Experts call for focus on mental health issues
▶ On the occasion of World Mental Health Day, The National speaks to doctors about the draft law awaiting approval and its future effect on the approach to treatment in the UAE
On World Mental Health Day, psychiatrists and psychologists in the UAE are calling for an update to the country’s mental health laws and services, which they say require heavy improvement to meet international standards.
Doctors described the country’s mental health system as sub-optimal, saying it lacks data, comprehensive insurance coverage, social services and inpatient facilities.
In 2013, a group of medical professionals drafted an update to the country’s Mental Health Act – which was introduced in 1981 – but are still awaiting its approval from the federal government.
The new law is expected to shift the authority of handling mental health patients who are a potential risk to themselves and others from police to medical professionals. It will also address suicide for the first time.
“Psychiatrists and psychologists will have a bigger role in laying down treatment plans for people who require intervention and admission,” said Dr Ghanem Al Hassani, consultant psychiatrist at Al Ain Hospital, and one of the doctors who helped draft the updated law.
He said the new law will be more comprehensive but will not, however, address the need for a national registry to collect data on the prevalence of mental health issues in the country.
Psychiatrists and psychologists have spoken about the need to update the UAE’s mental health law and improve services in the country, which they described as “sub-optimal”.
They said the UAE’s mental health system lacks data, comprehensive insurance coverage, social services and inpatient facilities, which is keeping it from meeting international standards.
“Currently the standards are low. We need to raise the bar to meet the needs of the community,” said Dr Ghanem Al Hassani, consultant psychiatrist at Al Ain Hospital.
Dr Al Hassani was among a team of medical professionals who helped to draft an update to the UAE’s Mental Health Act, which he expects to come into effect early next year. He said the updated law will shift authority for handling mental health patients from police to medical professionals and address suicide for the first time.
“The original Mental Health Act was introduced in 1981. It had no reference to suicide but mentioned mental illnesses and the role of government sectors and the police in detaining patients in general but not specifically,” he said.
Dr Al Hassani said the draft has been ready for three years but is awaiting approval from the federal government.
The new law, which will governs public and private sector hospitals, will be more comprehensive and outline a framework for the logistics needed to support mental health services.
Updating the law will help “develop it so that it’s not only treatment but awareness – battling the stigma – and we enrich it by involving social bodies such as a social support centre.”
He said the law would also allow medical teams to deal directly with patients who attempt suicide. “Currently it is more in the hands of the police and judicial authorities but after the law [is passed], we will become partners and the responsibility is shared.
“Psychiatrists and psychologists will have a bigger role in laying down treatment plans for people who require intervention and admission.”
At present, all cases of suspected suicide must be reported to the police. Individuals are not arrested but are questioned by police who then defer to a doctor
for a medical report.
If the report states that they suffer from a mental illness such as depression, then they are not jailed as per the law which states that any individual who attempts suicide shall be fined and/ or will be jailed.
Some medical professionals see police involvement as a deterrent to suicide but Dr Al Hassani disagrees.
“It is not a deterrent because when someone decides to take their own life, they don’t consider religious or legal matters. Police involvement does not reduce or prevent suicide.
“In fact, if I was depressed and wasn’t successful in committing suicide, being arrested would add to my burden.”
Under the new law, special teams of medical professionals will determine the course of treatment for a patient and police involvement will be at their discretion.
Dr Faisal Abdullah, a psychiatrist at Seha’s Sheikh Khalifa Medical City (SKMC), said there was still room for police involvement but that it should be regulated. “What we want and need is proper police intervention, an act to have a set of consistent rules as opposed to police intervention that is haphazard.”
Dr Abdullah said that police intervention was sometimes necessary, particularly with patients who are a risk to themselves or others.
Often without police intervention, he said, patients suffering acute episodes will refuse to be admitted to a hospital.
A topic the law does not address, however, is the level of in- volvement private hospitals are affordedin treatment.
At present, patients requiring admission must be referred to a government hospital.
At SKMC, patients suffering from issues such as biopolar disorder, schizophrenia and depression can be referred to a day centre by psychiatrists where they are rehabilitated using group classes such as art, yoga and cooking, that are performed by the Behavioural Sciences Pavilion.
“All developed countries have a national registry except for the UAE. A registry will not only help us track the numbers but also do proper research and run awareness programmes. We need transparency.”
Dr Al Hassani has been collecting data on the number of suicides in the UAE for the past three years.
Each month, the psychiatric department at Al Ain hospital sees between 1,200 and 1,400 outpatients of which more than 65 per cent are UAE nationals.
“Any study about suicide is difficult. Data is very limited and inaccurate because people don’t want to declare it, so even the available data currently is not accurate. Unless we have a national registry, the figures we have now are useless.”
Generally, suicide rates are low among Emiratis but are high among the expatriate labour force, Dr Hassani said.
A 2011 study published in the International Journal of Social Psychiatry showed that, in Dubai, suicide rates among expatriates were seven times higher than among nationals.
He emphasised the need to address mental health issues because an increase is noted in cases among children and young adults between the ages 14 and 20.
Current predictions from the World Health Organisation indicate that by 2030 depression will be the leading cause of disease burden globally.
Homework, extra tuition, exam preparation, afterschool sporting activities and music lessons are just some of the things that students cram into their daily schedules. Add to that constant pressure from peers and the unending demands of social media, and the result is a rather chaotic day. In the midst of all this, young people are seeking a calm space where they can just “be”. For many, mindfulness is proving to be the answer they seek.
The opposite of multitasking, mindfulness requires you to focus on one thing at a time. Jon Kabat-Zinn, a scientist, writer and meditation teacher, explains: “Mindfulness means paying attention in a particular way: on purpose, in the present moment and non-judgementally.”
The concept seems far removed from fun-loving, naughty children and socialmedia-loving tweens and teenagers. Nonetheless, it is becoming an increasingly popular philosophy among young people, with a handful of schools in the UAE creating dedicated mindfulness rooms and introducing mindfulness sessions under the watchful guidance of counsellors.
Greenfield Community School in Dubai has introduced a mindfulness room and a dedicated programme in which children from primary and secondary school engage in mindfulness. Andy Wood, principal at Greenfield Community School, explains how one of the school’s teachers, Rola Ghadban, conceptualised the room and the classes, which encourage children to perform relaxation and breathing exercises, among other things.
“This is an opportunity to slow down and think; to take your shoes off and feel the carpet, to relax and breathe and collect one’s thoughts. Those teenagers need a calm place in a crazy, busy, noisy world,” Wood says.
The school started with a mindfulness room in the primary section last year and has now rolled it out into its secondary school. Most importantly, students have “taken ownership of the programme”, Wood explains.
“It has added a calmness to the school, though the difference can’t be measured in mathematics scores. How do you quantify happiness and contentedness? These are incredibly important qualities of character. We are aware of the need to [create] a balanced experience at school, and include time for physical and spiritual and mental health.”
“This is one of these really important things to do. You can count your sports scores and the number of victories or your exam results. It’s difficult to measure well-being. I would encourage schools to explore different options to support student well-being.”
Dr Christine Kritzas, counselling psychologist at The LightHouse Arabia, a mentalhealth clinic in Dubai, confirms that teaching mindfulness to children and adolescents is a growing trend in the region.
“I believe a reason for mindfulness becoming a buzzword in the UAE has a great deal to do with the fastpaced, transient nature of this region,” she says. “As a result, individuals are desperate and hungry to find coping strategies that will bring some stillness and peace of mind, amidst the excitement and chaos that this interesting yet challenging region provides.”
The idea that mindfulness can only be achieved when you are in a quiet room is misguided, however. Once you master the technique, you can be mindful in any environment – while taking a walk, doing yoga, meditating or even going to the mall. And it should not only be used in reaction to specific problems that a child might be facing; it can also be used in a preventive, proactive way by well-adjusted children, Kritzas explains. She uses mindfulness in combination with cognitive behavioural therapy and narrative therapy because it complements other therapeutic frameworks.
With stress affecting many children and teenagers in
the UAE, research suggests that mindfulness alleviates symptoms of depression and anxiety in children, and can improve attention spans in the classroom. Nonetheless, it is important to note that it is not a one-size-fits-all solution.
“Parents often think of mindfulness as a silver bullet, but it isn’t,” Kritzas says. “Parents must also provide a nurturing and mindful environment at home.”
For Haneen Jarrar, a counsellor and head of Camali Clinic’s School Readiness Programme, mindfulness is about being in the present moment while being aware of your emotions, and clearing your mind of any thoughts about the future or the past.
“Mindfulness is not intuitive as our brain is wired to make us feel anxious,” she says. “You have to actively and purposefully train your brain not to go into an anxious state, but focus on the present.
“People are just starting to realise how effective and simple it is, and that’s why it has become so popular. It is a skill that can be taught very early on, and that’s why they have started teaching it in schools. A lot of schools are replacing detentions with mindfulness. Mindfulness can help children with anxiety because when you are mindful, you can’t worry about what will happen in the future,” Jarrar concludes.
Joanne Jewell, a child and adolescent family counsellor, runs workshops on mindfulness in the UAE for parents as well as children. She agrees that children in the UAE are under an increasing amount of pressure. “We are all looking for ways to alleviate stress, and people are seeing the result of stress when they are bringing up a family,” the mother of three says.
“Social media and the internet have created an environment where people are multitasking all the time. I think we are becoming more aware of the negativity of doing that. People are looking for a way to combat that. Mindfulness is free and easy to do, and you can do it anywhere. People feel the benefit very quickly. They feel calmer and more able to understand their own emotions. It improves children and adult’s self awareness and they find they are sleeping better.
“In Dubai, I think children don’t get enough time to be outside and play and just be. We are teaching them how to be, rather than do.”