Why Saudi Arabia's mental health landscape needs more attention: 'We are way behind in awareness'

Mohamed Al Jubran has had attention deficit hyperactivity disorder since childhood, but it was only diagnosed in 2014, when he was 26. The photographer from Saudi Arabia then didn't do anything to treat his mental health condition, simply because he didn't believe it would work.

"I had a five-year gap between being diagnosed and seeking treatment, simply because of ignorance … and I was afraid of the stigma," he tells The National.

When he finally sought help in 2019, it changed his life. “That is why now I recommend therapy for everyone.”

Mental health in Saudi Arabia

Al Jubran's experience is indicative of the mental health landscape in Saudi Arabia. About 77 per cent of Saudis said they or someone in their family have had a mental health condition at some point in their lives, according to a 2018 survey by the National Centre for Public Opinion Polls.

Yet 80 per cent of Saudis with severe mental health disorders do not seek any treatment, according to the 2019 Saudi National Mental Health Survey.

"We are way behind in awareness for mental health," says Hala Dahlan, who has been working in the field for the past 20 years as a family and child psychologist.

Although she has seen progress in people receiving help, it is not enough, she says. "People who come to my clinic today are more open to the idea of treatment, but the stigma is still here.”

She says the overarching perception of people with conditions in the kingdom and the everyday language surrounding mental health are major components of the problem. "People refer to someone who has a bad attitude or having a bad day as someone who is mentally sick, and this actually leads to stereotyping, that this is a negative thing.

“But everyone can have a mental health crisis. It is normal.”

Dahlan believes one of the ways to fight this is to raise public awareness. "We need more campaigns in the malls and on social media for these diseases. Just as we see breast cancer or diabetes awareness campaigns, we must do the same for depression, anxiety, bipolar disorder and so on.”

Documenting people's journeys

It’s not just a matter of people refusing to seek treatment, either, but also a lack of knowledge and understanding, as they simply don’t realise they have a mental health condition in the first place.

Saudi doctor Osama bin Nuyijfan is among those trying to tackle this issue with his Arabic-language podcast Wijdan (meaning "the heart"), which shares stories of people who have had a mental illness, and documents their journey in overcoming it.

"When you hear other people’s experiences and suffering, you feel less alone,” he says.

His show has been incredibly popular, too, as, since it launched in 2018, it has had more than three million listeners over the course of 95 episodes. It gets about 250,000 listens per month, 80 per cent of which are in Saudi Arabia, according to statistics shared by Nuyijfan.

"I feel the podcast created something of a #MeToo movement for mental health, as a lot of people started to share the podcast and then share their own stories,” says Nuyijfan.

"My inbox is always full of people wanting to share their stories now.”

Many listeners have also decided to seek help after listening to the show, he says. "I truly hope that we further move towards a place where more people feel safe to talk.”

A matter of access

For Basim Albeladi, founder of Labayh, a leading telemedicine app that provides mental health consultations in Arabic, it’s not just about awareness, but also a dearth of skills among medical professionals.

"There is a lack of enough training for therapists in Saudi Arabia," he says.

Labayh has, however, managed to recruit 150 psychologists and psychiatrists in Saudi Arabia to serve their 180,000 active users.

The app’s 200,000 downloads in 18 months, according to figures shared by Albeladi, prove there is a huge demand for this kind of help.

This is why Albeladi doesn't think the issue is with seeking treatment, but that "the issue is with the medium itself”. It’s a matter of access, he says.

This is something he’s experienced first-hand. When he returned to the kingdom from the US in 2016, where he had been studying, after a motorbike accident that left him in intensive care for more than a month, he had no job and no degree. "I was devastated and had post-traumatic stress disorder. I came back to my hometown of Madinah but there wasn't even a single clinic that could help.”

Eventually, Albeladi sought assistance from an American doctor online. "It was then that I realised we need a solution like this in Saudi Arabia. We need to digitise the process."

He also believes the mental health industry in the kingdom needs a rebrand “as something safe … to gain people’s trust”.

"Influencers and public people specifically should help by speaking out about their problems and how they overcame them. Unfortunately, people still can't speak about this loudly and publicly, and this needs to change.”

'We lack a whole system'

Even if medical professionals were trained, awareness campaigns were launched and more people sought help, it still wouldn’t be enough, says podcaster Nuyijfan.

"The problem is that we lack a whole system for mental health. The puzzle is not complete.

“You have people talking, you have clinics and therapists, you have medication, but what about the before?

“What I'm talking about are the support groups, the services that lead you to the clinic, the self-help books in Arabic, more podcasts – all of this is missing in Saudi Arabia.”

Dahlan agrees. "We teach in our [public] schools science and maths, but we don't teach anything about psychology, and it is just as important as any other subject.

“It is important to understand how the mind works, which can leave a great impact on someone with a mental health disorder, and it can help people understand those diseases if they occur.”

Al Jubran hopes his art will open at least a few people’s eyes to the issue. Since seeking treatment for his ADHD, the photographer has launched two new projects to start conversations around mental health.

His first was a series in which he interviewed people about their mental health while taking their portraits. “I want to normalise these conditions, but also give them a face, make it human.”

Now, he’s focusing on a second project, taking four photos of the same person in different emotional states using multilayered exposure shot in analogue. “In these pictures, you see how someone with PTSD can laugh while also being sad. What is on the surface is not what is inside, and there is no one image of what a mental health disorder looks like.”