This project was done as part of EA NYU Abu Dhabi’s local priorities research and aimed to provide an overview of mental health in the UAE and some potentially impactful careers related to it that individuals might explore. This is among the first local priorities research projects carried out by EA NYU Abu Dhabi and we would appreciate your feedback and suggestions. Please reach out to Aleksandrina Dimova at [email protected] if you would like to share your thoughts and critiques. This is an abbreviated version of the report, to read it in full, please visit https://www.eanyuad.org/mental-health/
Two-minute summary
The UAE is a high-income country with a high prevalence of depressive and anxiety disorders and with stigma being among the leading barriers to accessing mental health care. Although detailed statistics about mental health are limited, a report by the UAE Ministry of Health and Prevention (MOHAP) lists depressive and anxiety disorders as being among the top ten causes of ill health in the country. Legislation related to mental health in the country dates back to 1981 and there have been efforts to understand and address mental health disorders in the UAE since 1992. More recently, the country’s mental health promotion strategy has involved endorsing “The National Policy for the Promotion of Mental Health in the United Arab Emirates'' guidelines and taking additional steps to promote mental health during the COVID-19 pandemic.
Non-governmental efforts to address mental health are carried out primarily by individuals and commercial organizations providing mental health services. There are currently no non-profit organizations focusing on mental health. Although there are a variety of mental health providers, challenges to access still remain due to factors such as stigma and insufficient insurance coverage. Substantial efforts for improving access to mental health care have focused on providing virtual therapy, the most recent of which is a mobile application still in its development named Mindspire, which targets people with depression. Due to the mental health landscape in the country, opportunities to make a local impact with a career in mental health are currently centered around specific careers focused on mental healthcare (e.g. speech therapists), entrepreneurship, and research focusing on adapting evidence-based mental health treatments to the local culture. For a detailed overview of global mental health as a cause area and impactful careers globally, please refer to this recent report by the Happier Lives Institute.
In addition to providing an overview of current measures to address mental health challenges, this report also aims to summarize the scale and neglectedness of mental health in the UAE with data from the from the 2019 Global Burden of Disease (GBD) Report created by the Institute for Health Metrics and Evaluation (IHME) and the World Health Organization.
Further research questions:
The present report is limited as it represents a first step towards understanding the state of mental health as a local priorities research area in the UAE. Further research questions to be explored include?
- What is the burden of mental health disorders in the UAE/Middle East based on QALYs?
- How do the different types of mental health disorders (e.g. anxiety disorders vs. major depressive disorder) in the UAE/Middle East compare based on scale, tractability and neglectedness?
- What are the common attitudes towards mental health disorders among UAE citizens and residents as of 2022?
- What is the effectiveness of the different efforts aimed at addressing mental health in the UAE (e.g. effectiveness of different apps, government initiatives, etc.)?
Key uncertainties & limitations:
- The major limitation of this study and its associated uncertainties stem from lack of data availability. Examples of missing data that may change the evaluation of mental health based on scale, tractability and neglectedness include:
- No data about the UAE’s budget for mental health,
- No data about certain indicators related to mental health in the UAE’s WHO Member State Profile (e.g. total number of child psychiatrists, outpatient facilities such as mental health daycare, etc.)
- Some of the data included in this report were collected in 2017 or 2019 and may no longer be accurate but they were the most recent data published by WHO that were available at the time of writing this report.
How big is this problem?
Mental Health Disorders Prevalence and Burden
Approximately 970 million people around the world live with mental health conditions, according to data from the 2019 Global Burden of Disease (GBD) Report created by the Institute for Health Metrics and Evaluation (IHME). Although the number of people affected by mental health disorders indicates the large scale of mental health challenges as a global burden, these disorders often remain underreported and overlooked. Previous research has emphasized that middle- and low-income countries in particular have struggled with reporting and addressing mental health challenges. Nevertheless, this problem also exists in countries with high income per capita. The United Arab Emirates (UAE) is one example of a high-income country where the focus on improving local mental health has increased in the past few decades, but where there are still areas in need of quantification and improvement. The aim of this report is to discuss the scale and neglectedness of local mental health in the UAE by reviewing data from the GBD report along with empirical studies conducted in the country.
There are various factors that hinder the progress of improving mental health in the UAE. The stigma associated with mental health disorders has perhaps the largest effect, as many people avoid accessing mental health services due to it. Additionally, cultural factors such as mental health services not being tailored to the country’s cultural context and social inquisitiveness have been identified as barriers to accessing mental health services in the UAE.
The present report explored local mental health in the UAE based on two main metrics: the prevalence of MHD and the disability-adjusted life years (DALYs) caused by MHD. Prevalence is a metric that reflects a population’s total number of cases of individuals with one or multiple disorders at a particular time period. A DALY is defined as losing one year of full health and it is calculated through another measure called years lived with disability (YLDs) due to a disease in a population and the sum of years of life lost (YLLs) because of premature mortality.
Additionally, the report assessed the neglectedness of MHD in the country based on the size of the workforce employed in the mental health treatment sector, a source provided by the World Health Organization (WHO).
Prevalence
An average of approximately 24,000 cases of MHD were reported in 2019 in the UAE, with depressive disorders and anxiety disorders being among the most common. Substance use disorders were also among the most prevalent MHD in the UAE for 2019.
Disability-Adjusted Life Years
According to the GBD report of 2019, DALYs caused by MHD accounted for about 10% of the total DALYs in the country. Overall, substance use, depressive and anxiety disorders are the leading sources of the DALY burden, which is not surprising given their relatively high prevalence compared to other disorders.
What is the availability of mental health services in the UAE?
Mental Health Care Services
Mental health facilities can be broadly categorized into inpatient and outpatient care facilities. According to The National Library of Medicine, an inpatient is “a person formally admitted to a health-care facility and who is discharged after one or more days” while an outpatient is “a person who goes to a health-care facility for a consultation, and who leaves the facility within three hours of the start of consultation”. Thus, inpatient and outpatient care are distinguished by whether the person is formally admitted in the facility and the duration of the treatment.
Mental hospitals in the UAE, which are part of inpatient care facilities, have approximately 1 bed per 100,000 population and annual admissions, as per the data from 2016, are approximately 7 patients per 100,000. Out of those admissions, the total number of patients in mental hospitals is estimated to be 68. For 52.9% of inpatient admissions, treatment lasts less than a year; 8.8% of patients have a stay with a length ranging between 1 and 5 years; 38.2% of inpatient stays last more than 5 years. More than 75% of individuals who received inpatient care also received a one-month outpatient follow-up after they were discharged.
The WHO report also indicates that there is a considerable amount of missing information in the UAE’s member state profile regarding the number of facilities and how many people have accessed them in 2016. While it is easy to conclude that outpatient care is more readily available than inpatient care, more data is needed to be able to compare the two types of mental health services in detail.
Available workforce
The WHO’s Data repository reports that there are 1.65 psychiatrists and 4.37 mental health nurses per 100,000 of the population. The rate of psychologists, social workers, occupational and speech therapists is below 1 per 100,000. The WHO data estimates that the total number of mental health practitioners working in the UAE in 2016 was 664 with a rate of 7.5 per 100,000 of the population, which is below the global median of 9 per 100,000.
How solvable is it?
What is currently being done to improve access to mental health care?
There have been a number of policies introduced to target the improvement of mental health in the country but there are limited statistics about their effectiveness. Since 2019, the Ministry of Health and Prevention (MOHAP) has launched a number of digital solution technologies as part of the National Policy for the Promotion of Mental Health, including the use of virtual reality technology to understand schizophrenia and the experiences of those affected by the disease.
To support the spreading of awareness of mental health, reduce stigma and end discrimination against those with mental illness within the UAE, Al Jalila Foundation awarded three Emirati journalists, the ‘Mental Health Journalism Fellowship’. The fellowship promotes the publication of quality discussions around mental illness encouraging awareness and acceptance to a stigmatized hidden condition.
To address the mental health challenges brought by the COVID-19 pandemic, there have been governmental efforts to support maintaining mental health during the pandemic. Resources include the Hayat (Life) Programme for mental health support that targets government employees, the Mental Support Line (800 HOPE) aimed at people experiencing a mental health crisis, the hotline aimed at addressing COVID-19 concerns, and an online National campaign to support mental health during COVID-19. Although those resources indicate efforts for policy support of community mental health, we currently do not have information to help us quantify their cost-effectiveness or how many people are utilizing them.
Additionally, the platform mentalhealth.ae has been launched with the aim to raise awareness and to recommend available resources. For-profit organizations also provide initiatives to improve the community’s preparedness to tackle mental health challenges, e.g. Lighthouse Arabia’s Mental Health First Aid Training.
How neglected is the problem?
How many resources are available?
The shortage of beds for inpatient psychiatric patients stands out as one of the most severe indicators of the neglectedness of mental health in the UAE (less than 1 bed per 100,000 people in 2016). The most recent global consensus regarding the number of psychiatric beds that should be available estimates that 60 beds per 100,000 is optimal, 30 beds is the minimum and any number of psychiatric beds below 15 constitutes a severe shortage. Thus, the UAE would be classified as having a severe shortage of psychiatric beds, which is rare in high-income countries.
Although we expect that the situation might have improved in the past few years given the mental health plan the country has adopted and the updated legislation surrounding mental health in the UAE, we do not have current data to evaluate this. Similarly, while the average number of 7.5 mental health professionals per 100,000 in 2016 in the country was close to the global median of 9 professionals per 100,000, the distribution of mental health professionals up to date is unclear. Additionally, WHO data indicated that even in 2016 some neglected professional areas were evident, such as speech therapists and occupational therapists.
Furthermore, there is no publicly available data on the UAE budget dedicated to mental health and how it may be distributed, which limits our ability to assess neglectedness.
What groups are working on mental health?
The groups working on mental health at the moment are commercial mental health service providers or individuals who aim to improve the well-being of their local community. The focus is primarily concentrated on individual mental health assistance provided through therapy or medication and there is room for introducing widely available cost-effective group therapy interventions.
What are the EA-aligned organizations and charities operating in the UAE?
There are no charities or EA-aligned organizations in the UAE that are currently working on mental health. The only non-profit that operated in the UAE, Darkness into Light, has ceased all its support services in 2021 due to insufficient funding. Although the organization is no longer active in the UAE, its LinkedIn and Instagram profiles remain active with limited availability to respond to enquiries.
Careers in mental health in the UAE & Gulf region
Career opportunities for UAE nationals and residents interested in mental health include participation in research, becoming a mental health service provider, and advocacy for reducing the stigma surrounding mental health disorders and increasing access to mental health care.
Overview
EA Forum cause area profile: mental health
Problem area report: mental health
Career Advice: Happier Lives Institute
Local evaluation
In the past two decades, there have been significant efforts to improve mental health access in the UAE as evidenced by the adoption of “The National Policy for the Promotion of Mental Health” and under landmark legal changes to officially decriminalise suicide and attempted suicide, which was undertaken in late 2020. Although this has certainly aided the destigmatization of mental health, a recent study on the effects of COVID-19 on mental health in the UAE has indicated that stigma remains one of the main barriers to accessing mental health care along with the need for developing culturally appropriate mental health interventions. Furthermore, insurance coverage also does not currently provide adequate coverage for all UAE citizens and residents, which has caused medical professionals to call for insurance companies including mental health care in their plans.
How to approach the area
Final year High School student or 1st, 2nd, or 3rd year undergraduate student
Psychology classes are among the most feasible opportunities to explore mental health in the UAE as a high school student or as an undergraduate. This preliminary cause area overview is a useful starting point for becoming familiar with mental health as a cause area.
Since this report found that mental health has not been extensively and systematically researched as a cause area within EA, it is challenging to highlight impactful opportunities to engage with it in the EA community. However, undergraduate students may consider a thesis aimed at improving health and well-being metrics, which is one of the recommended topics by Effective Thesis, which aims to help students engage in impactful thesis research. Another possibility to explore is getting involved with Effective Self-Help, which is a non-profit research organization focusing on the best ways to improve one’s well-being and productivity. In addition to offering information that may help directly improve individuals’ mental health, Effective Self-Help also offers internships, which may allow undergraduates to get exposed to mental health-related research in the context of EA.
Final-year undergraduate student
For students who are at the end of their undergraduate careers and would like to work in the field of mental health in the UAE, it would be necessary to complete a Master’s program to be eligible for certification. It may be useful to consider the Master’s program in Clinical Psychology offered by United Arab Emirates University. It is the only Clinical Psychology Master’s program in the country and it consists of two years of coursework and internship experiences to ensure a practical component to the training students receive. The program has specific coursework prerequisites that should be met before the start of the Master’s program but if your undergraduate courses do not satisfy the requirements, there is an option to take the necessary courses as preparation for your Master’s.
Entrepreneur
The UAE has recently seen a surge in interest from startups along with interest from the local community in remote and virtual mental health support. Therefore, a career as a mental health entrepreneur is a potentially impactful option for individuals who are interested in mental health but do not envision a career in providing mental health services. One example of a promising mental health startup is Takalam, which aims to connect individuals with online therapists. Although mental health startups in the UAE have drawn the interest of the local community as safer, more convenient, and more anonymous forms of accessing mental health support, the effectiveness of the different types of interventions offered through mental health tech is yet to be quantified.
Opportunities
UAE organizations within the area
American Wellness Center, Lighthouse Arabia, and Human Relations Institute & Clinics, Dubai are treatment centers based in Dubai that offer counseling and clinical psychology services. All of them have internship programs that may help recent Psychology graduates to explore their interest in mental health. Although shadowing therapy sessions are generally not permitted, these organizations offer other ways for aspiring mental health professionals to get exposure to working in a mental health care environment such as through role-play activities, which are a popular training tool in psychotherapy. In Dubai, before merging with Dubai Health Authority (DHA), DHCC had options for clinical interns to obtain a license allowing them to shadow therapy sessions with the explicit verbal or written consent of the client but it is unclear whether this is still permitted.
Peer-Minded is a local startup that aims to foster student mental health by exposing students to a mental health curriculum. The organization accepts interns thrice a year and offers a variety of positions related to content marketing, design, and curriculum development. Although an internship with this organization would not be suitable for people who seek exposure to clinical or counseling psychology, it would be an excellent opportunity for people interested in mental health entrepreneurship.
Rashid Hospital volunteering program offers an opportunity to gain experience in a hospital setting which may be useful to many aspiring mental health professionals. Al Amal Psychiatric Hospital has previously offered a volunteering program and may be able to offer positions to individuals who wish to volunteer with psychiatric patients.
Acknowledgements
I would like to thank Thoraiya Kanafani, Reema Baniabbasi, Chasity O’Connel, Hafsa Ahmed, Lenah Ankliss, Yara Ihab Am Ali, and Farah Almohammed for their support on this project. Additionally, I extend my gratitude to Koki Ajiri, Joao Bosco de Lucena and Brian Tan who provided valuable feedback throughout my work on this project. Any thoughts or opinions expressed in this report are my own and do not necessarily reflect the views of the aforementioned individuals.
