Sunday, May 20, 2012

From the Archives: Virtual Insanity

As someone who is familiar with the cultural phobia elicited from the general discussion and practice of psychiatric health and care, I wrote the piece below in 2010 for Qatar's leading business publication, 'TheEDGE', looking at said taboos and tribulations. The first half of the article looks at the Qatar Health initiative and the state's ranking as compared against global health systems. The latter half includes excerpts from an interview I conducted with Dr Suhaila Ghuloum of Weill Cornell Medical College in Qatar, plus a look into a survey re mental health conducted in that year. Have YOU had a positive or negative personal experience with psychiatric aid locally, or internationally?  


Healthcare continues to be one of the highest priorities for Qatar, emphasised by its position as an industry leader within the region. Through its strategic developments in recent years and most notably since the inception of the primary health body, Hamad Medical Corporation (HMC), Qatar has gained the reputation as a regional health leader. However, certain medical practices are viewed as contradictory to cultural and traditional norms. Reem Shaddad discovers the qualms behind trusting in psychiatric care, both on a local and international scale.

Established in 1979, HMC is responsible for the management of four specialised hospitals and their clinical counterparts. These include Hamad General Hospital, Rumailah Hospital, the Women’s and the Psychiatric hospitals, respectively.

Opening its doors in 1982 after changing locations from Rumailah to its current address at Grand Hamad Street, Hamad General Hospital (HGH) has experienced both an increase in patient numbers as well as its facilities. Among the services offered at HGH, the facility has a high capacity for inpatient care, a sizable outpatient department with the provision of specialty clinics and a wide array of departments including accident and emergency, pathology and radiology. Its span of offerings proves the availability of necessary therapeutic services, ensuring that HMC as a whole remains abreast of international medical standards and further local schemes.

In 2005, Qatar founded the National Health Authority (NHA), which instantaneously became one of the several government panels responsible for executing the ongoing sets of national health goals. The most prominent of these goals remains the ‘Health for All’ slogan, as pledged by the state. Deemed as having already achieved this particular health goal, as outlined in a number of reports published by the Eastern Mediterranean Regional Offices (EMRO) of the World Health Organisation (WHO), Qatar is in a place of envy for other EMRO countries. This belief stems from the national supplement of free health care to all residents of Qatar, whether national or non-national, as per the WHO 2001 Country Profile reports.

Unfortunately, the same reports also noted an absence of any formal health strategy – at that point in time – due to the conviction of responsible officials, concerning the success/ achievement of the ‘Health for All’ concept.

The WHO attributes this to the country’s sturdy economic situation, which continues to be internationally regarded as the major reason for the success of this goal. Yet in the same enthused manner Qatar handles all its national advancements, since the WHO reports published in 2001, much has changed in favour of the medical scope in the country. The most recent noteworthy health initiative offered by the state is known as Qatar Health 2009, held in December last year for the duration of five days.

The event –the first of its kind to be held in Qatar and is arguably one of the largest health events in the region – is a medical congress and exhibition drawing together an impressive number of participating countries and professionals to share, learn and dynamically create solutions and leeway’s into the improvement of the medical field. Encompassing a series of 13 medical tracks covering departments and issues from the vast array of medical services available throughout HMC, Qatar Health 2009 was a success in provoking case in point queries to Qatar.

More  than  100  companies  were  present  to  offer  their expertise on the latest in healthcare technology, including equipment, products, services and even informative offerings from medical schools and universities, both local and global. Delegates participating in the congress consisted of a variety of professional and semi-professional healthcare staff, physicians, nurses and paramedics from each of the medical tracks.

The 13 tracks, included trauma and disaster, pediatrics, surgery, internal medicine, dental, radiology and psychiatry, respectively, each hosted a series of lectures, workshops drawing critical global expertise into the local arena. For the local Psychiatric Hospital, this public exposure to the varieties of mental health issues spelled a potential bridging in the knowledge of, and attitudes toward, mental health practice and patients.

With speakers from a host of internationally renowned institutions, such as Tufts Medical Centre in Boston and the Institute of Mental Health, Robert Gifford Hospital in Quebec City, this particular set of sessions was informative beyond expectations. Lecture topics included research into the paradigms of psychiatry and the difference between certain philosophies and practical strategy, the integration of mental health care into the primary health care systems and most notably, the attitudes, values and beliefs of professionals and general public towards mental illness in the Arab world in specific.

Day one of the psychiatric presentations, included elements of the aforementioned issues particularly during Doctor Suhaila Ghuloum’s talk surrounding a cross sectional survey conducted to reveal the knowledge of mental illness and mental health practices in Qatar. Not only is Ghuloum a practicing consultant psychiatrist, but she is also the chair of the psychiatry department at Qatar’s Psychiatric Hospital. In addition, Ghuloum is an assistant professor at Weill Cornell Medical College in Qatar and is the focal point of negotiation and cooperation between Qatar and the WHO’s EMRO and the Gulf Cooperation Council’s (GCC) Mental Health Council. In a private interview with Ghuloum, sentiments surrounding the lack of formal health strategies were echoed concerning the absence of a Mental Health Act.

Annual GCC Mental Health Council meetings held in different locations around the region have voiced these concerns and are currently in the process of formulating a Mental Health Act that is flexible enough for moulding into the ethnic variations comprised in the GCC countries. The council meetings provide grounds for the exchange of experiences, clinical, practical and research support, and the study of mental health legislature in different countries to aide their own goal. This goal also includes the principal issues of securing the rights of individuals with mental health issues, particularly where modern psychiatric techniques are not trusted.

According to Ghuloum, things are looking up for the future of psychiatry in the region. She believes the council is close to achieving its goal of setting solid regulatory rules for mental health practice through all-encompassing Mental Health Council. Ghuloum also emphasises the time consumption problems that are facing the council in running legislative ideas through the governing Supreme Council of Health, approvals from the Ministry of Interior and the Ministry of Social Affairs. Aside from that, there have been obstacles in the form of professionals not understanding the need for a regulatory Mental Health Act due to its restrictive nature spelling an untrusting image between colleagues within the same field of practice.

Ghuloum also expresses apprehension regarding the GCC Mental Health Council. She highlighted the just treatment of mentally ill patients as an area for particular for concern, chiefly in legally binding situations, which, among others, includes punishment versus treatment of a mental health patient post committing a crime and the standardisation of treatment of said patients. When questioned about statistics recently published concerning the rise of mental disorder cases within Qatar, Ghuloum was quick to highlight the discrepancies and “scandal” that can be normally associated with mental health figures, rather than the compassion and understanding that is also demonstrated by professionals in the psychiatric field.

“I don’t think there is a rising number of mental health cases,” she said. “The population has increased, so the rise in the number of mentally ill patients is justly proportionate to that rise.”
Ghuloum does not condemn the exposure that mental health has received, but rather she believes this exposure has helped spread awareness through the Qatari community and within the HMC itself: “This has brought awareness to the fact that we cannot continue things the way they were 10 years ago. We need to improve and certainly HMC has taken many steps in the right direction, improving on its psychiatric services.”

However, the question remains: What is the dominant view on mental health illnesses and practice in Qatar? During Qatar Health 2009, Ghuloum’s talk revolved around this topic for debate. An epidemiological research undertaken through support from the Qatar Foundation (QF) National Priorities Research Program (NPRP) and conducted by Ghuloum and a cooperative team examines the prevalence of mental illness in Qatar and its population.

Through distribution of questionnaires, the team was able to pose queries to the general public on their knowledge of mental illness, its causes, cultural beliefs and guidelines moulding their ultimate concepts of mental health and personal attitudes towards those suffering specific illnesses. Ghuloum revealed the results were very much a mixed bag of favourable and negative responses. In questioning the public’s willingness to seek professional psychiatric help, the research revealed an impressive number of positive responses where an average of 70 to 75 percent of interviewees volunteered that they would actively do so.

In contrast, a significant number of respondents said they would opt to seek out alternate medicine (faith healers) instead of, or in conjunction with a professional psychiatrist. Ghuloum says the problem lies within those seeking purely traditional means of treatment as opposed to compromising with seeking both a qualified psychiatrist and a traditional healer. The other considerable concern, as uncovered by the research, was the uncomforting belief by many respondents that regardless of the criteria of mental disorder, patients cannot maintain a position of employment.

Similar concerns were echoed after results demonstrated that the majority of respondents would not feel comfortable continuing friendships with individuals, who had been diagnosed with mental disorders, or working in the same environment with somebody who had a mental illness. These feelings were true for all sorts of patients, even those affected by mood disorders such as anxiety and depression – individuals that can be medicated and function coherently in any setting. Reasons behind these sentiments were not noted as part of the research, but Ghuloum points to lack of knowledge surrounding the varieties of mental disorders as a potential influencer.

“The majority of respondents could not name a single mental illness that they had heard of…the majority considered mental retardation to be a mental illness – a huge misconception,” she states.
These are the key issues that Ghuloum is calling to be publicly addressed in a bid to foster a better understanding of mental health throughout the state, and hence, to encourage empathy and awareness towards those suffering from such illnesses. Ghuloum was also quick to note the role that the media plays in this misinterpretation of mental health disorders. Ghuloum’s theory is supported by countless examples across all media platforms, where individuals diagnosed with mental disorders are often presented in a negative light. Inevitably, misleading portrayals can have significant repercussions on both society as a whole and sufferers of mental illness – particularly in the instance of people, who have had no prior exposure to, or knowledge of, mental health issues.

Irrespectively, Ghuloum remains largely optimistic about the future of psychiatry in the region, particularly in light of what some regional events and professionals are doing in regard to highlighting critical issues. According to Ghuloum, numerous independent schools have approached the Psychiatry Hospital in Doha to attend open speaking days as to better educate young minds on the services available to them. Community care, day care centres, crisis intervention and a bio-psycho-social approach to medication rounds up these services, with emphasis on the need for a better understanding on the benefits of psychotherapy.

As acting chairperson for the department of psychiatry in Qatar, Ghuloum’s ultimate vision remains central to the integration of mental health care with general medical services to help reduce the stigma of mental illness. On the whole, Ghuloum says Qatar appears to be living up to its name as a regional leader in healthcare advancement: “Things are improving. We are still not where we would ideally like to be, but then again, this stigma related to mental illness is not an exclusively local problem, rather a global one."

Note: This particular article doesn't live anywhere on the internets, but THIS is its home.

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