Whilst discrimination, stigma and misinformation about mental illness is a world-wide issue, attitudes are less developed in certain countries – as is access to quality mental health care.
If you’re a new expatriate, you may be wondering what kind of mental health care is available in your new country of residence. After all, 1 in 4 of us will experience mental illness at some point in our lives. That’s more than the combined total of people who are affected by asthma, diabetes, kidney disease, breast cancer, and prostate cancer.
Mental illness can manifest itself in any number of ways and can be highly distressing, disorientating and disruptive. If you are in a foreign environment and don’t have access to the necessary medical or psychiatric care, the impact can become compounded.
What follows is a list of the most popular expat destinations alongside a synopsis of their mental health care programmes.
If you or anyone you know is suffering with a mental health issue, you should always seek medical or psychiatric help at the earliest instance. Furthermore, it’s wise to check your international health care insurance policy before moving abroad, just to guarantee that you’re covered against every eventuality.
According to Ayesha Almazroui at the National “seeking faith healing [in Dubai] is more popular than seeking psychological support.” Faced with an acute lack of psychiatric resources and a prevailing attitude that anxiety or depression are symptoms of ungodliness, mental health care in Dubai is in serious need of reform.
However, this issue is not only reserved to UAE. Currently, Qatar is the only GCC state with a national strategy for mental health. Announced last year, Qatar National Mental Health Strategy is a five-year plan “to build a high quality mental health system and to transform the way mental illness is perceived and treated in Qatar”.
Thankfully, expats seeking mental health care do have access to support. The American Centre for Psychiatry and Neurology has centers in Dubai, Abu Dhabi and Sharjah. It is staffed by an expert team of psychiatrists, neurologists, psychologists and therapists – most of whom are American Board certified. According to their website, “Staff are able to provide the tantamount quality and confidentiality in healthcare that is available in the United States.”
Hong Kong is a similar picture to Dubai in that traditional Chinese cultural practises (or religio-philosophic belief) overshadow medical diagnosis and treatment. For example, Taoism advocates medical inaction towards mental health and instead promotes an integration with the Law of Nature. Buddhism teaches that positive and negative personal circumstances are due to our actions, and that mental illness is caused by misdeed in a previous life.
Tellingly, the actual word for depression doesn’t exist in Chinese vocabulary. As such, many Chinese psychiatric professionals believe that mental illness is vastly under-diagnosed. A generally negative attitude to the openly mentally ill further deters people from seeking help.
However, in the last six years demand in Hong Kong for mental health services has doubled and is now far exceeding supply. From April 2010 to the end of March 2011, 176,100 patients received mental health treatment – more than ever before. Nonetheless, those figures pale in comparison to the population of Hong Kong: some 7.1 million.
In response to this increased demand, the council conducted a public consultation with more than 200 involved organisations. Most agreed to co-ordinate more mental-care services and the results remain to be seen.
In the first instance, those seeking mental health care should contact the Mental Health Association of Hong Kong.
As an ex-British colony, Singapore has a similar mental health history to the UK. In 1841, a mental health service was established. However, it consisted of custodial care in large asylums and the mentally ill were often hospitalised for years. These asylums were managed by British medical professional and nurses until closure in 1928.
Fortunately, times have changed and Singaporeans now have access to modern mental health care programmes and services. In light of an ageing population, there have been increased efforts to improve services and these efforts include public education, integrated programmes and extensive mental health research.
Despite all of the above, social stigma is also an issue in this country, with taboos and traditional belief systems discouraging people from addressing their mental health and seeking help. Instead, Malaysian Shamans (known locally as bomoh’s) are consulted for their healing expertise. Studies have shown that the strength of the social support, as well as relatives’ belief in supernatural causes of mental illness, are strongly associated with the decision to seek treatment with a bomoh over a psychiatrist.
In the UK, mental illness accounts for a third of all illnesses and at any given time one in six people experiences anxiety or depression. In England alone, treatment costs approximately £105 billion per annum.
Mental health services are delivered in the UK using a multi-disciplinary approach, calling upon the skill and expertise of a number of different departments and teams. However, because mental health care is provided by the tax-funded National Health Service, waiting lists for psychiatric treatment can be month’s long, impacting health and recovery. For this reason, UK GP’s will much more readily prescribe SSRI’s, anti-depressants which can have significant long-term side effects.
As with all of the countries discussed, people in the UK struggle to get help for mental illness, with only 1 in 6 depressed people discussing it with their GP. This month, the government addressed this culture in their “Making mental health services more effective and accessible” policy, which commits to providing £400 million by 2015 to give people improved education and access to psychological therapies.
According to the Australian Institute of Health and Welfare (AIHW), Australia has a strong record of innovation in mental health but a poor one in terms of sustaining reform. AIHW estimates that over $6 billion per annum is spent on mental health-related services, including residential and community services, hospital services, consultation with specialists and general practitioners.
However, despite the substantial increase in policy attention and funding since the early 1990s, poor mental health continues to affect many. According to the Psychiatric Times, the mental health, social services and support payment systems are characterised by “fragmentation and insufficient coordination.”
In response to the call for reform, Australia’s Federal government committed to a ten year process of reform and investment in mental health care. The first port of call was to appoint Australia’s first Mental Health Complaints Commissioner, who will be in charge of ensuring complaints regarding public mental health services are addressed and resolved. Lynne Coulson Barr was appointed on April 28 2014.