"To Whom Should I Refer Her?" Factors Contributing to Religious Informal Helpers' Referral Decisions for Women with Mental Illness and At-Risk Women: The Case of Israeli Balaniyot.

Religious informal helpers may play a crucial role in recognizing and providing referrals to mental health professional for at-risk individuals, including those with mental illness, especially since members of religious communities tend to conceal their difficulties and to view religious leaders as a sole source of assistance. This quantitative study aimed to explore Jewish bathhouse attendants ("balaniyot") who assist women in their monthly immersion, a unique situation in which mental health symptoms (e.g. obsessive-compulsive disorder, postpartum depression, post-traumatic stress disorder, eating disorders) and intimate partner violence may come to light. The Health Belief Model (HBM) which suggests factors explaining the likelihood of seeking or referring to professional help for physical and/or mental illness guided the selection of the variables. Israeli Balaniyot (N = 166) completed self-report questionnaires assessing factors deriving from HBM: religious affiliation, mastery, spirituality at work, knowledge of mental health, and tendency to assist IPV victims. Binary regression analysis examined the contribution of variables to choice of referral source (professional vs. spiritual/rabbinical). The findings indicated that most participants (69%) tended to refer at-risk women to professional help. Predictive factors included religious affiliation (with a higher tendency among Orthodox balaniyot), weekly workdays, mental health knowledge, a focus on protecting women's safety and family integrity, and high mastery conditioned by low spirituality at work. The findings validate the HBM and its application among religious informal helpers and suggest the need to increase balaniyot's knowledge of mental health issues and trust in professional figures and to respect their religious beliefs.