Bahrain's Mental Health Hospitals Have Become Drug Stores
22 September 2016
By Islam Al-Zeyni Manama, Bahrain, (Al-Araby Al-Jadeed)– Um Fatima, 52, sits to recount the history of depression. For two decades, she received no therapy to help her assimilate into the community and to live her life normally. She claims that the hospital – the only one of its kind in Bahrain specializing in mental health – simply hands out medication.
“I need a human being to hear me and understand me, to understand that medicine is no substitute human interaction and kindness,” she says.
Um Fatima suffers from bipolar disorder, a condition characterized by alternating periods of depression and euphoria, according to the U.S. National Institute of Mental Health. Ahmad Al-Garibi, a physician researching patterns of psychiatry in Bahrain, issued a study in October 2015 stating that depression was a major concern, constituting 33.4 percent of all medical cases.
This was confirmed in discussions with five other physicians, including psychiatrist Abdul Karim Mustafa, and clinical psychiatric advisor Bana Posbon. Both said that depression was one of the most common problems of patients.Testimonies of 30 patients interviewed for this story echo Um Fatima’s story. They confirmed that the hospital has a critical lack of doctors capable of processing influxes of patients, and say that this has left patients vulnerable to personal setbacks because of a medicine-only focus at odds with the international mainstream use of therapy.
A mother of one patient, who spoke on condition of anonymity, said her son’s struggle with schizophrenia was only treated with drugs that kept him quiet and docile, but left him unable to reintegrate into society. She says they have been forced to seek expensive treatment in private clinics.
A hospital doctor, refusing blame said the lack of therapy sessions was due to a shortage of psychologists. He and his colleagues spend only a few minutes a day with each patient when they have 50 patients per physician.
Behavioural Therapy Equipment
Sharifa Suwar; a behavioral and cognitive therapy specialist, confirmed that psychiatric patients need between 12 and 14 sessions, focusing on rehabilitation and addressing concerns about themselves, their lives, and their mental state.
The rise in the number of psychiatric patients coincided with a budgetary increase from $14 million in 2010 to $28 million in 2016, out of a general budget of $1.254 billion set aside for Bahrain’s health sector.
According to Khaled Said, a regional advisor on mental health, the budget increase was attributed to greater spending for 80 medical treatments, as well as an expanded staff of 600 employees at the hospital. But this was not reflected in the number of psychologists hired. That number went only from 47 to 50 over five years, and remains below the global standard of 20-30 doctors per 100,000 citizens set by the World Health Organization. Currently t3.6 doctors serve every 100,00 Bahrainis.
In the daily care unit of the Ibn Rushd Hospital, the head of the Behavioral Therapy Department says that there is only one doctor, and sometimes two assistants patients, despite the increasing number looking for rehabilitation.
“We have hundreds of patients waiting to meet a specialist just meant for them,” she says. “May God help the specialist and the patients.”
Asked why there were not more specialists, she said: “There is no desire for it in Bahrain, so students are inclined to choose other fields.”
Psychiatric Patients Awaiting their Sessions
She showed this reporter an audio tape containing various techniques and methods for cognitive and behavioral therapy, claiming it helped calm patients. Then she added that there was no specific methodology that a majority of experts agreed on.
Outside her office, in a unit founded in February 1992, patients sat waiting for their sessions to begin.
Over the course of 80 visits to the unit between Feb. 10 and March 22, 2016, this reporter found that only four of the 20 in-patients awaiting therapy had sessions. The remaining 16 were left waiting due to the lack of a full-time specialist in the facility.
By these patients’ accounts, the hospital does not take the initiative to offer the sessions, and requests by parents or guardians usually result in a pile of forms and paperwork culminating in “useless” therapy. These sessions are irregularly scheduled, with months in between each of them. Hospital supervisorsl say that “patients who have money should not waste their time here.”
Psychiatrist Sharifa Suwar confirmed that patients like Um Fatima suffering from manic-depressive disorders do not need such lengthy hospital stays, and agreed that sit-down sessions could better address anxieties and help with social integration.
However, according to her medical records, Um Fatima received no such treatments, though the head of the hospital Dr. Adel Al-Awafi declined to comment, citing doctor-patient confidentiality.
Imbalance and Disruption
Awafi said that there were instances where it was affordable to seek care abroad, but insisted that therapy in all its forms was available in Bahrain. He also said that drug therapy was successful and had improved the conditions of 70 percent of patients, while social conditions had impacted the rest.
Dr. Michael Craig Miller, an assistant professor of psychiatry at Harvard Medical School, disagreed. “Therapy is as important as antidepressants, because it is based on the fact that our thoughts make us suffer as much as external factors. It can work to change our way of thinking unhealthily, and give us a sense of comfort,” he said.
The Root of the Problem
Dr. Tarek El-Madawy, owner of a private psychiatric clinic, says Bahrain lacks government-employed psychiatrists, and that has driven citizens to private clinics. However, this investigation found that many such clinics seemed to benefit from the situation, using techniques that lacked scientific proof, or promoting religious-based therapy.
This has meant that only 143 patients received treatment in 20014, according to official figures. No numbers were available for 2015 or 2016.
Khalid Saaed, the WHO’s regional adviser for mental health and addiction, says that Bahrain lacks reliable statistics about psychiatry. He adds that the country needs to adopt a mental health bill, be it the one suggested by the Ministry of Health, or one that has been in parliament since 2013.
Resorting to Private Care
Although the psychiatric hospital provides free treatment to citizens, many choose private clinics instead, believing therapy will help them overcome their problems. Some of those, however, are unable to pay the costs and appeal to charities. Others borrow.
Of 50 patients interviewed, in two private clinics, 18 said that their relatives had been treated first at public hospitals before moving to private clinics due to ineffectiveness. They asserted that, unlike in private care, the public health service detained patients and pacified them, rather than really address problems.
“The hospital is working to the capacity available,” said Dr. Awfi, adding that those leaving the hospital for private care were perhaps looking for “more privacy”.
However, in five comparisons of different types of depression, this investigation found that those who received private-sector treatment improved and found it easier to integrate into society or return to their studies or work.
Table: A comparison of five different depression types, being treated in both private and public healthcare.
The average cost of treatment in the Bahraini private sector ranges between $110 and $265 per hour. A patient might need as many as two hours a week, at a cost $372. This in a country where the average income is $1,358.
In addition, Awafi said that Bahraini insurance companies have no provisions for mental healthcare, a fact our investigation confirmed. As a result, patients are left to endure the public hospital’s drug regimen or pay for treatment in private clinics.
Medicine Is Free But Not Enough
Bahrain’s psychiatric departments have dedicated wings for children and the elderly, and the government provides any medicine necessary, free of charge despite the high expense, sparing patients thousands of dollars for antipsychotics and neuroleptics.
This has cost the government hospitals around $2.6 million, according to the Ministry of Health.
Parents of patients interviewed believe that the drugs are not enough, insisting that therapy is also needed. Awafi says that for patients to benefit from therapy the psychiatrists must determine it necessary and uniquely prepare for each case, after which permission must be granted from both the patient and their family or guardians.
Mental Health in Limbo
The absence of a Mental Health Act to determine the process of treating patients, or the right type of treatment, is making this problem worse. In 2013, members of the Bahraini House of Representatives submitted a bill “for the promotion of mental health services and patients’ rights”, but the proposal has yet to pass.
This investigation was completed with support from Arab Reporters for Investigative Journalism (ARIJ) and coached by Ghassan El Shihaby. Nicolas Awad translated the investigation into English.
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