New research has shown that less than half of the healthcare professionals working with children and adolescents in the UAE are able to identify the three major mental illnesses or recommend the correct treatment.

It is one of a number of challenges facing developments in addressing mental health treatment in the UAE, which are being targeted by an international team of academics to assess means to better protect children and adolescents – those most vulnerable to developing mental health conditions.

Dr Nabeel Al Yateem

Dr Nabeel Al Yateem, assistant professor in the department of nursing at the University of Sharjah, has been leading the project, which saw 641 healthcare professionals working in hospitals and schools across the UAE interviewed about their knowledge of mental health conditions. Of these, less than half were able to correctly identify the signs and symptoms of the three major mental illnesses: Post-traumatic stress disorder, psychosis, and depression with suicidal thoughts; nor were they equipped to recommend treatment.

Dr Yateem said these are “the people who play a vital role in the initial recognition, assessment, and referral of children who are at risk of developing mental health issues or those who are already experiencing such issues”.

He says the findings are “concerning” and show a huge need to not only reform current healthcare education but also to up-skill healthcare professionals and experts working in schools and hospitals.

Co-researcher Dr Rachel Rossiter, associate professor at Australia’s Charles Sturt University, said more research into mental health is vital as issues commonly develop during teenage years or early adulthood.

“Undetected and untreated mental illness greatly impacts upon every aspect of a young person’s life at the time when they are undertaking their education, building the skills and the relationships that will equip them for a productive and healthy life as a contributing member of their community. Increased funding for research will likely improve data on the burden of the illness; provide evidence on which intervention offers value for money, which interventions work; and how preventive measures can be incorporated in the national guidelines for the management of mental illness.”

Long-held cultural and religious beliefs still prove a challenge to overcoming the stigma surrounding mental health. Dr Rossiter said: “Some of the cultural influences and strong levels of stigma toward mental illnesses present in a significant proportion of the UAE population, tends to negatively affect the willingness to seek professional help. For many people experiencing emotional distress, religious beliefs have been linked to a strong preference to seek treatment or help in times of need from traditional treatment providers or using prayers and religious practices to manage psychological distress.”

Globally, insurance cover for mental health, continues to be a challenge, and the same can be seen in the UAE, says Dr Michael Otim, assistant professor at the University of Sharjah, who said: “While mental illness has been identified as the greatest cause of morbidity [illness], loss of productivity and diminished quality of life, the percentage of GDP spent on mental health services compared with general health services fails to reflect the impact of mental illness on individuals, communities and the economy. In the UAE, there is limited insurance cover for mental health. As if it is not difficult to overcome stigma to access mental health services, meeting the hefty costs of therapy, in the form of co-pays and high deductibles makes access to services difficult. UAE nationals have full cover for both psychiatry and psychology therapy, but expats have very limited cover are provided by insurance companies.”

Osama Diabat, clinical leader on the psychiatric nursing team in Rashid Hospital, agrees. He said: “Making the difficult decision to reach out for help with anxiety, depression or an assortment of other mental health issues is only the first hurdle. The next challenge is meeting the hefty cost of therapy. In the UAE the majority of basic insurance covers does not include coverage to mental health services. The coverage to such service has to be added to the plans, which will consequently cause a significant increase in the cost of insurance plan.”

The UAE has additional environmental and cultural risk factors for the development of mental health problems, particularly among the young, says Dr Shameran Slewa-Younan, senior lecturer in mental health at Western Sydney University, including large family units and consanguineous marriages.

“Consanguineous marriages have been shown in several epidemiological studies to be a contributing factor for a number of genetically transmitted mental illnesses with a higher risk of schizophrenia or bipolar disorders among offspring from consanguineous couples. Further, due to the rapid industrialisation of the

UAE, reports of high serum levels of heavy metals have been potentially linked to an increased number of children exhibiting learning disabilities in the UAE.”

These factors and the identification of mental health care services as a priority area in current UAE health care policies, he says, point to “a strong need to further develop existing mental health services”, in particular, “to support children and adolescents living with chronic illnesses to achieve their full potential physically, psychologically and emotionally”.

Dr Yateem says there is hope. With new medical graduates having gone through compulsory mental health first aid training before commencing their degree or before undertaking their first clinical placement, he says things are slowly improving.

“However, there remains much work to be done in this area, not just in improving mental health literacy, but also in ensuring that this translates into person-centered, compassionate and evidence-based care. It is imperative that a focus on improving mental health literacy is not limited to health professionals, but is extended to the entire community. The ability to recognise early indicators of a developing mental illness and to respond appropriately in assisting the person to access appropriate help makes a significant difference to the longer term outcomes for the person. Just as early detection and treatment for physical conditions such as diabetes and cardiac disease can prevent the development of severe disease, the same holds true for conditions such as depression and psychosis.”

The research, ‘Clinical and Economic Evaluation of a Community Mental Health Support Service For Children and Adolescents With Chronic Conditions in the UAE’, has been funded with the support of the Al Jalila Foundation. Its then-CEO, Dr Abdul Kareem Sultan Al Olama, said mental health must be a bigger focus today.

“It is believed that worldwide one in five people suffer from mental health issues and whilst we do not yet have any data in the UAE, we are not immune to these statistics. According to the World Health Organisation, depression will be the second-highest cause of disease burden by 2030, so the time to act is now.”

Since 2014, 13 of the charity’s 76 grants have focused on mental health. “Mental health constitutes some of the most serious, unrecognised and underreported health problems around the world. The alarming statistics (from WHO) mean that mental health is likely to affect a significant part of the population and we need to start taking the condition more seriously, be it collecting data, offering relevant services and looking at ways to better support those affected,” he said.

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Shattering the social stigma attached to mental illness is a major part of the process too, he says.

“Breaking the taboos is the first step to creating a more compassionate society where people affected by mental health are not discriminated against or marginalised. It will help to collect data and understand the extent of the issue. It will also encourage people to look for support and access available services. In our efforts to reducing the stigma we sponsor a mental health journalism fellowship programme at the Carter Center to encourage journalists to report on topics related to mental health and mental illnesses thereby creating a better understanding of the condition in the society.”