How to go about the burden of mental health in the region

In Arab culture, expressions are riddled with the topic of health — common when about to enjoy a meal (bil saha wal hana, which means “in health and wellness”) — but also the typical way of asking how someone is (keef sahtak, or “how is your health”).

But what is good health?

It is as much the mental as it is the physical and yet, we seem to focus on one more than the other. 

This neglect has been taking its toll, as the burden of mental health in the Eastern Mediterranean Region (EMR) is much higher than in the rest of the world and continues to rise. 

It is time to put a stop to that. 

In the recent “Burden of mental disorders in the Eastern Mediterranean Region” paper, myself and my fellow collaborators highlighted that countries in EMR, which comprises nations in the Middle East and North Africa, as well as Afghanistan and Pakistan, have higher rates of mental health disorders than the rest of the world.

More specifically, we found that mental disorders such as depression and anxiety accounted for 19 per cent of years lived with disability (YLD) in the region, compared to a 17.4 per cent rate globally, making them the leading cause of non-fatal disease burden in the region.

The numbers speak volumes, and are alarming. Not only are YLD in the EMR more than in the rest of the world, but at 9.7 per cent, the increase in the burden of mental illnesses is almost twice the global rate (5.5 per cent). 

Women bear a greater burden — women lost 3.3 million total disability-adjusted life years (DALYs) to depression, compared to men’s nearly 2 million DALYs in 2013.

Following decades of political instability, our findings indicate that low-income countries actually have a lower burden, but this can be simply explained by the fact that those living in countries affected by conflict do not have the privilege of attending to their mental health, and it is also difficult to conduct exhaustive nation-wide studies. 

While our investigation focused on data from 1990-2013, we are now in the process of studying the numbers from 2015 and beyond, and the latest figures indicate that the aforementioned trends are going to continue.

In the Gulf Cooperation Council countries, progress is being made. 

Qatar has a national mental health strategy, and Kuwait is integrating mental and primary healthcare.

The UAE, meanwhile, created a Ministry of Happiness in 2016, which aims to promote the country’s plans, programmes and policies to promote the happiness of UAE society.

Such initiatives support awareness of mental health and greater investment in it, but there is still more to be done.

Typically, there are three necessary layers towards creating, or reforming, mental health systems.

Politically, very few EMR countries have concrete mental health policies and regulations; neither do they have legislation that protects those with these diseases.

The first step, therefore, is to mobilise policymakers, by bringing their attention to the impact of a strong mental healthcare system, and ensure that budget for mental health is integrated in the primary healthcare budget, for they are one and the same. 

Next is the medical perspective, and EMR nations require more community-based mental health services.

In order to make the most efficient use of resources, it is important to understand what types of mental health disorders or diseases people are suffering from.

For example, not everyone needs to be admitted to the hospital, so an outpatient community centre or clinic might be a more effective option.

Finally, from an education perspective, prospective medical students need more incentives to pursue psychiatry.

Current or future medical students should be targeted at an early stage, and the appeal of a career as a psychiatrist, and the high demand for it, must be communicated.

Across each of these layers, it is critical that we address the stigma of mental health, which is a challenge that is not limited to the borders of our nations.

Integrating mental health into our primary healthcare systems is one way to counteract this.

By going to a family doctor first and disclosing one’s symptoms before (potentially) being referred to a specialist, the fear of being judged might just be alleviated, and more people would seek help. 

Just as one seeks a doctor’s help for physical pain, one should resort to doctors for mental health. 

We need to cater to individuals with mental health problems with the right support system, ultimately ensuring that the burden of mental health disease is minimised in the long run.

The writer, MD, is a post-doctoral researcher at the American University of Beirut Medical Centre and lead author of “The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013”. This study is based on findings from the Global Burden of Diseases, Injuries, and Risk Factors Study  coordinated by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. He contributed this article to The Jordan Times.