Reforming approach to mental health in the Middle East
Stigma, discrimination a harsh reality for patients and the largest barrier to progress
Making mental health a top priority on public health agendas across the Middle East has never been more important. Many of the region’s governments are recognising the urgency based on the growing evidence of the magnitude of mental health issues in the Middle East. Mental health disorders affect as many as 25 per cent of people every year in the region, and over the course of a lifetime, up to 45 per cent of people suffer from at least one mental health disorder. The resulting burden on society and the economy is significant: accounting for 7.4 per cent of the burden of disease worldwide, 9.34 per cent in Saudi Arabia, and 8.05 per cent in the United Arab Emirates, creating “more economic costs than chronic somatic diseases such as cancer or diabetes”.
The common understanding of mental health in the region tends to be limited and mainly associated with specific disorders such as schizophrenia or bipolar disorder. However, the scope of mental health is wider and includes other disorders that impact people well-being such as depression, anxiety, developmental disorders (eg: autism, ADHD), addiction and eating disorders to name a few.
There is now a clear consensus on the need to change the mental health provision and shift to more inclusive and effective systems, with multiple GCC countries initiating national strategies to overhaul the mental health sector. In this effort to reshape the system and improve the quality of care and life of mental health patients, several fundamental elements need to be carefully incorporated to drive this crucial transformation.
A fight against stigma
Education institutions play a crucial role in promoting and destigmatising mental health in society as well as being the first gate to detecting developmental disorders in children and adolescents.
The stigma and discrimination that mental health patients face is a harsh reality and the largest barrier to progress. Arising from a lack of knowledge, misconceptions or embarrassment among other reasons, the stigma drives many people to hide their mental illnesses, causing them to delay seeking help, or follow unproven and often dangerous remedies and approaches. Moreover, the stigma is pervasive across the system, misguiding policymakers and health care professionals alike in their decisions by underestimating the impact of mental health.
Normalising mental health is the first step toward greater acceptance of mental illnesses and better integration of people with mental disorders within society. This can done through educating policymakers, providing appropriate funding, and developing and enforcing policies to address discrimination and preserve patients’ rights.
From asylums to community-based care
Many developing countries around the world spend most of their mental health funding on inefficient approaches to managing — rather than treating — mental health patients. A hospital-based provision for mental health care has proven to be insufficient and indirectly contributes to strengthening the stigma.
Stronger community-based care, complemented by more specialised and advanced care in hospitals for the few acute cases, has proven to be more effective in supporting, as well as preventing, mental health disorders. This shift toward more inclusive and shared care supports mental health patients integrate into their communities and have a more active role in society.
A capability-building journey
A crucial backbone of the mental health transformation is a qualified and efficient workforce, and it is currently one of the major obstacles of implementing an efficient community-based care delivery model. In fact, scaling up the number of health care professionals and their abilities to deliver the required change and services has been extremely challenging, even in developed countries. This is mainly due to the lack of dedicated staff, limited financial resources, low motivation levels, and lack of collaboration between the various layers of care. This challenge is even more acute in rural areas where the need is high, but supply is limited.
In the Middle East, governments need to put together innovative approaches to tackle the workforce gap. This includes moving mental health functions from more specialised professionals to general practitioners and nurses through training and capability building, creating new positions in mental health, such as psychosocial workers who are trained to support and manage mental health patients in the community.
A cross-agencies mandate
Mental well-being sits at the crossroad of multiple agencies and sectors, including health care, education, labour, social services, and justice. A cross-agency mandate will require strong collaboration to ensure better prevention, early diagnosis, improved treatment, and efficient integration of patients into society.
Health institutions need to provide the required treatments at various levels of care along with community support. Education institutions play a crucial role in promoting and destigmatising mental health in society as well as being the first gate to detecting developmental disorders in children and adolescents. Social services agencies can play a central role in catering to the socioeconomic needs of patients and their families and providing the right set-up to facilitate their integration within the society. The workplace also plays a significant role in dealing with mental health issues and can implement adequate programmes to lower the psychological burden their staff is facing. Finally, the justice and law enforcement institutions will need to develop the right laws and policies to provide appropriate legal protection and support to mentally ill patients and their families.
The path of transforming the mental health sector has historically been rife with challenges and obstacles. Developed mental health systems around the world have emphasised key enablers to smooth the transition: core medical requirements, such as fit-for-purpose facilities, access to medication, and multimodal integrated care, need to be available. Additionally, adequate health care capabilities and personnel, appropriate funding mechanisms and efficient collaboration among service agencies will be mandatory to ensure smooth handling of patients and their families and caregivers.
— Mohamed Berrada is partner and head of Healthcare Practice, Kearney, and Younes Rahmoune is manager of Healthcare Practice, Kearney.