Mental Health in the Middle East & North Africa: Is the Stigma Over?

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“What mental health needs is more sunlight, more candor, more unashamed conversation” (Glenn Close)

How many times have you attempted to discuss your mental health and it was ignored? 

Why is mental health deemed less important and trivial compared to physical health? 

Just because suffering occurs mentally, should it not count as ill health?

These are the many questions people ask themselves regarding mental health, just because it is not seen or talked about, does not mean it does not exist. 


There are many factors that play into mental health being regarded as a “hush-hush” topic. The biggest factor would be Culture.

Culture is a culprit of treating mental health as nuanced and problematic.

The Arabian culture in the Middle East and North Africa have always ignored mental health as an actual problem in society, but today, with increased technology and openness to new ideas and ideologies, there is an attempt to eradicate the barriers of ignorance towards mental health in these countries and in their culture.

How is mental health seen in Arabian culture? 

It is heavily stigmatized, is associated with family shame and personal failure, and more controversially, caused due to the lack of the Islamic faith and demonic possession.

Source: Unsplash

The stigmatization of mental health is extremely detrimental; stigmatization of any mental health worsens the problem. In this culture, seeing mental health as a source of shame, personal failure, and an excuse for laziness and in general seen as taboo will keep the individual quiet, and thus, they will less likely talk about their suffering and seek medical or psychological help. 

As portrayed by Reuters Event, “this stigmatization is more detrimental for women because of the conservative societies they live in, rigid gender roles, social and political marginalization and sexual and physical abuse contributed to the mental illness of women. In these societies, women are kept quiet over fear of what people will say and they are oppressed in society.” 

Source: Psychology Today
Source: Times of Malta

Thus, a large portion of women in these countries suffer from mental health illnesses mainly depression, anxiety, and PTSD because of the abuse they suffer. These women who have grown up having this being a norm in their world and seeing it occur to other women in society has made them quiet and internalize their problems.

Source: Unsplash

According to MentalEast Medical, “The internalization of the problems results in increasing mental stress, which ultimately leads towards clinical depression and even suicides in most of the cases.” 

Today, even though mental health awareness is being discussed world-wide, the Arab world still lacks the foundational knowledge of accepting mental health as an illness. 

If there is an attempt to discuss mental health, what many people will hear is “fix your relationship with God, and everything will be sorted.” 

Are these words supposed to be comforting? Are they supposed to be the remedy to mental illnesses? 

The influence of the culture and their words oppresses the individual from seeking help, even with the limited availability of resources for mental illness, people will keep their issues to themselves and allow themselves to suffer in silence because of culture. 

“Sticks and stones may break my bones, but words will never hurt me” is a lie, the words of people do hurt, when attempting to discuss your issues of mental health, how many of you have been silenced and have heard hurtful words towards yourself? 

“Lazy.”

“It’s all because of that phone.”

“You want to get out of studying.”

“In my days, there was no such thing as mental illness.”

“Be quiet, if so-and-so hears what will they say about us!”

If you have heard that and countless other similar discouraging words when attempting to speak of your mental illness, put your hand up as you are not alone. 

These discouraging words hurt, they break people, and when internalizing these hurtful words and keeping quiet about mental illness, your mental health will deteriorate.

On the positive side, Arab youth today are trying to vocalize the issues of mental illness as a problem that must be taken in consideration of needing more talk, less shame, and services to help people with mental illnesses.

Source: Unsplash

Every year, an Arab Youth Survey is conducted by ASDA’A BCW comprising 17 Middle East and North Africa Countries (MENA).

According to the Arab Youth Survey conducted in 2020, 38% of respondents know someone who is struggling from depression and anxiety.

56% of Arab youth say it is difficult to get quality medical care for mental health issues in their country.

Young Palestinians (85%), Yeminis (80%) and Syrians (77%) mostly said that the quality of mental health care is difficult to access.

Almost half, 48% of Arab youth said that seeking medical health care for mental health issues is viewed negatively by people in their country.

The social stigma of mental health being highest in; Morocco (76%), Lebanon (72%) and Libya (70%).

With 65% of the Arab population comprising people under 30, this survey has highlighted the importance of mental health interventions. There should be a consensus focus on dealing with mental health because of the alarming rates of mental illness in the countries. 

Despite this research and its finding, Middle Eastern and North African countries do very little to solve this issue. They devote a minimum to little of their health budgets to mental health care.

Moreover, according to Center For Strategic & International Studies, “among individuals who attempt to seek treatment, they may face misdiagnosis at hands of primary care physicians who are often overworked and have little training in mental health.”

Strained health budgets and stigmas with accepting mental illness have prolonged these problems; governments are now attempting to resolve these problems by having public awareness campaigns about mental health, the more important, there must be resources put in place to help people who are victims to mental illnesses.

All hope is not lost! 

In recent years, many MENA countries are trying to address the neglect of mental health services through “decentralization of psychiatric units into general hospitals, training programs for healthcare professionals and public-awareness campaigns.”

Qatar, United Arab Emirates, Saudi Arabia, and war-torn Syria are some MENA countries that are attempting to destigmatize mental illnesses and put the issues into the forefront.

QATAR

Qatar Ministry of Public Health “launched a mental health strategy in 2013 which was set out as a vision for a mental health system in Qatar. The vision was to provide good mental health and wellbeing for the people of Qatar supported by integrated mental health with access to the right care at the right time in the right place.” The strategy had four specific objectives; “mental health promotion and prevention, provision of comprehensive and integrated services, strengthening of mental health leadership and governance, and improvement of information systems, research, and evidence-based practice.”

This graph discusses the key achievements of the Qatar government towards mental health services.  (Source: Qatar Ministry of Public Health)

Regarding 2019-2022, mental health is seen as one of the 16 priority areas for the public health agenda in Qatar.

Some of these new models’ “priorities will be encouraging positive dialogue around mental

health and wellbeing, making a real difference in improving mental health and working together in partnership with key stakeholders to ensure high-quality mental health services, developing the data system efficiently, and importantly, support the implementation of the Mental Health Law in Qatar society.”

Thus, Qatar is rapidly creating mental health services to help their population. They are a MENA country which is taking mental health as a priority in their agenda.

United Arab Emirates

The UAE government regularly takes new measures and initiatives to address mental health issues and reduce the stigma attached to it. 

The National Policy for the Promotion of Mental Health in the UAE identifies five main strategic objectives:

  1. Enhancing the effectiveness to promote the awareness of mental health and reducing the stigma.
  2. Developing, strengthening and integrating responsive mental health services for patients of all ages.
  3. Strengthening multi-sectoral collaboration to implement mental health promotion policy.
  4. Promoting the prevention of mental health disorders for all ages
  5. Strengthening capacities and improving information systems and conducting mental health research to develop their services.

“Many actions of the policy focus on the provision of mental health services to outpatients, developing mental health institutions for inpatients in mental health hospitals, and establishing community mental health services.”

For example, the Ministry of Health and Prevention organized awareness lectures in English and Urdu to raise Sharjah taxi drivers’ awareness on mental health disorders. A medical team from the ministry conducted examinations of 100 drivers to assess their mental health and they distributed mental disorders related brochures on how to control these disorders and places they can go for diagnosis and treatment.

Dubai’s Health Authority observes 10 October every year as World Mental Health Day. “In the Arab world, it is estimated that 17.7 percent of the population suffers from depression.” This is just an estimate, and it does not include the people who feel stigmatized and ashamed to discuss their problems.

Dubai is increasing their knowledge of mental illnesses and is providing services to people, especially people who have much more vulnerability of having mental illnesses. They want to increase their mandate which is why they are creating many policies.

Source: Twitter
Source: u.ae

SAUDI ARABIA

The Borgen Project talks about Saudi Arabia growing mental healthcare resources, “The government began to improve their mental health services in 1983, to address their mental health crisis. The government has a General Department for Mental and Social Health (GDMSH) developed in 1983. Their task is to improve access to and quality of mental healthcare in the nation.”

Primary healthcare centers became available with the purpose of opening these services to Saudi citizens. “The GDMSH uses the First National Strategic Plan to modernize their psychiatric facilities and provide well-trained staff for mental healthcare institutions. The GDMSH is currently working to protect the rights of patients in the mental healthcare system.”

In 2014, the Saudi government established a Mental Health Law, and with the assistance of the World Health Organization to generate data on the state of the mental health services in the country, and converted their findings into legislation, and thus, passed the act.

Saudi Arabia has made great steps into improving its mental healthcare, “they have a 55% ratio of psychiatric nurses to mental healthcare professionals which is reportedly 37% higher than most developed countries.”

 Although this nation still has a lot more progress to create, they are on the right track.

Source: Arab News
Source: Al Arabiya

Syria

According to the World Health Organization, “In Syria, approximately 1 in 10 people are expected to be living with a mild to moderate mental health condition, while 1 in 30 are likely to suffer from a more severe condition. Prolonged exposure to conflict increases the prevalence of mental health conditions, yet stigma and shortages of trained health workers are barriers to treatment.” 

“WHO and its partners have decentralized mental health care and have increased community-based approaches. Such as trained and supervised doctors and health workers who are attempting to provide integrated mental health care in over 540 primary healthcare centers in Syria.”

WHO supports health facilities with regular supplies of mental health medicines and covers operational costs of inpatient units in hospitals, moreover, they have created four mental health mobile clinics and 24-hour telephone helplines.

“Syrian schools have integrated a school mental health program which was launched in 2018, teachers, counsellors and social and community workers in schools and community centers are trained on how to detect, help and refer to children who go through mental health disorders.”

The outcome of WHO’s presence in Syria has been reflected in the improved effectiveness and performance of the Syrian health and community care providers.

WHO’s efforts to integrate mental health into the healthcare system has been substantial, with the on-going war, it is exceptional how WHO have used their resources to help the people of Syria deal with mental health and diminish the stigmatization and the lack of knowledge of mental disorders. 

This is a great start from the MENA countries to destigmatize mental disorders and implement it as an issue that needs to be addressed.

Mental Health Resources

Mental Health resources are needed in the Middle East and North Africa, and there are many programs and organizations which are helping to demolish the barriers to mental health stigmatization and help people suffering.

International Medical Corps

Source: Mental Health Innovation Network

International Medical Corps is an international relief organization that helps to prioritize prevention and treatment of mental health and psychosocial needs in humanitarian crises. They advocate for mental health care with donors, governments and policy makers to assess needs and mapping services and promote best practices and guidelines.

World Health Organization

WHO works with member states and partners to improve the mental health of individuals. They promote mental well-being, prevention of mental disorders, and efforts to increase the quality care that respects people’s human rights. They have extended mental health care services in more than 110 countries and have launched the WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health. They are active in the areas of integration of mental health in general health, suicide prevention, workforce development for mental health, promotion of the quality of care and rights of people receiving care and mental health policy and legislation.

Suicide Hotlines

http://www.suicide.org/international-suicide-hotlines.html

This website provides hotlines for suicide prevention and awareness along with countries that have suicide hotline numbers. As mental health is stigmatized in Arabian culture, and there is not enough action against mental health people who are suffering in silence can attempt to end their suffering by suicide. Therefore, suicide hotline numbers are made for people to talk to professionally trained mental health volunteers and speak of their issues. This is important because often, the people we are close to do not understand the problems that other people would understand.

World Federation for Mental Health

World Federation for Mental Health is an international membership organization to advance the prevention of mental health and emotional disorders, the proper treatment for these resources, and the promotion of mental health.

Conclusion

MENA countries rely on international relief organizations to get mental health resources in their countries. As mental health research and understanding of mental illness is increasing in these countries, the health providers and government do not know how to take the proper steps to ensure that mental health awareness will increase. Thus, they rely on these international organizations where they team up with international organizations to make efficient mental health services. 

Moreover, mental health services have been improving in the Middle East and North Africa, it is because of the world-wide interconnection and globalization which is helping to stop the barriers on mental illness and achieve help for people.


As Michelle Obama puts it “At the root of this dilemma is the way we view mental health in this country. Whether an illness affects your heart, your lung or your brain, it’s still an illness, and there should be no distinction.”

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