healing practices and social connectedness. We showed respect to their values and beliefs and this appeared to help encourage them to trust us. Abi-Hashem (2014) highlights how many MENA-origin people expect the therapeutic exchange to be warm and friendly and would not respond well to mechanical, formal, business-like relationships. Mental health professionals adopting a formal expert position that accentuates the power imbalance is likely to impede access to and engagement in therapy for this client group (Hammad & Hamid, in press).

During the initial stages of the group, some group members had difficulties and arguments with each other which required us to offer mediation. Conflict between group members is a common feature of the group process known as the storming phase (Tuckman, 1965). Other challenges included the time needed to build relationships between services and the community and working in a setting with high levels of media and political scrutiny. There were challenges to working informally, which primarily related to time-keeping and ensuring people did not talk over each other. We managed this by revisiting the group contract. Some of the group facilitators also experienced the tension between their therapy training advocating a neutral stance and nondisclosure on the therapist’s part, and our cultural awareness that we needed to make non-significant disclosures to help reduce the power imbalance, strengthen the therapeutic alliance, and to create a warm environment. Hamid, Scior, and Williams (2020) found that mental health professionals reported finding it helpful to make disclosures to reduce perceived power imbalances with refugee Syrians.

We coproduced and carried out two separate service evaluations of the Hand of Hope therapeutic group interventions with two different groups of women. The service evaluations followed the same procedures. Both interventions focused on engaging bereaved MENA Muslim women affected by the Grenfell Tower fire by coproducing a culturally appropriate faith-informed therapeutic group intervention. Both groups consisted of women who had lost multiple close friends in the fire. We used the same approach, adaptations, and framework in both interventions. The differences pertain to the time period, different presenting problems the women were experiencing, and cultural healing practices. The primary aim of the first group intervention was to improve access to mental health services and to support stabilization. The second group intervention primarily focused on promoting wellbeing and resilience.

The first Hand of Hope therapeutic group intervention ran 10 months after the Grenfell Tower fire in 2018 with first- and second-generation MENA-origin Muslim women. The following issues were identified for this group of women: shame and stigma associated with mental health and accessing mental health care, mistrust of all statutory services, presentation of symptoms consistent with posttraumatic stress disorder (PTSD) and traumatic bereavement, difficulties in mourning/grieving, non-engagement with mental health services on an individual and family level, lack of mental health awareness, and disruption to social support networks and Islamic and MENA customs following bereavement and collective trauma and loss. The group sessions were focused on restoring these customs and the following cultural healing practices: group cooking, communal gatherings over food, and oral storytelling—‘hikaya’.

The second Hand of Hope therapeutic group intervention ran 22 months after the Grenfell Tower fire in 2019 with first-generation MENA-origin Muslim women, all of whom reported having no family in the UK. All group members had accessed individual therapy in connection to the Grenfell Tower fire. The following presenting problems were identified: low mood, social isolation, and the women reported not engaging in life like they did prior to the fire. The group sessions focused on the following cultural healing practices: communal gatherings over food, oral storytelling of seerah and Qur’anic stories of the prophets, and group nasheed singing and traditional drumming (Muslim women’s choir).

In the next section, we outline the first Hand of Hope therapeutic group intervention and the service evaluation for this group intervention.

The first Hand of Hope therapeutic group intervention was coproduced with a group of 10 British Arabic-speaking, MENA-origin, Muslim first- and second-generation women, affected by the Grenfell Tower fire. All reported witnessing the fire. Eight women were bereaved and had lost multiple close friends in the fire; six women described symptoms consistent with PTSD, and three women were permanently displaced in connection with the Grenfell Tower fire. Prior to establishing the group, only two women were accessing therapy via NHS GHWS, but none of the group members’ children nor the other eight women were engaging with mental health services or accessing therapy. For the first Hand of Hope therapeutic group intervention, the group requested to connect with other bereaved women, cook and share a meal together, focus on their religion, and access faith-informed culturally appropriate therapeutic support. Some of the women knew each other from the community.

The Hand of Hope therapeutic group intervention consisted of eight once-weekly two-hour sessions and ran from April to June 2018, 10 months after the Grenfell Tower fire. The aim was engagement, to provide culturally appropriate faith-informed therapeutic support, reduce the shame and stigma attached to mental health and therapy, provide psychoeducation, strengthen and activate social support networks, support stabilization, and improve access to services for the service users and their children. The group sessions focused on the cultural healing practices/collective cultural coping strategies: group cooking and communal gatherings over food (Abi-Hashem, 2006; Zarifi, 2015), and ‘hikaya’ oral storytelling (Atallah, 2017; see Table 2.).

Table 2. Cultural healing practices used in Hand of Hope therapeutic group intervention one

Cooking and sharing a meal as a group

We provided food (e.g., traditional biscuits and bread, olives, fruit, meze appetizers, etc) and mint tea. As per MENA cultural customs, we served the group members because we invited them and the host serves its guests. The group decided together what they would like to cook for the next session and as a group we wrote out a shopping list of ingredients and amounts, which we (facilitators) purchased. The main dish that the group members and facilitators made together was typically intricate traditional Arabic pastries. Some group members chose to bring in dishes to share with the group.

By restoring culturally familiar ways of coping with trauma and loss, we observed that when gathering as a group and cooking a meal together, the group members were processing their traumatic experiences and loss collectively, as they normally do culturally; it was natural, non-threatening and at their own pace. This appeared to help them to feel at ease and fostered bonding between the group members and the facilitators, and strengthened some of their interpersonal relationships. The group members also collectively mourned and remembered the deceased.

The processing of traumatic material and loss was done informally whilst cooking and eating together because a) cooking stimulates the five senses (Josephy 1994) and utilizing the five senses is the main way to help ground traumatized individuals so that they do not dissociate; b) the use of physical movement can facilitate trauma processing as it sends a non-verbal message that the trauma is over (Rothschild, 2003) and can also help to create dual awareness so that the client remains fully present during trauma recall; and c) cooking taxes the working memory (Wang et al., 2011). There is evidence to suggest that engaging in tasks that tax the working memory reduces the vividness and emotional intensity of disturbing memories (Engelhard et al., 2010). Cooking is considered a creative art; the use of creative materials has a soothing effect that decreases stress reactions and aids expression (Malchiodi, 2014).

In this section, we outline the first Hand of Hope therapeutic group intervention. “Engagement and Consultation,” the first two sessions, focused on establishing relationships and a group contract, building trust by exploring the religious concept of amanah (trust), facilitating group bonding and engagement via group activities and icebreakers, identifying the group’s needs and coproduction. To manage interpersonal difficulties mediation was offered to group members who had historic personal difficulties with each other.

Session 3, “Coping with Loss”, involved exploring ways of coping with loss informed by their faith and supporting bereaved friends and family, exploring their views on bereavement, loss/grief-related emotions, and the impact of suppressing emotions. The aim was to provide psychoeducation on bereavement and strengthen positive coping.

Session 4, “Managing and Making Sense of Traumatic Experiences/Responses,” focused on supporting clients to recognize and manage trauma responses/symptoms by providing psychoeducation on trauma responses, reducing shame and stigma by normalizing trauma responses, promoting stabilization by exploring self-soothing techniques, and trauma and anxiety symptom management, including faith-informed grounding techniques like listening to Qur’an and dhikr (remembrance of God).

Session 5, “Exploring Impact of Bereavement and Grief,” focused on exploring their perspectives on grieving/mourning including Islamic perspectives, psychoeducation on grief/bereavement responses to increase awareness of the impact of bereavement and reduce shame and stigma, and remembering their loved ones and sharing memories of them. To support the processing of loss and distress, we normalized grief responses and permissibility to cry using Qur’anic stories of the prophets to promote balanced thinking regarding negative religious coping and support cognitive processing regarding beliefs about crying and expressing distress. We reflected on the religious concept of sabr (perseverance) and Qur’anic verses and Hadith group members found meaningful to aid positive coping.

Session 6, “Exploring Experiences of the Grenfell Fire Tragedy,” involved exploring the emotional impact of their trauma and loss and processing trauma in a culturally familiar way. Some group members chose to narrate their experiences of the fire in sequential order and were supported by the group. We explored religious forms of coping and religious conceptualizations of their experience.

Session 7, “Talking about Loss with Others and Mental Health Awareness,” explored what mental health and therapy is and associations made to increase mental health awareness and challenge stigma associated with mental health and seeking therapy. In this session, we explored the group ending, remembered the deceased, and normalized difficult feeling states. We also addressed their concerns that they would be burdening their friends if they opened up about their difficulties, by modelling difficult conversations, promoting social support, and exploring how group members would like to be supported by others.

Session 8, “Group Ending/Marking Eid,” involved exploring experiences of Eid without their loved ones, reflecting on the group’s journey, and supporting their request to mark their first Eid al-Fitr since the fire as a group.

All 10 group members were verbally invited to take part in the service evaluation. Seven participants that took part in the service evaluation were British first- and second-generation MENA-origin Muslim bereaved women, ages ranging 36 to 83, affected by the Grenfell Tower fire. Three group members who were unable to take part in the focus group interview due to other commitments were contacted individually to provide verbal feedback as part of the service evaluation; their feedback is included.

Prior to the service evaluation, NHS approval was obtained. All participants were verbally provided with a description of what the service evaluation involved, the purpose, and the voluntary nature of their participation. Verbal consent was gained by the participants before taking part in the service evaluation. Participants were aware that they could withdraw from the evaluation, refrain from answering any questions, that the data would be anonymized with no identifying details, and that their participation would not negatively affect current or future services offered.

A mixed-methods service evaluation of the Hand of Hope intervention was conducted by the first three authors. A semi-structured focus group was held in June 2018 with seven group members in Arabic and English, which included the group members anonymously rating quantitative questions on a Likert scale. The focus group was audio-recorded with the participants’ consent and transcribed verbatim in English. Examples of focus group questions included: “how have you found the group?” and “how did you find the cooking activities?” The questionnaire was read aloud and participants completed a paper copy anonymously, which was deposited in a box. The audio recording of the focus group was translated by the third author, and transcribed verbatim in English by the first author. The data regarding referrals and access to therapy/services before and after the group was monitored, overseen, and collected by the first three authors and checked on each service’s databases; participants were also individually asked if they were accessing any services/therapy prior to inclusion in the group.

A thematic analysis following Braun and Clarke’s (2006) guidelines was conducted on the English translation of the focus group interview by the first author and was cross-referenced by the second author. The transcript was analytically coded on a line by line basis to generate initial codes and to identify possible themes. There was an emphasis on identifying distinct themes which related to the barriers reported in accessing therapy/mental health services, service user experience of the intervention, and evaluating the impact and outcomes of the intervention. The potential themes were reviewed to ensure that it captured the data contained in the transcript, and some subthemes were collapsed and renamed to better represent the data. Data extracts are provided in the findings section to allow the reader to evaluate whether the theme is representative of the data. The anonymized quantitative ratings were averaged using a calculator.

The findings regarding the theme of barriers to accessing mental health services and therapy will be discussed first, followed by the (theme) outcomes of the first Hand of Hope group evaluation. To avoid repetition, the data extracts on the barriers presented are in response to the question, “Have you encountered any difficulties or barriers to accessing therapy in relation to Grenfell?”.

Consistent with the literature, all reported that the shame and stigma attached to mental health and seeking therapy was a major barrier to accessing mental health services (e.g., Alhomaizi et al., 2017; Arday, 2018; Hamid & Furnham, 2013; Memon et al., 2016; Rayan & Jaradat, 2016; Woods-Giscombe et al., 2016). Some participants reported fears of being ostracized if they accessed support. All referred to mental health as meaning someone is “mad,” and some expressed that therapy is for “crazy” or “psycho” people. It is possible that their understanding of mental health and mental health care is informed by their experiences in their countries of origin. Mental health typically has negative connotations and is popularly associated with people experiencing severe mental illness (e.g., Amri & Bemak, 2013) such as psychosis or people with a forensic history; mass media often depict people with mental health problems as dangerous and unpredictable (e.g., Overton & Medina, 2008). Mental health support in the MENA region is also often associated with being locked up in an asylum (e.g., Amri & Bemak, 2013; Youssef & Deane, 2006). Asylums were introduced during periods of British and French colonialization and lacked standards of psychiatric care (Fernando, 2014). Research in Egypt indicated that mental illness can be perceived as a threat to social order, which is managed by the segregation and physical isolation of psychiatric facilities (Coker, 2005). Some comments made by group participants follow.

“I wouldn’t go and ask for help…I feel embarrassed and ashamed to ask for help.”

“I feel quite shy to ask for support, I worry I would be left out by other people if I seek support.”