A recent WHO report noted that one in 100 deaths is by suicide. Countries around the world need to improve suicide prevention strategies. That includes the Eastern Mediterranean region, and the United Arab Emirates (UAE) even if the country (with 6.4 suicides per 100,000 people (2021) ) doesn’t do too bad, compared with some other countries in the world.
The greatest danger concerns those who cannot reach out for help – unable even to recognize what their exact ‘problem’ is, or have it recognized. Unfortunately, children are most disadvantaged in this respect. In children, mental health illness is a double burden in that a mentally ill child will most likely become a mentally ill adult as well, if they don’t receive care. Indeed, children with mental health disorders, if left untreated, suffer immensely in terms of development, educational attainment, and the potential to live fulfilling and productive lives. They have higher rates of suicide, substance abuse, and smoking, as well as educational impairment. These issues carry on into adulthood, resulting in higher medical costs, work impairment, and impact on their family and community. Adolescents suffering from depression have a poor perception of their general health and make thus sometimes excessive use of health services. Furthermore, children already suffering from chronic illness are more prone to depression and anxiety – all issues adding to the existing burden on health services.
All children are equal in their right to live fulfilling and productive lives, but the burden of mental health illness severly jeopardizes this right for many children. Worldwide, 10-20% of children and adolescents experience mental health conditions of some kind, half of which begin by the age of 14 and three-quarters by their mid-20s. Neuropsychiatric disorders are responsible for 45% of years lost to disability (YLD) in youths aged 10-24 years old.
Poor mental health also costs money. It is estimated that depression and anxiety disorders cost the global economy around US$1 trillion per year due to reduced work productivity and rates of labor participation. And there’s also the link between mental disorders and unhealthy behaviour contributing to other non-communicable diseases, further contributing to treatment costs.
Children & Adolescents’ mental health in the UAE
Studies indicate that between 17% and 22% of youth suffer from depressive symptoms in the UAE. In children with chronic illnesses, up to a third report symptoms of depression and anxiety. In a 2020 study, South Asian and Emirati adolescents had the highest prevalence of depressive symptoms with 1 in every 3 South Asians and 1 in every 5 Emiratis displaying depressive symptoms, respectively. Identified factors that increase the risk of mental health disorders in children include low socioeconomic status, large family size, stressful life events, bullying, low self-esteem, lack of social support, being female, and suffering from a chronic illness.
And then there’s the impact of the pandemic on mental health. Recent research on the impact of the covid-19 pandemic on the life of students conducted by the Mohammed Bin Rashid School of Government indicated how the COVID-19 pandemic affected students’ experiences with teaching (lectures and tutorials/seminars), supervision/mentorships, assessment, and workload, teaching and administrative support as well as student performance and expectations, across the UAE. Some of the emotions while attending classes and studying since the outbreak of COVID-19 included feelings of frustration (60%), anger (45%), anxiety (61%), and hopelessness (26%). A common “whole school” approach seems to be lacking, and this has become increasingly concerning, echoed also in the changes made to the National Mental Health Policy in Social and Emotional (SEMH) practices. Students who demonstrate SEMH needs are now managed under the Students with Educational Needs and Disabilities (SEND) umbrella program in the UAE.
What is being done about it?
In 2019, the UAE government developed the National Mental Health Policy and laws, one of a series of initiatives taken to promote mental health in the country, improve access to mental health services and reduce stigma. While this policy provided broad guidance at the governance level and referred to children within ‘people of all ages’ who should be targeted, there is neither a separate section in the policy nor a standalone policy that deals with the mental health of children and adolescents. In another initiative, the Supreme Council for Motherhood & Childhood and UNICEF launched the Anti Bullying Program in Schools in 36 private and public schools nationwide.
UAE Federal laws about child mental health include Federal Laws 28 and 29, passed in 1981 with an update in 2008 to include malpractice, a section in a draft federal law concerning minors, as well as the Child’s Rights Law – previously known as Wadeema’s Law – drafted in 2012 and launched in 2016. One of the issues to note is that while the new laws give families greater responsibility in treatment decision making, they also expand the role of social workers so they can take more responsibilities and reduce the burden on the family. However, these laws cannot be seen in isolation of the current workforce size. The rate of mental health professionals per 100,000 is as follows in the UAE: 1.65 psychiatrists, 0.76 psychologists, 0.36 social workers, 0.04 occupational therapists, 4.37 mental health nurses and 0.07 other health workers. In other words: training and hiring qualified individuals must go hand in hand with the legislation calling them into service…
What more can be done at the policy level?
Several policy options could be considered. One option is harnessing the power and accessibility of Information and Communication Technology (ICT), in the form of mobile apps and telehealth, to provide assessment, treatment, and counseling in a comfortable and anonymous environment. Being widely available and with young people nowadays already comfortable with their use, this saves time and helps overcome structural barriers to seeking healthcare. Mobile phone apps in particular, with their immediate accessibility and portability, allow real-time monitoring of symptoms and enable personalized early intervention and relapse prevention. The abrupt increase in telehealth during COVID-19 further highlights the importance of ICT in supporting tele-mental health. Studies show that diagnoses and recommendations made by psychiatrists in these tele-consults are rather similar to the ones made in face-to-face consults. And while no doubt more research is needed, online treatment programs – specifically cognitive-behavioral therapy (CBT) – led to significant reductions in rates of anxiety and depression.
A second option for policy is integrating mental health services into primary and community healthcare settings, which has been widely recommended and is already referred to in the National Mental Health Policy. It is crucial to improve communication between the different levels of care, with clear referral criteria and pathways to minimize loss to follow-up and long waiting.
Thirdly, building capacity in child mental health is vital by expanding training to undergraduate and postgraduate levels, increasing training opportunities, and improving mental health literacy among all staff working with children. A public health approach to mental health should be adopted rather than targeting children already showing signs of mental health disturbance. It is also vital to increase awareness of the higher risk of mental disorders in children with chronic illnesses. Patients should also be aware of the importance and availability of mental health services at the PHC level by displaying educational material at waiting areas and encouraging staff to engage with them.
School-based health centers (SBHCs) make up a fourth option. They are widely considered to be one of the most effective strategies for delivering all-inclusive primary and preventive services to young people by offering screening and counseling, school-wide programs to promote positive development and peer-to-peer support, as well as collaborating with parents and healthcare providers. They are accessible to families, non-stigmatizing for students, and give access to disadvantaged youth. SBHCs have the potential to reach adolescents considered high risk and provide early intervention. Students can discuss issues affecting them that contribute to mental health issues such as body image and psychological well-being and address bullying and violence through targeted action and prevention programs.
An inclusive, holistic approach to child mental health based on regular and thorough revision and evaluation and using best practices from similar contexts enables robust policy development that will assure no child suffers or is left behind in the UAE.