Mental health overhaul planned

ABU DHABI // Mental health care in Abu Dhabi is to be overhauled as the Government attempts to tackle public attitudes and gaps in treatment and funding. The Health Authority - Abu Dhabi (HAAD) is researching how access to care can be increased and paid for while looking at ways to change perceptions of a traditionally taboo subject.

Mental health care in the UAE is haphazard, with a lack of psychiatrists and hospitals and no standardised means of funding treatment. Dr Oliver Harrison, the authority's director of public health and policy, said: "The authority is going through all our regulatory policies and standards to close up the gaps that we have." He said HAAD was investigating how services could be better paid for, as most private insurance plans do not cover mental health. It will consider what combination of private contribution, government payment and insurance coverage best suits Abu Dhabi's needs.

"We would want to look at whether the government would directly pay for services for mental health care, or whether there are sources of funding, other than health insurance," said Dr Harrison. "Typically, where health insurance does not cover a condition, there are other options. The first is the Government pays, [perhaps through] setting up a charity fund. Another is that people pay out of pocket."

People with mental health conditions can have difficulty paying for their treatment, he said, because of the effect the stigma can have on their lives. He said that educating Emiratis about mental health was also key to improving the services, and that HAAD was conducting research into perceptions. "We are trying to understand in Abu Dhabi, in the individual communities, why mental illness appears to be more stigmatising, in 2008, than it is in many other countries.

"There is something in the nature of mental health problems that makes people feel embarrassed or ashamed. It's deserving of sympathy to have a heart attack or cancer, but it's not OK to have depression, substance misuse, a personality disorder or schizophrenia." Dr Layla Asamarai, the head of psychology at Rashid Hospital in Dubai, said: "The biggest hindrance is a lack of knowledge about what psychological care means. Often people are very worried that you'll think they're crazy, but they're not, they're just troubled."

Dr Sana Hawamdeh, assistant professor of mental health and behavioural sciences at Sharjah University, said often mental illness was mistaken for people with bad attitudes. "They say she's having a breakdown, that it's her nerves, her way. They describe women as nakadah - the one who makes other people's lives hell. The problem is part of her personality and nothing unusual." Dr Asamarai said the stigma even prevented people from studying psychology, leading to a lack of Emirati counsellors.

"It is hard for an Emirati woman to study psychology because men won't marry them. They think that they might 'catch crazy' from their patients. The stigma runs very deep." Dr Harrison said the HAAD would also push to get more GPs involved in the treatment of mild mental health issues, such as depression, to base treatment in the community and reduce stigma. Currently, many doctors feel unequipped to deal with the situation, either choosing to ignore or downplay the problem.

"We want to make sure that people receive treatment in an environment most appropriate to their condition," said Dr Harrison. "In the West, you see psychiatric hospitals used for just psychosis, which is where people have a distorted picture of reality, as opposed to more common disorders such as depression, anxiety and personality disorders." He said for many patients, receiving treatment in a psychiatric hospital disrupted their lives and could damage their reputation.

"People might create rumours or feel embarrassed or ashamed about the fact that they have psychiatric disorders. "We do believe that a substantial proportion of GP consultations are mental health related, and those mental health problems can present in a variety of different ways, including chest pain, pains around the body, headaches, nerves, anxiety, stress, alcoholism, substance misuse. "They should also be aware of what counselling services offer by psychologists, religious groups and support groups within their community, so they can give advice to people about where they should turn to next."

Dr Yousef Abou Allaban, a psychiatrist from the American Centre for Psychiatry and Neurology in Abu Dhabi, said it was important to train GPs in how to deal with mental health complaints if they are to become the service's "gatekeepers". "To people here, trained in general medicine, psychiatry is a taboo - mental health is a taboo. This can lead to situations where doctors are either unaware that their patients have mental health issues, or do not know what to do about it.

"GPs are just not aware of the issue," said Dr Hawamdeh. "In the medical curriculum there is not a focus on mental health. The doctors in community health centres say they're not qualified because they have not had enough courses, they are even worried about referral." he HAAD plans to have its new policy document published within 12 months. The proposed changes would only affect Abu Dhabi but the mental health problem is so significant that other health authorities are also looking at it.

The Ministry of Health announced last month that it would be including psychological tests in a health survey of children. Dubai Health Authority is consulting professionals from around the world on mental health provision. Mental health care is split into two fields. Psychiatrists are medically-trained doctors who specialise in treating mental disorders. Some have undergone extra training in therapy. A psychologist has not trained in medicine. The National has reported how haphazard services have allowed some psychologists to illegally prescribe drugs for their patients.