DUBAI: While the focus on raising awareness in the UAE on mental health is ever relevant, there is some good news. Over the last five years, more people are ditching the stigma attached to seeking help for psychological problems and getting their lives back on track, said experts.

As the many instances of celebrities and even non-celebrities committing suicide due to mental issues prove, the times we live in do not offer us the luxury of being in denial [of what is troubling you]. Any such denial comes with a heavy price to pay.

Dr Deepa Sankar, clinical psychologist, NMC Speciality Hospital, Dubai, said, “Although stigma exists [about mental health], there is an increase in awareness about it thanks to the availability of knowledge resources (especially media). Probably, this is why more people are reaching out to the professionals. Another reason for the increased awareness is that [some] insurance companies have started covering psychotherapies.”

Dr Saliha Afridi, director, The Lighthouse Arabia, said, “I believe mental health awareness [in the UAE] is still in its infancy. I have been here for 10 years and I do think I have seen that there are more people seeking treatment now than before. This could be a result of many factors such as more awareness but also factors like the popularity of the smart phone and the subsequent deterioration of attention, relationships, and the increase in pressure brought on by social media.”

What are the main factors in an expat’s lifestyle that can be stressors?

Dr Sankar: “That depends on the stage of life expatriates are in. For parents with very young children where both the parents are working, the stress is about bringing them up without adequate support. [The parents] leave very early in the day and return home late, due to long work hours or commute. Some couples bring their old parents to look after their children but many cannot do that. So they leave their young children with a babysitter or housemaid. The housemaid normally leaves the children in front of the television or tablet while she goes to complete her chores. As a result, children are not getting a socially stimulating environment, they get addicted to screens. They develop speech delay due to the lack of a stimulating environment or exhibit behavioural problems.”

Dr Saliha Afridi: 1) “Social life. Because a person has a lot of support like nannies and maids, they can have a lot more leisure time to spend on their social life. That results in lots of issues such as people falling behind at work, not getting enough rest/sleep, spending too much money, not tending to their partners, children or home.

2) Spending habits: People typically fall into two categories:

a) Indulge: Income does not match spending and they usually end up not saving. There are also those who have felt ‘deprived’ of certain things during their lifetime and once they come to Dubai and earn more, they feel that they ‘deserve’ more and, thus, end up spending what they make or more than what they make.

b) Live outside their means: Many people compare themselves to those that earn more, or spend more, and feel they should be able to afford similarly.

3) Parenting issues: I have seen that many parents love their new-found freedom because of maids and nannies so they feel that it is ‘their time’ and they can ‘indulge’ or ‘tend to themselves’. So children are not really getting the attention and care they need from their parents. This results in all sorts of issues such as behavioural difficulties, attention difficulties, anxiety, depression, and other serious mental health difficulties in children which then puts stress on the family and the marriage and the cycle begins.”

How significant a concern is the absence of extended families in an expat’s life:

Dr Sankar: “It is a significant concern for many, especially for parents with young children with no other form of social support. When they or the children fall sick and especially hospitalised, they have to depend on friends, many of whom are working and having the same issues.

Dr Afridi: “It really depends on what their relationship to their family is. I have seen this play out in two ways.

1) Missing: These people move away from their family and genuinely miss them, their company and their support. Their void is felt and may even be disruptive to their life or result in more serious difficulties like depression.

2) Free: This group of people moves away from their family and while they miss them, they have enough distance between them where they can grow, explore and come into their own.”

What are the psychological issues with children, teenagers and youth?

Dr Sankar: “There is an increase in the number of parents bringing children to get help for various reasons such as academic difficulties, poor focus and concentration, and overuse of gadgets.

“There are a number of issues among young adults and teenagers including poor emotional regulation, poor time management, delayed task initiation, following through on tasks, behavioural regulation, perfectionism and exam phobia.”

Dr Afridi: “Anxiety in children is the most common issue that we see, followed by depression. Parents are more likely to bring their children in for treatment and invest in the child’s well-being than to do it for themselves.”

Other issues:
a) “Parents of school-going children often come stressed that is related to their children’s poor academic performance.

Children develop anxiety about exams from 9th grade when the pressure to perform well starts. This peaks in grades 11 and 12. I have seen this in children attending schools with certain curriculums which are very demanding. The whole family goes through stress during exams. Traits of perfectionism and anxiety in the child coupled with unrealistic parental expectations worsen the scenario.

b) “Parents of college-going teenagers report behavioural regulation issues like staying out late night, not coming home after the class hours and smoking especially with boys.

c) “Teenage/young girls are reported by parents to have impulsivity, self-harm issues, slashing and cutting themselves due to lack of adequate emotional regulation.

d) “Many report overuse of the phone, inability to stay focused on their academics or work, and they have difficulty delaying their need to check their phones for message, internet and social media. This is culminating from a strong desire to stay continually connected with what others are doing, otherwise called “FOMO (Fear Of Missing Out) phenomenon. They get restless if they cannot check their phone frequently.”

What more can be done on a social, governmental and personal level to empower people to seek help for mental health?

Dr Afridi: 1. Educate: “As we have community campaigns for obesity, diabetes, and other physical health problems, we need to educate the community about mental health problems.

2. Normalise: “More and more people feel the pressure to be ‘happy’ all the time. They think being sad makes them dysfunctional or inept. They ignore, resist or deny their feelings and do not address them or treat them. Happiness is not the absence of difficult feelings like grief, anger, or sadness but rather a way of being with emotions. It is not feeling uncomfortable feelings but rather it is getting comfortable with feeling uncomfortable feelings.

3. Treat: “We need to let people know that treatment exists through the public and private sectors and we need to hold the treatment providers to the highest of standards. Low-cost or no-cost options of education and treatment should be made available for those who cannot afford the treatment.”

Dr Sankar: “Creating more awareness is the key. Awareness is a form of education. It can be created through newspapers, radio or television programmes, social media, talks, seminars, or workplaces organising talks about importance of mental health to their employees. Talking about it openly, with people sharing their stories, helps significantly. Discourage people from using words like “mad” or “crazy” to describe people with mental health issues.”

Initiative to raise awareness in schools

Dr Sankar strongly urges the removal of the stigma associated with pyschological issues among schoolchildren.

“The stigma associated with mental health issues is making children bully/tease their peers who need care and psychological support. The child with a mental health issue is probably coming from a culture/family where seeking psychological help is perceived as a weakness. These factors reinforce stigma.”

Dr Sankar offers advice on how to make it easier for children to seek help:
1) Encourage and appreciate children who are helping out/showing empathy to peers who experience mental health issues (behavioural problems, emotional problems, or problems associated with poor academic performance in school).

2) Recognise children who show empathy. Every school has to identify one person from each class. So, over the years, empathy and awareness become qualities to be admired. Chances are, over time, stigma fades. When a person understands that a peer is non-judgemental about their mental health issues they become more comfortable sharing their problem.

3) Schools should encourage children not to use derogatory words and phrases to describe children with mental health issues.

4) Schools should start initiatives in giving classes/showing short movies about mental health and community’s responsibility in helping a person with mental health issues to change the stereotyped image of the person with mental health issues. The themes should also include how words can hurt.

What are the common age groups and family profiles of people seeking help?

Adults stressed, and/or lacking support.

Parents seeking help for their children.

Married couples with children.

Couples going through marital discord and separation.

Singles for individual problems (adjustment, anxiety disorder, adult ADHD, depression, personality disorders).

Families where only one spouse is working.

(Dr Deepa Sankar and Dr Saliha Afridi)