Socio-cultural adaptation of Mental Health First Aid to insular religious communities: the case of ultra-Orthodox society in Israel

ObjectiveThe introduction of Mental Health First Aid (MHFA) in Israel has required a dynamic adaptation of the curriculum to the local social, cultural and religious context. The adaptation to the Jewish ultra-Orthodox community has been particularly rigorous and challenging. This article aims to analyse this process, its principles and steps, as well as the challenges and dilemmas it entails.MethodThe article employs a qualitative case study design, specifically, the instrumental case study. The adaptation procedure includes five steps: engaging local experts, organising focus groups, collaboration with communities, pilot testing in diverse communities, and iterative feedback loops. The article draws primarily on the perspectives of 45 community members, rabbis and health professionals who participated in four focus groups.ResultsThe adaptation in ultra-Orthodox society addressed stigmatisation, silencing and concealment of mental health issues; gender segregation; educational gaps; and cultural misunderstandings of healthcare approaches. We demonstrate the need to modify the language, scenarios and examples in the curriculum, and engage with religious leaders and educational institutions. This process raises professional and ethical dilemmas, such as how MHFA should approach topics that remain unspoken in ultra-Orthodox communities.DiscussionThis case demonstrates that cultural adaptation is vital but may be insufficient. Attention should also be paid to social and structural forces, such as social hierarchies and systemic discrimination. A structurally competent approach should be adopted. This is the first case of accommodating MHFA for an insular religious group. It can contribute to adapting MHFA to other insular, encompassing, high-tension religious communities worldwide.