Cairo metro suicide warnings shed light on Egypt's mental health apathy

Stigma about mental illness and lack of professional help blamed for crisis

Egypt’s Metro authority warning commuters not to commit suicide has shocked Egypt. AFP

In early September, a man committed suicide by jumping on the tracks in front of an oncoming train at a Cairo Metro station.

The response was shocking: Egypt’s Metro authority warned commuters not to commit suicide on the tracks because it would be an inconvenience to the public.

The insensitivity notwithstanding, it brought to light the issue of suicide in Egypt.

In the past three months, there have been more than seven cases of suicide by people jumping in front of Metro trains in Cairo.

Mental health and suicide are tough subjects in Egypt, as elsewhere. But public services are severely underfunded, professionals often lack adequate training and the stigma surrounding the issue means that mental illness is misunderstood and not talked about.

“Being depressed isn’t terminally ill but if you have a mental health issue and you go to Abbasiya [a mental health hospital in Egypt] or something, someone’s father won’t allow me to marry their daughter,” explained Ally Salama, who started the Facebook page Break the Silence Egypt to open a conversation about the issue among young people.

The Break the Silence Facebook page shares knowledge about mental illness and, perhaps more importantly, attempts to make people feel comfortable talking openly and honestly about it.

Just how prevalent mental health problems and suicide are in Egypt is difficult to gauge because of the stigma surrounding the issue – many people are unwilling to admit to having a problem.

As such, official statistics are often misleading and incomplete, augmenting the already complex situation of how exactly to define mental health illnesses.

A nationwide survey carried out in April by the Ministry of Health found that 25 per cent of Egypt’s population was suffering from some kind of mental health problem.

Of this, more than 40 per cent had anxiety disorders while 30 per cent of respondents identified as having depression linked to substance abuse, with a higher proportion suffering in the countryside, where there are fewer opportunities and more poverty.

Mental illness also seems to be on the rise.

Figures released in March 2017 by the General Secretariat of Mental Health stated 516,000 people were admitted to mental hospitals across the country in 2016, compared to 444,650 in 2015.

According to a study by the Journal of Clinical Psychiatry, Egypt is by far the most affected country in the region for depression, according to the metric of Disability-Life Adjustment Years (DALYs), a metric to measure overall disease burden.

Egypt ranks first in terms of DALYs with a figure of 622,000, with Saudi Arabia the next highest in the region with 201,000 DALYs.

Those suffering are also often young, explains Mr Salama, arguing that it’s because they are unable to secure their future by getting a good education and job.

“Why do a lot of people in Egypt commit suicide? Because they feel trapped,” Mr Salama says.

To compound matters, in Egypt, romantic and sexual encounters are largely taboo outside of marriage. Often the only way that people can be open to family and society at large about their relationships is to get married.

But marriage is expensive and, with Egyptian youth unemployment averaging at 30 per cent in recent years, making it work is out of reach for many.

That’s why, among other reasons, Mr Salama believes it’s so important for people to start talking more openly about mental health problems.

“People avoid it, people don’t talk about it and then the pressure falls on the kids, it’s toxic,” Mr Salama says. “A lot of adults don’t really realise it – because a lot of kids suffering don’t talk to the people closest to them.”

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Ostensibly, Egypt has one of the lowest suicide rates in the world, various studies and polls have found.

According to the World Population Review rankings in 2018, Egypt ranked in the bottom 10 countries globally for the number of suicides per capita, with 2.6 per 100,000 people.

The World Health Organisation (WHO) reported that the suicide mortality rate in Egypt was four cases per 100,000 people in 2016.

But anecdotal evidence suggests the rate is higher than statistics show – or at the very least, cases of suicide have become more prominent in traditional and social media.

According to the Egyptian Co-ordination for Human Rights, an NGO, from January to August 2018, there were 150 cases of suicide for people between the ages of 20 and 35.

Mr Salama, who is studying in Canada, says that each time he returns to Egypt, more of his friends are depressed.

“I believe [suicides are] underreported, I believe it's way more,” he says.

He says that he has had suicidal thoughts himself.

“To have that thought present in your mind is terrifying,” he says. “But Egypt doesn’t even have a suicide hotline for God's sake.”

Research suggests that suicide hotlines are important because people generally only have acutely suicidal thoughts for a short period of time, perhaps only up to an hour, so being able to talk to someone in such a state might be crucial to the person’s decision.

Dr Tamer El Amrousy who runs a private addiction clinic and was the former head of addiction with the health ministry, says that, as with drug dependency, people are often unwilling to seek help for mental health because of poor public infrastructure.

“No one seeks help because of the weak services,” he says. “We have a big problem with professionals leaving Egypt to travel to the Gulf for work because they receive very limited salaries in Egypt.”

Noting that there is a stigma surrounding suicide and that sometimes families of people who have committed suicide try to have the cause of death listed as otherwise, he still believes that the rate has increased.

“And if there is no effort to improve services it will continue to increase … people are angry and emotional at the moment with the state of affairs in Egypt,” Dr El Amrousy says.

Zeinab El Mahdy, who was in her early twenties, took her own life in 2014.

The reasons were not clear. Some friends suggest that her involvement in politics was a potential cause: she was bullied, essentially, because of the independent positions that she held.

Wedged in between the hostile camps, Ms El Mahdy felt stuck and lonely, later becoming depressed and despondent, according to a friend who spoke to her before her death.

“She was emotionally devastated,” explained her friend Hana, who did not want to use her real name to avoid upsetting friends. “And she isolated herself in the last few months.”

“The last time I saw her she said: ‘I have everything worked out,’” Hana says.

“It was sick. It was complex. She was very mature and very strong.”