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When it comes to mental health services, the government should put its money where its mouth is, says Professor Sheikh Saoud Abdulla Al Mualla, president of mental health affairs in the UAE, and head of the psychiatry department at Rashid Hospital, Dubai.

Is it fair to say that mental health services are almost nonexistent in the UAE?

If you look at the health system in this country, which probably spans about 30 years, all medical specialties started at the same level. Every specialty progressed - except psychiatry. Psychiatry 30 years ago was almost the same as it is now. In this whole country of ours, there is not a single, private psychiatric bed.

Have treatments also been as slow to progress?

Patients can access almost all medication but psychiatric medication. We class all psychiatric drugs under the same umbrella and that is not fair. Sedatives are dangerous drugs and they need to be controlled [but] anti-depressants are among the safest drugs and they are classed the same.

None of the medication for rehab is licensed in this country. You cannot get things like methadone. I am trying to get the restrictions lifted; anti-depressants should not be restricted in this way.

Is that due to a government reluctance to acknowledge psychiatric problems?

We can't keep blaming stigma for this level of service. The reality is that there is a lack of resources. Rashid Hospital, Dubai has the only acute unit that deals with these issues, which is unbelievable. I see people who are desperate and they present themselves to place likes the American Hospital and Welcare and they don't know how to manage them.

Can patients access services within the primary care system?

I have to be fair to primary care physicians. It is improving. For example, just a couple of years ago they were not even able to write a simple anti-depressant - now they can write two or three. But [Rashid Hospital] is meant to be secondary care and we are still taking most of the primary care.

It will take a lot more doctors before services are truly available at primary care - at the moment, [Rashid is] everything for everyone.

Why aren't patients being diagnosed within primary care?

Because people don't typically present themselves saying, ‘I'm depressed'. They present themselves with somatic symptoms. If someone is psychotic then anyone can tell - it is those who do not present with dramatic symptoms that need proper psychiatric assistance. I have patients coming to me who have had several invasive surgeries because of somatic problems.

They think they have a heart problem, like palpitations, and they come to me as a last resort. Often it is a simple problem, like an anxiety disorder, that would have subsided with a course of anti-depressants.

What impact has this had on the national health system?

In this country, mental health issues are extremely common. We are not talking about something on the periphery - we are talking about something that is touching everything. I cannot tell you the statistics but you can assume that suicide is higher here than most countries.

If, as a country, you have a problem with severe mental illness, you will be more burdened than if you had the same size problem with HIV and AIDS.

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