Before conflicts in the region began that have since exacerbated people’s health and wellbeing concerns, a Fall 2022 McKinsey study conducted across Kuwait, the UAE, Saudi Arabia, and Qatar found that two-thirds of Gulf Cooperation Council (GCC) respondents were already experiencing symptoms of poor mental health or had a diagnosable mental health condition.

This is a major concern for their employers, as McKinsey’s findings also showed that more than twice the percentage of GCC respondents reported an intent to leave their jobs compared with global statistics (36 vs. 16 per cent respectively), as inflated rates of stress and burnout plague workplaces across the region.

With that said, GCC employers have now reached a pivotal moment regarding mental health. As Middle Eastern countries continue to make tremendous strides toward providing comprehensive mental health care and embracing modern, open-minded beliefs about mental health, how those in charge navigate this growing mental health crisis decides whether the region continues to advance toward better health and healthcare, or regresses back into disarray and disorder.

And in the context of the workplace, how well leaders navigate this crisis is measured largely by how well they fight back against stigma.

Mental Health Stigma and Its Impact on the Workplace

As a wide breadth of research on mental health trends in the Middle East espouses, in the Arab world, “a large diversity of stigmatising beliefs, actions, and attitudes toward treatment of mental illness” stemming from cultural and religious beliefs are prominent, negatively impacting how concepts related to mental health are perceived. Among these ideas include the belief that mental illness is contagious; that it “may have something to do with being possessed by bad devils, having weak faith in God, or being affected by black magic,” as one Emirati person explained; or that it will threaten the integrity and reputation of one’s family.

Each of these cultural nuances and perceptions can significantly impede upon individuals’ ability to receive care for a number of reasons. For one thing, stereotypes such as that which purports that mental illness is contagious have been widely attributed to the severe lack of mental health personnel across the region, whereas additional research indicates that a considerable portion of the local populations do not trust in the validity of psychiatric interventions and instead prefer to seek help from traditional faith healers. For all those caught somewhere in the middle, such stigmas can be especially damaging, as those who do wish to seek clinical support fail to find available care, or worse, avoid seeking help out of fear of what those around them will think, while others remain largely unaware and uninformed about key concepts related to mental health—which only reinforces stigma.

And this cyclical avoidance or failure to receive help can come at a considerable cost to employers, in the annual sum of a whopping $3.5 billion. And that’s not all: As Lina Shadid, industries leader at PwC Middle East, reveals, “we estimate that in the GCC at least 37.5 million productive days are lost per year due to untreated mental illness.”

Thus, as distress rates continue to increase across the Middle East, for employers hoping to stay afloat in 2024, it is now imperative that they proactively address the mental health concerns of their employees in order to prevent the seeds of stigma and burnout from taking root.

What to Do

Interestingly, while many are quick to blame “dated” religious beliefs and traditions as the root cause of persisting mental health stigma, new research has since suggested that higher religiosity is in fact “significantly linked” to “more favorable attitudes toward [mental health and] seeking formal professional help.” A recent study conducted among individuals from 16 Arab countries, for instance, observed a “positive correlation” between higher levels of mature or well-established religiosity and higher engagement in progressive coping strategies like help-seeking. In their findings, the researchers recorded that respondents who demonstrated a stronger or more confident belief in God felt more encouraged to face their mental health problems or emotions head-on, believing that God could “alter the situation for the better,” and thus that they could successfully attain relief.

Suffice it to say, seeking professional treatment for mental health issues does not conflict with seeking help from God, contrary to what some might presume. Instead, researchers assert that it’s preexisting stigma that’s to blame for any weakened ties between one’s religiosity and help-seeking attitudes. That said, many experts have underscored the need for a greater integration of religious- or spiritual-based mental health practices with clinical ones. This helps to promote the idea that having a strong faith in God and needing and or seeking formal, professional care are not mutually exclusive.

Harnessing The Healing Power of Religion

For employers, this means investing in and organising wellness programmes that incorporate not just clinical and counselling support, but other forms of complementary health practices, such as yoga, tai chi, and qi gong; meditation; breathing and relaxation techniques; and mindfulness interventions—all of which promote religiosity, spirituality and mentality as potent drivers of health. As plenty of studies affirm, the “power of placebo” is a real and valid determinant of health. Just as what one believes to be true about their health or about their control over it can result in actual manifestations in the brain and body, so, too, can what one believes to be true about their God or spiritual leaders and their control over one’s health and wellbeing result in mental and physical manifestations. By promoting activities as well as services, resources and coping strategies that call on people to harness their faith to improve their health and wellbeing, employers can effectively reassure their staff that their mental health does not have to come between them and their faith, and furthermore work to disillusion them from the stereotypes that mental illness is some form of divine retribution or marker of poor faith.

Education and Awareness as Integral Components of Employee Wellbeing

But, of course, just as positive thoughts can have a positive influence on one’s health, so, too, can negative ones have a harmful impact. Thus, equally as important to integrating faith-based interventions with more traditional ones are educational strategies that aim to dispel or eliminate the presence of stigmatic or misguided beliefs in the workplace. As researchers with Economist Impact note in their latest report on mental health in the Middle East, any improvements in population-based mental health literacy and stigma that have been made over the last few years are likely thanks to an increase in awareness and education efforts in the region—specifically those orchestrated by a “range of actors outside of the health sector,” including workplaces and community groups.

According to experts, such educational campaigns should prioritise several key concepts, the first pertaining to the normalisation of seeking help for one’s mental health and receiving professional intervention. As the Economist Impact report notes, many individuals in the area maintain an antiquated and somewhat mythical view of professional mental health treatment, resembling sensationalised portrayals of asylums frequently depicted in pop culture. This perspective inevitably dissuades people from speaking out about their mental health out of fear of being physically restrained and detained; losing their job, their property, their children and other possessions; and losing their rights, their privileges, and their own autonomy. To hear directly from their employer that they are not at risk of losing their job for taking care of their mental health can be a huge sigh of relief for many and a huge step toward improving access and utilisation of mental health services.

Another essential focal point for these campaigns must be the general overview of common mental health issues—how they’re caused, how they manifest and how they’re treated or managed—and how individuals can spot warning signs of poor mental health in themselves and in their peers. As Dr. Arokiasamy Perianayagam, a professor at the National Council of Applied Economic Research (NCAER), explains, “Communities [in the Middle East Region] are rarely educated about warning signs for mental illness, or the physiological and environmental factors that can contribute to it.” When individuals don’t even know what mental illness looks or feels like, it can be a lot easier for them to antagonise others for speaking out about their own; consider, for instance, how often many rebuke others for complaining about something that “happens to everyone,” or, conversely, how often many accuse people of “making their symptoms up in their head.”

Leveraging Peer Support and Positive Peer Relations to Promote Empathy and Knowledge

In terms of who bears the brunt of the cost of mental health stigma, it’s widely understood that men often shoulder the heaviest burden. In most cultures—and especially those in the Middle East—men are expected to be tough, independent, stoic, unemotional. If they do experience or exhibit signs of mental illness, then it must be due to some ‘flaw’ in their character or inherent weakness, both worthy of shame. Because of this perceived peer pressure between men, many men have historically feared ever coming out about their mental health issues. But as clinical psychologists from the Aspris Wellbeing Centre in Dubai testify, there has been a marked shift in attitudes among men about mental health and help-seeking.

“I now see more male patients coming forward for support compared to five years ago and I strongly believe this is as a result of the promotion of more diversified, positive masculinity role models, who are becoming great advocates and trying to reach more men who might be suffering from mental health disorders,” admits Ozan Akbas, one of the clinical psychologists with Aspris. “This, in addition to increased encouragement and education of mental health in companies across the UAE, is all making a positive impact.”

That said, in addition to educational and individual interventions, many experts have underscored the benefits of implementing mental health promoter programmes or wellbeing ambassador programmes in the workplace. Through these programmes, employees gain the opportunity to learn with and from each other, by listening to their own peers’ experiences with mental illness and how they dealt with it; swapping success stories, bonding over past or current hardships, and overall sharing valuable insights that work to provide everyone with a well-rounded, in-depth, and nuanced understanding of mental health.

Digital Health Interventions as Driver of Equity and Accessibility of Resources

Secondary only to stigma, poor access to or availability of mental health services is also one of the biggest barriers preventing people in the Middle East from seeking help for their mental health, researchers with Economist Impact report, as previous studies highlighted within the organisation’s report indicate that as high as 80 to 90 per cent of people in the Middle East don’t know where they can access support. To make matters worse, the widespread shortage of mental health practitioners means that whatever services are available are largely unaffordable, as a recent report named the UAE as the country with the second most expensive therapy.

To remediate these roadblocks to effective treatment, research has demonstrated the benefits of implementing digital health interventions, such as personalised mental health applications, telehealth services, helplines, and more; benefits that include: portability, accessibility, affordability, convenience, anonymity, and promptness.

As student researchers at Canadian University Dubai assert, these attributes can be especially beneficial in the name of combatting stigma, as they help individuals to access support privately and anonymously, in any location of their choosing. They also further reinforce the importance of self-care and self-management of one’s own health, allowing people to track their own progress and develop their own self-treatment plan based on their particular needs (e.g., whether they would like to focus on physical activity, sleep quality, nutrition, mindfulness, etc.

As geopolitical tensions continue to grow with no peace in sight, poor mental health outcomes among all those in the Middle East region are expected to increase. But the silver lining according to Dr. Ahmed, Chair of Behavioural Health Councill, SEHA, is that now, at least, there is more awareness surrounding mental health, and a greater willingness to seek support. “People come out and say, ‘Yes, I need help,'” he explains. “Earlier people were very stigmatised or ashamed of seeking help but are coming out and saying, ‘I don’t care.’ So, the stigma has gone down because of all the campaigning and awareness, so [there are some] positive changes [that] we’ve seen.”

Whilst there is still much further to go when it comes to improving the mental health situation in the Middle East, by tackling stigma at work and creating a more tolerant and open-minded workplace culture, employers can work to alleviate one of the most long-standing barriers to mental health care in the region, and significantly improve their employees’ health and wellbeing.