Conversations about mental health are changing in the Middle East

It is hard to say exactly when it happened, what the month was – or even the year.

There is no doubt a change in the national approach towards mental health acceptance is already upon us. There may be some way before employers, health insurers and even friends universally view depression with the same sympathies as a physical injury, but gradual progress is under way.

Rosalynn Carter, the former First Lady of the US, has made it her life’s work to help achieve a wider acceptance of mental health issues and the devastating impact poor support services can have.

Next year marks a quarter of a century since Mrs Carter launched her mental health journalism fellowship programme, supporting journalism around the world by increasing public understanding of what can be a difficult subject. It is a cause supported by The National to increase regional reporting of what is a sensitive topic for a variety of reasons, including cultural and religious.

Every year World Mental Health Day, which we just marked, offers an opportunity to look at the way these subjects are reported and how that is changing. One of those changes, and an important one, is the terminology used to describe mental challenges and how we refer to suicide.

Suicide prevention was the theme of the day in 2019, and encouraged a rethink towards mental illness. Historically, mass media has often referred to the act of someone taking their own life as “committing suicide”, as if it is a criminal act. That is no longer the case in the UAE.

The act has been decriminalised, with those in crisis offered counselling and psychological support to treat the root cause of their problems, rather than face prosecution through the courts that once led to a Dh5,000 fine or six-month prison sentence.

After taking up a fellowship in 2018, peers and colleagues said mental health was a “soft topic”. Others predicted I would find it challenging to see my words well read, or even make it into print because of entrenched social and religious taboos and related stigma.

After two years of reporting on regional mental health, it is clear that those challenges are diminishing, but there is still room for improvement. People are talking and writing openly about the subject like never before. Good work is being done across the country to accept and support effective mental health provision and development of adequate services.

The National has appointed two fellows for the 2020-21 intake on to the Carter Centre programme, business reporter Deena Kamel and columnist Raya Al Jadir. Both have extensive ideas and plans to take mental health reporting forward in the UAE in the coming year.

Further special features on the subject are planned for Lebanon and the wider region to explore the impact of Covid-19 and the devastating explosion that rocked Beirut this August on psychological well-being of communities. With the immediate prospects of young people in particular severely impacted by the pandemic, an uncertain future is likely to worsen existing anxiety throughout the Middle East.

The full extent of the damage done to mental health from the pandemic across the region is yet to be felt.

In the UAE, the government-backed Ma'an fund to support social enterprise is a fine example of local progress, offering finance and mentorship to emerging mental health groups in Abu Dhabi. Social impact bonds are being introduced by Abu Dhabi's Authority for Social Contribution, aiming to use private capital to tackle social ills.

However, discussing that progress openly or what further change needs to be made is not something that comes easily to some. The ambition of a 24-hour crisis phone line, similar to the volunteer-led Samaritans number in the UK, is some way off, although momentum behind the idea is gathering pace.

It is two years since more than 26,000 signatures were gathered by Dubai student Amal Al Ghory in support of a petition to encourage a UAE government-funded support line, but a permanent national service is yet to be established. The demand is clearly there. Research published in the International Journal of Social Psychiatry found that expatriates were seven times more likely to take their own lives than nationals.

A high-profile case surfaced in January, involving a Briton in Dubai with long-term depression who decided he no longer wanted to live. Even as a cry for help, the support he found was astonishing, both online and in person with emergency responders from the police and ambulance service deserving praise for their quick action in apparently saving the man's life.

In the wake of what became a well-read news story, questions remain about what specific services are in place to help those involved. Other questions over when and how authorities respond when someone is considering fatal self-harm, or who is at the end of the phone, should someone call the 901 police crisis support line, remain unanswered.

The Briton’s suicide attempt was not an isolated case, and not all cries for help are answered in time.

In October 2019, a British army officer became another victim of suicide in Dubai, although in stark contrast, his story has gone largely unreported in respect of the wishes of his family. Few of those closest were aware of his difficulties with depression, confirmed in conversation with an expert in Post Traumatic Stress Disorder, who recognised his reported symptoms and the distressing episodes witnessed by his loved ones.

The experienced career soldier had led men into combat during several tours of Afghanistan and Iraq, later returning to Baghdad as a private security contractor after his military retirement. Referred to as “Officer X”, the scars of war ran deep and left a permanent mark on those closest to him during a decade in Dubai.

The stigma around mental health was so great that he refused to ask for help and did not know where to turn in his darkest hour. That void of despair inevitably closed in around him, but his story has opened closer investigation into the support offered to retired servicemen who may struggle to deal with the consequences of war.

Between 2002 and 2014, British soldiers such as Officer X were involved in some of the fiercest combat seen in recent years in Afghanistan during Operation Herrick. It has been highlighted as a consistent factor in the suicides of more than 130 servicemen since 2018.

According to reports, more than 70 former and serving personnel took their lives in 2018 and at least 50 suicides occurred last year, including Officer X in Dubai. To put this into context, a total of 454 British forces personnel or Ministry Of Defence civilians died while serving in Afghanistan since the start of operations in October 2001.

While one suicide is one too many, the high proportion of veterans who have taken their own lives who had links to Operation Herrick has forced a public inquiry to open in the UK. Plans for specialist support for veterans with suspected PTSD have been fast-tracked by the NHS, the government healthcare system, to complement existing programmes and drag former soldiers out of destructive patterns of behaviour, often fuelled by addiction and debt.

The psychological impact of conflict and war is unfortunately all too familiar in the Middle East and we must continue to work at tackling them at the individual and community levels.

Nick Webster is a Carter Centre fellow and a reporter at The National