Stigma originally meant a mark made on the body by pricking or branding. In the past we did this intentionally, for example, by branding the letter F on to a person’s face to mark them as a felon. The convicted would forever wear the shame of their misdeeds, making it very easy for polite society to shun and exclude them. Today’s stigma is not nearly so brutal, but the consequences are similarly damaging. This is especially so when we stigmatise people experiencing mental health problems.
Today we talk about social, rather than physical stigma, and we continue to unjustifiably stigmatise people with psychological disorders. People with such conditions can find themselves being viewed as somehow defective, dangerous, suspect, or perhaps even responsible for their own problems. Such unhelpful attitudes are rapidly falling out of fashion although they continue to exist. A recent article in this newspaper discussed how the fear of social stigma often prevented people from seeking help for mental health problems.
This is particularly problematic when there are many people who could benefit from such help. The widespread prevalence of mental health problems in the Gulf countries is fairly well documented. For example, a study of mental health problems undertaken among more than 1,600 Qatari citizens reported a rate of 13.5 per cent for clinical depression. Those most likely to experience depression were in the age group 18 to 34. They were also those with the highest levels of education. This makes depression a huge challenge for workforce nationalisation.
In the UAE, more than a decade ago now, a large-scale study known as the Al Ain Community Psychiatric Survey was undertaken. This study involved conducting diagnostic interviews with more than 1,300 Emiratis, with a view to determining the prevalence of mental health problems. The study found that the most commonly diagnosed issue was clinical depression, with rates of 2.8 and 10.3 per cent for men and women, respectively. This is one of the most gender skewed ratios reported anywhere in the depression literature. The study’s authors suspect that Emirati men were underreporting.
As social stigma erodes – as it is – people will find it easier to report problems, and actually start seeking help. This then throws up the issue of access to help. For example, in the context of depression in the UAE, how accessible are the most effective, evidence-based, treatments? For some mental health problems – depression included – research suggests that talk-based psychotherapeutic interventions are the most effective means of treating the problem, and more importantly, preventing future relapse. How many qualified psychological therapists do we have? How many do we need? These are undoubtedly strategic questions of national importance.
Many of the UAE’s mental health professionals bemoan the lack of experienced psychologists. I agree, but I would also suggest that all experienced psychologists were once inexperienced, and before that they were students. Both healthcare and educational institutions have a key role to play in increasing the numbers of experienced and culturally competent mental health professionals. How best to prepare the healthcare workforce of tomorrow, today? This is another strategic question of national importance.
In addition to our focus on de-stigmatisation and improving access to psychological therapies, we also have to think about prevention. Public health professionals are right to focus on weight loss and smoking cessation, but they can’t afford to ignore depression, the world’s leading burden of disability. How can we best safeguard the psychological well being of the UAE’s population, and how can we best promote emotional resilience, and who should do this?
It has become a bit of a cliché that our universities are places where we prepare students to perform jobs that don’t even exist yet. I would argue that these are some of those jobs. We need professionals who can prevent the onset of psychological problems and be instrumental in promoting well-being. Given the chronic and recurrent nature of many psychological problems, our national strategies for mental health cannot overemphasise prevention.
Dr Justin Thomas is an associate professor of psychology at Zayed University and author of Psychological Well-Being in the Gulf States
On Twitter: @DrJustinThomas
