TANHAN, AHMET, Ph.D. Mental Health Issues and Seeking of Formal Mental Health Services Among Muslims in the Southeastern U.S.: Preliminary Investigation of a Contextual Theoretical Framework Based on the Theory of Planned Behavior/Theory of Reasoned Action and the Social Ecological Model. (2017) Directed by Dr. J. Scott Young. 314 pp. The Muslim community in the Southeastern U.S., being a small part of the larger Muslim population in the U.S., faces many psychosocial issues and underutilizes mental health services. Muslims’ underutilization of mental health services to address their psychosocial issues affect both Muslims and non-Muslims alike. Given today’s highly interconnected world, the issues of one individual or community often impact others in ways not experienced at other times in history. However, there is lack of research on Muslims and especially for those in the Southeastern U.S. regarding their approach toward mental health issues and seeking formal mental health services. Researchers stress the necessity to understand Muslims’ approach toward mental health issues and seeking the services by utilizing well-grounded theories to create and/or shape contextual theoretical frameworks (models). However, few researchers have utilized clear theoretical frameworks to ground their studies, which creates an unsystematic approach to research and clinical practice for this vulnerable population. In their study with 88 counselors in the U.S. Cashwell et al. (2013) found that although the participants rated the integration of religious/spiritual aspects into counseling as very important, they integrated these aspects less frequently into their counseling practice than how ratings of importance would suggest. Young and Cashwell (2011) stressed attending to client’s spiritual/religious perspective by stating, “meeting the client where [they] are, without judgment and with compassion, is the foundational building block” (p. 22) to address issues in counseling. The purpose of this study was to understand how Muslims in the Southeastern U.S. approach mental health issues and seeking formal mental health services. A second purpose was to partially test (examine) the proposed contextual theoretical framework based on Theory of Planned Behavior/Theory of Reasoned Action (TPB/TRA) and Brofenbrenner’s Social Ecological Model (SEM) to answer the eight research questions. In total 209 participants’ responses were used for statistical analyses. The results indicated that the participants had slightly higher than the moderate/favorable level on the five constructs: cultural beliefs about mental health issues/problems and their causes and treatments (CBMHP-cultural beliefs), knowledge about formal mental health services (KFMHS-knowledge), and perceived behavioral control toward seeking formal mental health services (PBC) constructs; and a moderately favorable level on attitudes toward seeking formal mental health services (ATFMHS-attitudes) construct; and slightly under the moderate level (meaning participants had a little stronger stigma than moderate level) for perceived social stigma toward seeking formal mental health services (PSTSFMHS- stigma) construct. Meaning that, the participants did not strongly favor or disfavor the five constructs. In addition, the participants strongly aligned with a medical/scientific explanation of mental health issues and their causes and treatments based on responses to the measure of CBMHP-cultural beliefs. The paths (relationships/analyses) among the five main constructs were positively or negatively significant except for one. In an open- ended question, the largest group of the participants defined mental health providers from a medical/psychopathology perspective while the others fell under three other categories. In addition, majority of the participants did not feel safe and attributed it to the current climate of exosystem and macrosystem systems in which they live. In sum, nearly all researchers in the Muslim mental health literature have stressed the importance of understanding contextual factors for more culturally, spiritually, and structurally appropriate interventions and services. Therefore, it was first necessary to assess and understand how Muslims in the Southeastern U.S. approach to mental health issues and seeking formal mental health services through a well-grounded theoretical framework. In this way, mental health providers and researchers will be able to understand Muslims within a more culturally and structurally contextual perspective and address the mental health issues of this population more effectively by utilizing the results of this study. MENTAL HEALTH ISSUES AND SEEKING OF FORMAL MENTAL HEALTH SERVICES AMONG MUSLIMS IN THE SOUTHEASTERN U.S.: PRELIMINARY INVESTIGATION OF A CONTEXTUAL THEORETICAL FRAMEWORK BASED ON THE THEORY OF PLANNED BEHAVIOR/THEORY OF REASONED ACTION AND THE SOCIAL ECOLOGICAL MODEL by Ahmet Tanhan A Dissertation Submitted to the Faculty of The Graduate School at The University of North Carolina at Greensboro in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Greensboro 2017 Approved by J. Scott Young Committee Chair In the Name of Allah (God), the Entirely Merciful, The Especially Merciful Humbly, this work is dedicated to all of us as humanity— especially to the ones of us who are oppressed/exploited in so many different ways including, yet not limited to, economically, physically, spiritually— starting from here the USA, Muslims, and all across the globe. May Allah make/keep all of us striving for a more livable world for all. ii APPROVAL PAGE This dissertation, written by Ahmet Tanhan, has been approved by the following committee of the Faculty of The Graduate School at The University of North Carolina at Greensboro. Committee Chair J. Scott Young Committee Members Craig S. Cashwell A. Keith Mobley Vincent T Francisco March 27, 2017 Date of Acceptance by Committee March 27, 2017 Date of Final Oral Examination iii ACKNOWLEDGMENTS Alhamdulillah, which means all praises and thanks, first and foremost, to Allah (God) who is the main sustainer of all beautiful, meaningful, and just thoughts/beliefs, intentions, and actions. If there is anything just, beautiful, and meaningful in this work, that is due to Allah. All praises to Allah for giving such a rich experience, full with opportunities and tests, to meet teachers, professors, and supporters with great intentions and actions that made this season of my life meaningful and productive. And, therefore, I humbly wish and pray that Allah give my teachers, professors, supporters, their families and friends, and all people around them all beautiful things including, but not limited to, peace, mindfulness, patience, and prosperity here and hereafter and make this humble work a small dot in the history of humanity to keep striving for a more livable world for all. This humble work would have not been possible, first without Allah’s permission, without the support I have received from the following people, teachers, professors, and supporters, to mention only a few. First, I cannot explain my appreciation for my professors (committee members) Drs. J. Scott Young, Craig S. Cashwell, A. Keith Mobley, and Vincent T. Francisco for constructing a dissertation process with support, patient, wisdom, knowledge, and challenge. Special thanks to my chair, Dr. Young, J. Scott, for constantly being open, humble, supportive, and mindful when I would get stuck so many times. I have learned much from you and maybe the most important thing is letting some things go and being open to receive some help. Thank you for taking extra time, even if it were in the middle iv of the hot summer to meet and plan so that I could move forward. Special thanks for making the department so inclusive from day one, which set an example for some other Muslim students to talk at the university level. Thanks so much for all as a chair for my dissertation you have done for me and thanks so much as the chair of our department and being very humble and inclusive. Special thanks to Dr. Cashwell; from the moment I sent him an email to apply to the department/school and to the current moment his constant openness, encouragement, and support is difficult for me to explain; special thanks to him for putting me in touch with Dr. Francisco while I was almost stuck and did not know where to go for my cognate. Special thanks to Dr. Mobley for constantly being open, supportive, and humble, and especially for all he has done to provide a great experience for us in our clinic, which has been my favorite place to study and where I have completed most of this work. And special thanks to Dr. Francisco (my cognate professor for public health)—from the moment I sent him an email to see if I could talk to him, his instant and warm message that with him we can do some good work. A special thanks goes to him for investing his time—even weekends—and energy to help me grow from a theory and practice perspective and learn how to integrate theory, research, and practice to affect life happening in front of our eyes, starting from our UNCG campus. I would not have been able to be part of such meaningful projects and construct this current work from such a large perspective without his support and challenge. I cannot adequately express my appreciation for each, and only Allah (God) knows how much I appreciate v their support. From the bottom of my heart, I wish and pray that Allah (God) give them all, their families, and all around them peace and prosperity here and hereafter. Second, I want to thank all of my professors (Drs. Wester, Borders, Benshoff, Wachter Morris, Gonzalez, Murray, Champion, Pope, Paredes, Harris, and Jones) at our counseling department at the University of North Carolina at Greensboro for their constant support and teaching. I have gained much and that cannot be expressed in few lines. Deep appreciation goes to Mrs. Lorenz for her constant support and smile from the day I applied to the school; she made my journey at UNCG easier and more productive.