MENTAL HEALTH
The mental health landscape in Saudi Arabia Promoting and improving wellbeing during the COVID-19 pandemic, while reducing the stigma of mental illness
T
he COVID-19 pandemic has been an unprecedented global crisis. Uncertainty, loss of loved ones, social distancing, and economic insecurity have had a marked effect on mental health and exacerbated problems for those already suffering from mental disorders. How are Saudis coping with psychological distress, and how is the country dealing with this demanding situation? A few recent studies and surveys have offered an overview of the services, attitudes and challenges related to mental healthcare and wellbeing in the Kingdom.
Mental healthcare by the numbers
There were only two psychiatric hospitals in Saudi Arabia in the early 1980s, but mental health research and treatment have been made a greater priority and an urgent concern in past decades. The Kingdom’s General Department for Mental and Social Health, created in 1983, focused on allocating funding to mental healthcare, developing modern infrastructure, and training staff. Furthermore, in line with Saudi Vision 2030, the Ministry of Health aims to develop 42
December 2021
a new patient-centred healthcare system that takes into account social, mental, and physical wellbeing.1 The number of counselling clinics that provide primary mental healthcare has grown to 55.2 Saudi Arabia devotes 4% of its healthcare budget to mental health disorders, above the world average (<2%) but still behind other high-income countries (6%).3,4 With 19.4 mental health professionals per 100,000 citizens, the Kingdom’s rate is higher than the global average (6.6 per 100,000) but much lower than the world’s wealthiest countries (64.3 per 100,000). While depression and anxiety disorders were some of the most prevalent mental illnesses even before COVID-19, the crisis has taken a toll on the mental health of a larger segment of the population. Researchers at King Saud University set up a social media survey to monitor mental health symptoms during the pandemic. They have reported that around 21% of the participants experienced moderate to very severe depression, 17.5% anxiety, and 12.6% stress.5 In keeping with findings from China, Italy and Spain, young adults, women, and people with a history of mental illness were more likely to suffer from severe symptoms.6,7 “This research is important to recognize the effect of COVID-19 and devise strategies for prevention and treatment,” says Ahmad N. AlHadi, an associate professor at King Saud University who led the study.5 He also emphasises the need for further studies and prevention and treatment programmes for other mental health issues, such as bullying, behavioural addictions (online gaming and social media), and burnout.
Providing counselling and focusing on prevention
Traditionally, studies on mental health carried out in the Kingdom have focused on specific diseases or populations, such as patients in hospitals. The first comprehensive scientific survey was conducted between 2011 and 2016, when Saudi Arabia became the first Gulf Cooperation Council state to join the World Mental Health Survey Initiative. The Saudi National Mental Health Survey (SNMHS), launched in 2010, which included 4,004 male and female
participants between the ages of 15 and 65, found that approximately one in three Saudis are diagnosed with a mental health condition at some point in their lifetime. These results are comparable with data collected in France and the Netherlands.8,9 A number of initiatives have been organised in the Kingdom to help prevent or overcome the psychological distress caused by COVID-19. For example, the National Center for Mental Health launched the ‘Labayh Al Amal’ initiative in 2020 to provide confidential psychological counselling through a free smartphone app, as well as engaging public sector employees through the ‘Promoting Mental Health in the Work Environment’ programme to enhance their efficiency and productivity at work.10 Furthermore, the Saudi Center for Disease Prevention and Control published a ‘Preventive Guide for Mental and Social Health’, which recommends some best practices for mental health during the COVID-19 pandemic.11 For example, the guide highlights the importance of physical exercise, because integrating mental and physical health is considered an important prevention strategy. Saudi Arabia has the highest rate of physical inactivity among the Gulf Cooperation Council countries, and a recent Saudi survey found that moderate aerobic physical activity is associated with lower depression among male participants, leading to fewer symptoms of anxiety and depression.12
Open challenges: stigma and community perception toward mental health
The SNMHS survey also revealed that 80% of Saudis with severe mental health disorders do not seek any treatment, and around 9% of the population consult religious or non-medical healers.9 Stigma and other social barriers prevent people from visiting mental health experts, adhering to treatments, or even taking part in surveys related to mental health.13 As a result, vulnerable individuals delay medical treatments, making their condition become harder to treat. The high prevalence rate of untreated mental disorders in the Kingdom, together
