Abstract
Mental health disorders are very prevalent in Saudi Arabia, present in almost one-fifth of primary-care clinic attendees (Al-Khathami & Ogbeide, 2002), and reportedly reaching rates as high as 48% in certain populations (Almutairi, 2015). Despite these alarming figures, however, social stigma (Alnamlah, 2006) and doubts towards the legitimacy of mental illnesses (Al-Habeeb, 2003; Hussein, 1991) still persist in the Saudi society.
Almost all of the published literature pertinent to the subject in Saudi Arabia comes from hospital audits (AbuMadini & Rahim, 2002; Alnamlah, 2006) or attitudes of health care workers (El-Gilany, Amr, & Iqbal, 2010, Shahrour & Rehmani, 2009). The attitudes of health care workers are not necessarily representative. Because of their direct interaction with mental illness patients, health care workers are often found to be accepting (Corrigan et al., 2001) and caring (Shahrour & Rehmani, 2009). Literature on the attitudes towards mental health from the wider population is still lacking.
The only available data on the acceptability of mental health come from a large study on anxiety and depression in Saudi patients (Alamri, unpublished). This study involved administering the Arabic Hospital Anxiety and Depression Scale (HADS) to a sample of 237 outpatients in a tertiary neurology clinic and their family members. A cut-off score of 11 on either sub-scale (anxiety or depression) was the threshold to suggest referral to mental health services for further assessment.
A total of 34 patients (14.3%), who were excluded from the study, were surveyed. Fifteen patients refused to complete the HADS once they learned it was investigating anxiety and depression, while the other 19 patients initially agreed to the study, but declined to continue once mental health input was suggested. These patients were not different to patients included in the study in their sex (male, 61% vs 56%, p = .64), age group (<35 years, 52.6% vs 37.5%, p = .31), education level (tertiary education, 47% vs 57%, p = .49) or marital status (single, 58% vs 56%, p = .85). The most common reasons cited by patients were that they felt they did not need help or that mental health services were only for ‘crazy’ patients. Of the surveyed patients, only one (2.9%) admitted to previous interactions with patients with mental disorders.
These findings suggest that attitudes towards mental health in Saudi Arabia may not necessarily relate to the person’s socioeconomic status. Other factors, such as upbringing (El-Gilany et al., 2010) and prior contact with patients with mental illnesses (Hussein, 1991), may play a more significant influence on the person’s acceptability of mental illness. Indeed, interacting with mental illness patients has been shown to significantly improve attitudes toward mental health disorders (Corrigan et al., 2001; Griffiths, Carron-Arthur, Parsons, & Reid, 2014).
The data are not sufficiently powered to provide definitive answers. They, however, shed light on the persistent prejudices towards mental illness in Saudi Arabia. These findings call for further research addressing this problem specifically, and targeting non-health care workers. Educational campaigns, involving patients with mental illness and their advocates, are needed and are hoped to change attitudes towards mental illness.