The COVID-19 pandemic and ensuing lockdowns led to increased demand and pressure on mental health services. Studies have clearly shown a deterioration in global mental health due to prolonged periods of lockdown across 2020 and 2021.
Now, as we start to recover from the pandemic, the challenges are being felt across health economies globally. But despite our shared experience, responses have varied according to the economic and socio-cultural context of different countries. Assessing the response of two widely contrasting cultures - the UK and the Arab Gulf States (GCC) - we explore strategies implemented by each and ask: which approach best meets the mental health needs of the population?
Mental health stigma persists, but attitudes are changing
As in many parts of the world, the provision of mental health services and facilities has faced significant socio-cultural barriers in the GCC. This can largely be attributed to the stigma associated with mental illness and mental health treatment intrinsic to social culture. A study undertaken in Saudi Arabia revealed that 80% of Saudis with severe mental illness do not seek support due to the association of shame and stigma. Additionally, from a group of 325 people in the UAE, only 40% would seek help for their children if they became mentally unwell. However, this seems to be changing as a generational shift in attitudes has produced a focus on the challenges of mental health issues.
Several awareness campaigns have been launched in recent years via podcasts and social media, reflecting a cultural shift in attitudes brought sharply into focus by the COVID-19 pandemic. In September 2021, the Gulf Health Council launched an awareness campaign for young people under the slogan ‘Mental Health Yabilha’. The campaign focused on raising awareness of the causes and symptoms of depression and anxiety, how to deal with stress, improving community attitudes towards mental illness and facilitating access to specialised mental health services for young people in the Gulf States.
This increased prioritisation of mental health has also been reflected in GCC legislation, policy and national health strategies. Qatar’s National Mental Health & Wellbeing Strategic Framework 2019-2022 prioritises equitable access to high quality, integrated mental health services both in the community and across inpatient mental health services, whilst also working towards cultivating a more positive dialogue around mental health and wellbeing to de-stigmatise the topic.
In the UK, developing community mental health services is at the heart of the NHS Long Term Plan, with the goal of providing new and integrated models of primary and community mental care to at least 370,000 adults and older adults nationally. To meet this challenge, the NHS community mental health framework is encouraging service providers to move their core community mental health teams towards new place-based, multidisciplinary services across health and social care, aligned with primary care networks. While the development of these place-based models is led by clinicians, commissioners, practitioners, managers and service users, estate will also play a key role in successful implementation.
This new, modernised community estate which integrates mental health, physical health and social care aims to provide accessible services to all those who need it in a centralised and effective manner. Currently, one of the greatest issues facing the NHS in terms of mental health care is inequality in service provision, which has led to a waiting list of 1.2m people waiting for treatment. The COVID-19 pandemic has undoubtedly worsened the pressure on the service, with depression rates doubling in adults compared to before the pandemic hit. The goal of these new community locations is to address this imbalance by making mental health centres central to community infrastructure.
Mental healthcare support must be accessible
However, the complexity of these projects requires collaboration between clinical leaders and healthcare planning experts to bridge the gap and ensure these new spaces meet the requirements for a clinical services space. In particular, good transport accessibility is very important in making these new centres easily accessible for all people. This might mean lots of car parking space in rural locations or good links to public transport in suburban/urban locations. While looking within existing health estates is most convenient, there are alternatives such as converting office or retail space. Amendments to the Town and Country Planning (Use Classes) Order 1987, which categorises the use of land and buildings, means that offices can be converted into health clinics without a Change of Use application. The input of estate planning experts will be vital here to ensure the viability of a location.
When comparing these two different approaches, it is important to recognise the difference in the starting point between the UK and the Gulf States. Improvements in mental health campaigns, policy and commitments to accessible treatment certainly show great strides in the GCC’s mental health strategy. However, prior focus on the provision of discreet inpatient and outpatient services have not been met with the scale of demand and must now evolve into a stronger outreach service. Conversely, the NHS community mental health service initiative appears to suggest better access and provision of services.
The future of mental health provision requires an integrated set of services, something which the GCC is lacking. However, in the current climate of cutbacks and underfunding, one cannot help but ask how these plans will be fulfilled.