11Am, Migrant and Refugee Communities Forum (MRCF)

KHAT_10_Aug_2010 revised.doc

Meeting held by Midaye, 10th August 2010.

11am, Migrant and Refugee Communities Forum (MRCF)

The Khat Issue

Our aim:

to explore appropriate social, medical, and health care strategies toaddress Khat issue among Somali people

Participants:

Dr Kathrine Darton, National Mind
Abdi Ali Kadar, Outreach from Midaye
Rachel Okoro, Substance Misuse Lead, Lisson Grove Health Centre,
Eloise Tabernacle, Kensington and Chelsea, Dual Diagnosis Team
Dr Natalie Tobert, Midaye, project co-ordinator
Deeq Yusuf, Khat project, Foundation 66

Apologies

Aidan Maloney, Project Manager, Kensington and Chelsea Mind
Bill Brookman, Khat Standing Comittee

The notes below were recorded at the meeting, and can be used as a guide to the material discussed. They may or may not be accurate, or they may reflect the opinions of those present. If you have comments or wish to add or amend anything, please email me the details. Thanks to those who have already done so.

How is Khat Used?

It is used in different ways inUKSomalia
It has a different composition: UKSomalia
People have different genetics and respond differently
In UK, Somali people chew more, they may binge
Why? In UK, men are not in work
women also chew but in secret[BB1]
In Somalia, there is a different practice, whereby it is taken after lunch and chewed until 6pm. In UK, women and young people may chew it as well, and all night long. It may also be combined with the use of cannabis.
The khat leafhas a short shelf-life and has to be chewed fresh - it loses its potency in about 48 hours

What resources are already available?

Foundation 66 Report, Plan F

Contact: Aiden Grey, LennoxGregson

Council and community: funding for Khat worker (Deeq Yusuf)
To help men stop or reduce khat use

What are the effects of chewing?

Direct effects on men

oral health, ulcers, black teeth[BB2]
problems over timescale of khat: men chew all night
May have mood swings, may sleep for 16 hours,
Stimulants, can’t sleep, deprivation, iritable[BB3]
Men become less rational,become depressed
Problems over parenting, with a sleeping parent
Father’s may miss their children’s development
Financial aspects: price £3 a bundle, which lasts 1/2hr to an hour
Many men who chew are not working
They can consume 3 or 4 bundles a day, sometimes up to 10 bundles
Chewing impacts on men’s physical health, their mental health, and their financial situation
Men become isolated from their community, and suffer loss of status
Khat is socially addictive not physically addictive
Effects differ: it may act as sexual stimulant, with impotency later
Khat has 3 phases: stimulant; euphoria; come down or confessional

Indirect Effects on women

As carers,
Home life may be stressful, dysfunctional, or with domestic violence
There may be communication breakdown
Women may have a low mood, become socially isolated
They may suffer domestic violence, husband’s mood swings
Children miss out on having their father present
may have damaged family economics

Legal issues

Khat is a legal drug, its chemical constituents are banned in UK, but the leaf itself is not. It is a vegetable, therefore it cannot be taxed
It may be impossible to ban it[BB4]: it was likened to alcohol use in UK
Lack of concern, it is not mainstream and only affects Somalis

Our concerns

Young people may follow role model of father
Explore ways to control use and minimise risk
We want to change behaviour and attitudes, which takes years
Issues of trust need to be considered
Shisha restaurants are opening and they invite Khat chewers
Some may want to stop, or reduce consumption, but don’t know about help
Research on khat, if done with European males, is irrelevant

What steps can we take?

Two levels: tactical and policy
We could undertake mental health promotion
Address substance misuse and dual diagnosis
Present the psycho-social effects
Offer clinics on ways Khat affects mental state
Invite users to undertake a health assessment (Rachel)
Offer educational workshops and psychological education (Eloise)

We could start a drive for ‘sensible’ Khat use
We need to address Somali people’s trauma, distress, isolation, and explore ways of political and social change
It may be that those who chew are less integrated in UK, and may require ESOL classes
We could approach community organisations, develop leaflets, and visit the khat chewing houses (marfish).
If it is grown in UKin hydroponic set-ups, like cannabis, could these be regulated or made illegal, even though the leaf isn't?

Collaborate using religious strategies
Work with mosque and iman.
Use Koran and sayings of Prophet (pbuh)
Train workers in community centres & mosques

Employ a female worker,
Women are more integrated than men,
They were sent to UK first after war
We could approach women and mothers, and ask them to help

Use culturally appropriate strategies
Identify marfish places where khat is chewed, and those who supply it
1:1 counselling is a western model, and doesn’t work
Group counselling is more appropriate

Stages of change model: Local v National

How do we make local issues of national importance?

Raise awareness with government and lobby MPs
request Marfish have a licence, and open at fixed times
fix age groups of those chewing
suggest restraint if person is intoxicated

Contact Somali organisations, like Midaye, HASVO
Explain support available for those who want to reduce consumption, prepare a photo essay[BB5].
Speak to industrial growers, importers and sellers of Khat
Run [BB6]an artscompetition for Somali young people, to write a khat song, or poem, or a photo essay, or do a poster.

Engage with PCTs in other boroughs, and with mental health charities
Engage with National Mind, to develop an information sheet
Develop a training pack for govt officials, medical and allied health care staff, and Somali men and women, to raise awareness
Approach PCT in Kensington and Chelsea, re. 2011 funding

Develop content and funding for a London wide khat conference
Focus: practical strategies to address issues. We don’t want research that doesn’t result in change and manifestations
Presentations from each borough: what works what doesn’t work

Testimony Project type narratives
Traumatic memories may be one reason men choose to chew: it makes them feel safe, and Somali.
Has anyone encouraged Somali men to talk about their experiences, and reasons they came to UK?They might be helped by being encouraged to tell their stories in a project on similar lines tothe British Library Testimony project.
Could we devise a project, and apply for funds (Wellcome Turst?) to hear Somali peoples’ narratives?

Potential collaborators:
East London Somali former mayor; PCTs, GP practices,Kings Fund
Somali organisations: Midaye, HASVO
Universities: Wolfson: Dr Nasir Warfa
National Mind: Diverse Minds, Marcel Vige
National Mind: prepare a campaign with them?
Local Minds: Kensigton and Chelsea, Westminster, Harrow
Dr Carmel Clancy at MiddlesexUniversity
Marcus Roberts, Drugscope
Department of Health
Departments of Work and Pensions
Abdi, write a piece for Lancet, or BMJ

Potential Timetable

November 2010, Prepare item for Brookman website

February 2011 prepare a press pack, and list grey and academic literature

March 2011, Conference: Where are people now re: good practice?

April 2011: Competition, invite young people to do songs and poems on Khat

June 2011, Prepare training, raise awareness for job centres, social workers

October 2011 Review of changes brought into effect after 6 months

Dr Natalie Tobert, Well Woman Programme Co-ordinator, Midaye

, office: 0208 969 7456

[BB1] Have seen 1 woman chew at a middle-class party in Hargeisa

[BB2]What about the red teeth I observe in the Horn of Africa?

[BB3]Spelling

[BB4]Many people want legalized drugs - not me - have we explored that?

[BB5]I will build photo essay in Somalia in next month (Sept/Oct 2010) if possible

[BB6]I can devise this if asked