On the occasion of World Mental Health Day, The National speaks to doctors about the upcoming Mental Health Act and its future impact on the country’s mental health care system.
Psychiatrists and psychologists have spoken out about the need to update the UAE’s mental health law and improve services across the country, which they described as “suboptimal”.
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 draft an update for 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 will be more comprehensive and outline a framework for the logistics needed to support mental health services in the country.
He said the scope of mental health services will be more integrated under the law which will govern both public and private sector hospitals.
"The new law will develop it so that it’s not only treatment but awareness, battling the stigma and we enriched it by involving social bodies such as a social support centre.”
He said the law will also allow medical teams to deal directly with patients who have attempted 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’m depressed and wasn’t successful in committing suicide, being arrested will add to my burden.”
Under the new law, specialised teams comprised of medical professionals will determine the course of treatment for a patient. Police involvement will be at the discretion of the medical team.
Dr Faisal Abdullah, a psychiatrist at Seha’s Sheikh Khalifa Medical City 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 which is haphazard.”
Dr Abdullah said that police intervention is sometimes necessary particularly with patients who are a risk to themselves or others.
“Sometimes they are helpful and sometimes they are not. Sometimes they refused to enforce a judgment from a judge that says for example that a patient must be forcibly admitted to the hospital. These patients’ families come to us because they are at the end of their rope and can’t themselves bring in the patient who is a risk. The police should help us and protect us, and the patients and their families must understand that they are not there to embarrass or punish them but to help us treat them,”
Often he said, without police intervention, patients suffering with acute episodes will refuse to be admitted into the hospital for treatment.
A topic the law does not address, however, is the level of involvement private sector hospitals are afforded when treating mental health patients.
Non-government hospitals are not permitted to have inpatient facilities and their doctors cannot involuntarily admit a patient.
At present, patients requiring admission must be referred to a government hospital.
“A higher committee will define the roles of all the partners to ensure that there is no abuse of power so it will be limited to specific areas – currently it is just government hospitals,” said Dr Al Hassani.
At Seha's Sheikh Khalifa Medical City, patients suffering from mental health 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.
The implementation of the law would mean more community work and services such as that performed by the Behavioural Sciences Pavilion, will be possible.
The drafted update also does not address the lack of research and statistics available in the country.
“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. It’s reported in every country in the world and we realise that it is negative on the community but it is also useful to us to ensure that we have the right protocols and it helps us protect this vulnerable population who are under stress or have been subjected to abuse,” said Dr Al Hassani.
He has been collecting data on the number of suicides in the UAE for the past three years.
Per month, the psychiatric department at Al Ain hospital sees between 1,200 to 1,400 outpatients of which more than 65 per cent are UAE nationals.
“Currently 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 and not useful for us. Unless we have a national registry and proper registration and management, the figures we have now are useless.”
Generally, suicide rates are low among Emiratis but are particularly high among the expatriate labour force, Dr Hassani said.
The most recent study was published in 2011 in the International Journal of Social Psychiatry and it showed that in Dubai suicide rates among expatriates were seven times higher than the rate among nationals.
“Our numbers are low but it is increasing because of lifestyle changes, increased stresses, high divorce rates, drug issues – the trend is there so we need to start taking action now," Dr Al Hassani said.
He stressed the need to address mental health issues now as doctors have begun to notice an increase of cases among children and young adults between the ages of 14 and 20.
“At the hospital, we see two to three attempted suicide cases per month and sometimes we see none at all. But our main issue is that we have to report all of them but that doesn’t apply for drug abuse, for example,” he said.
Current predictions from the World Health Organisation indicate that by 2030 depression will be the leading cause of disease burden globally.
- A bazar organised by the Behavioural Sciences Pavilion will be held at SKMC on Tuesday, in time for World Mental Health Day. It is open to all visitors from 9am to 2pm who are encouraged to by some of the artwork made by the patients. Proceeds are split between the patients and funnelled back into the program.