Dubai Makes Mental Health More Visible Through Establishing A Mental Health Strategy

With the launch of Dubai’s Mental Health Strategy, we unpack it’s announced pillars and explore their meanings.

Dubai is finally boosting its mental health services as it launched last April its first comprehensive mental health strategy affirming its commitment towards Dubai Vision 2021. Mental health issues worldwide are simmering under the surface demanding special attention be given. The mental health strategy is intended to cover a 4-year period. A realistic time-scale that could provide an infrastructure for future improvements, but would it sufficient for the public to start seeing outcomes?

Historically, there has been a far long tendency of the public to seek religious healers or consider mental problems as contagious subsists that provide shame to the individuals & their surroundings. The UAE has been one of the first countries in the region to recognize mental health in the 1970s (Sayed, 2015; The National, 2017). However, the rate of development of mental health services does not match the increasing needs. According to the World Health Organization, in the year 2006, the UAE had 0.3 psychiatrists, 0.51 psychologists, and 0.25 social workers per 100,000 population. By comparison of psychiatrists’ ratios, there were 7.79 per 100,000 population in the United States back in 2006. Nevertheless, there has been increasing rates of mental health awareness in the country, and the launch of the strategy after being in gestation for many years is a great stride forward.

Dubai’s mental health strategy has chosen four main pillars that will fulfill Dubai Health Authority’s (DHA) vision of a healthier & happier community. Since we only have a ‘trailer’ version of the strategy, it would be difficult to assess how robust the strategy might be. On the one hand, there is an emphasis on research, a shift of focus from service provision, family-inclusive mental care, prevention, and a whole-system approach. On the other hand, the strategy does not exactly demonstrate how things will be improved, if there are any indicators of progress available, or if it provides existing statistics, rates, and numbers that will ensure clear deliverables on the objectives it has set.

The first of its four pillars is “legislation, governance, and regulation”. UAE will soon have an updated mental health care & treatment act available (Alhassani & Osman, 2015). Dubai will be implementing its strategy in waves according to priorities, impact, and resources. It means that regular forms of multiple stakeholders will take place reviewing progress & coordinating future actions. Foremost, we hope that the strategy will employ an inclusive lens that takes into consideration the incredible diversity of Dubai’s population. It would also be useful to have a Citizens Reference Panel, much like the one in Canada, to include the public with policy analysis & updates. An independent oversight group that scrutinizes, researches evidence-based approaches, and provides regular assessments & reports framework would be of immense value. With this, people with lived experiences would be able to co-produce or co-design services. Having these will not only mean rules will ensure accountability of work and protection of human rights, they will also mobilize knowledge to reform services & provide ongoing evaluations. This pillar can only be made strong by developing a human resource plan, understanding the social & economic burdens (i.e., insurance coverage), providing details of funding breakdown, and detailing an action plan.

The second pillar is “promotion, prevention, and early intervention”. The health authority hit the nail hard by considering the undeniable role of society. As we evolve to learn that mental health is more than just complex conditions to realizing it also includes emotional wellbeing and managing daily challenges, everyone will be the center of focus. Building networks between mental and non-mental health staff could promote cross-sectoral collaborations that may enhance early detection, diagnosis, service delivery, research & ongoing data updates. In my opinion, mental health screening should equate with physical health checkup. However, we can only ensure this success if individuals recognizing their early symptoms of mental illness seek treatment without fear of self-disclosure. There is a gap between individuals identifying themselves as having a mental health issue & actually seeking help. To bridge that gap, we need to put family & caregivers of people with lived experiences at the center of the strategy’s focus. Mental health first aid and other support methods could constantly be provided to those caregivers.

The third pillar is “service delivery and final recovery”. Dubai seeks to move the emphasis from hospital-based services to the community providing comprehensive care, and a stepped model of care. This might ensure that services are being less restrictive, having increased quality, being culturally appropriate, and putting patients at the center of attention. I hope that one day Dubai will transform primary care just as Scotland did when it initiated the “Ask once, get help fast” campaign allowing timely interventions and the right care. Patients will be able to manage their own mental health via psychological self-help tools. The integration of health and social care services will ensure availability of secure environments to hospitalized patients who reach the recovery phase (Haque, 2016). This will ease their transition into the community. It is yet unclear how transitions will be made, and if more accessible resources will be developed or if existing resources will be altered.

The fourth and final pillar is “providing patient empowerment programs”. Recovery is a dynamic process that can be ensured with successful community integration. Dubai seeks to establish a proper framework & guidelines to smoothen out the transition back into the community. Germany would probably provide an invaluable insight into its care for mental health is community-based since the 1970s. This would include various areas such as education and employment. Another interesting example is the one in Japan. A group of 5 to 6 individuals discharged from inpatient mental health services are placed in a home where one staff visits them on a regular basis. Support systems & step-down programs will ensure the success of the transition. The impact of mental illness may be reduced consequently. There is so much room to be done here, and we need to start somewhere.

Making our strategy evidence-led, needs-focused, and widely endorsed by the people of Dubai will only make it more successful. In developing the strategy, DHA rightfully benchmarked against countries such as Canada, UK, and Australia with high-performing systems, as well as countries that have similar demographics such as Singapore. This will help us avoid unintentional mistakes, apply lessons learned, and accelerate our change. Education, research & training are elements that shouldn’t be regarded as extras that can be bolted on. Furthermore, data transparency, delivery plan, continuous progress reports, as well as clearly mapping various stages & services with a preventive focus and clear outcomes would be key components to success.

Many mental problems will be preventable, and almost all manageable. The success of the strategy hinges on our collective understanding and proactiveness. Full of hope, we can expect Dubai to provide high-quality, evidence-based services equivalent to those available for physical illness, regardless of where people are, or when they need them. With this strategy, we will frog-leap ourselves into offering world-class healthcare services by 2021.

References:

• Alhassani, G., & Osman, O. T. (2015). Mental health law profile: the United Arab Emirates. BJPsych international, 12(3), 70-72.
• A Sayed, Mohamed. (2015). Mental Health Services in the United Arab Emirates: Challenges and Opportunities. International Journal of Emergency Mental Health and Human Resilience. 17. 10.4172/1522-4821.1000263.
• Haque, A. (2016). Mental health systems development in UAE. European Psychiatry, 33, S609.
• World Health Organization (2006). Mental health in the Eastern Mediterranean Region; Reaching the unreached. Cairo: WHO Regional Publications.
• The National Newspaper (October, 2017): https://www.thenational.ae/opinion/editorial/the-uae-has-made-great-strides-in-addressing-mental-health-problems-1.666211