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Mental Health in the Middle East:

A Qualitative Review of Barriers Faced by Practitioners and Potential Strategies To Remove Them

Kaitlyn Arrow, BA and Şenel Poyrazlı, Ph.D.

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SUNUM AKIŞI

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  1. Problem Situation
  2. Objective - Research Questions
  3. Method
    • Research Design
    • Sample/Research Group
    • Data Collection Tool and Application
    • Data Analysis
  4. Findings
  5. Review
  6. Next Steps
  7. References

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Mental health is still stigmatized

  • Western-centric nature of psychology
  • Limited relevance for clinical work in non-Western countries
  • The Middle East is one of the most underrepresented regions of the world

PROBLEM SITUATION

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  • Need to identify what barriers exist and why
  • What can be done to overcome barriers?
  • Research focuses solely on service users
  • Lack of depth to current research
  • Clinicians in the Middle East are untapped resources

PROBLEM SITUATION

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  1. What barriers to mental health services and education have been identified

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  • What are some effective strategies that have been found to overcome these barriers?

OBJECTIVE - RESEARCH QUESTIONS

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METHOD

Research Model/Design

Sample/Research Group

Qualitative Literature Review

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Two Parts:

  • Peer Reviewed Articles
  • Articles and Handbook chapters describing clinician’s experiences

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Part One:

  • Continuing Gearing et al., 2013 systematic literature review from 2010-2024

Part Two:

  • Snowball sampling of international counseling handbooks

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METHOD

Data Collection Tool

Data Analysis

After analyzing the literature from both parts of the review process using thematic analysis, barriers and effective strategies that were found were grouped into three main categories: Educational and Health Systems, Clinical Training, and Societal Factors.

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FINDINGS

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FINDINGS

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FINDINGS

One of the most significant findings was the cultural dimensions that were necessary for consideration when developing indigenous modalities or adapting Western ones.

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RESEARCH REVIEW

People in the Middle East face many barriers to accessing Mental Health services. Systemic changes and cultural adaptations to Western models are needed such as...

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  • Current Qualitative study with students and Western trained clinicians in the Middle East
    • Focus groups
    • Semi-structured interviews
  • Understand experiences in education and clinical practice
  • Gain insight into improving collaboration and mental health services and education

MOVING FORWARD

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REFERENCES

Abo-Rass, F., Nakash, O., Abu-Kaf, S., & Braun-Lewensohn, O. (2024). Unraveling trust issues towards mental health professionals among Bedouin-Arab minority in Israel. Culture, Medicine, and Psychiatry, 48(2), 350–366. https://doi.org/10.1007/s11013-024-09862-8

Al Fayez, H., Lappin, J., Murray, R., & Boydell, J. (2017). Duration of untreated psychosis and pathway to care in Riyadh, Saudi Arabia. Early Intervention in Psychiatry, 11(1), 47–56. https://doi.org/10.1111/eip.12214

Alabdulla, M., Reagu, S. M., Kader, N., & Gad, E. (2022). Developing a gender sensitive women’s mental health service in Qatar: A rewarding challenge. Asian Journal of Psychiatry, 68, 1–4. https://doi.org/10.1016/j.ajp.2021.102969

Amro, I., Ghuloum, S., Mahfoud, Z., Opler, M., Khan, A., Hammoudeh, S., Hani, Y., Yehya, A., & Al-Amin, H. (2019). Cross-cultural adaptation of the Arabic Positive and Negative Syndrome Scale in schizophrenia: Qualitative analysis of a focus group. Transcultural Psychiatry, 56(5), 973–991. https://doi.org/10.1177/1363461519850345

Bar Zaken, S. (2024). Lost or found in translation: Multilingualism among Arab bibliotherapists in Israel. Journal of Poetry Therapy, 37(2), 69–86. https://doi.org/10.1080/08893675.2023.2219855

Cucchi, A., Liuzza, M. T., Saleem, Z. A., & Al Hemiary, N. J. (2020). A study on the effectiveness of cognitive behavioural therapy for obsessive compulsive behaviour in Iraq: Lessons for cross-cultural practice. International Journal of Cognitive Therapy, 13(2), 173–187. https://doi.org/10.1007/s41811-019-00065-3

Daass-Iraqi, S., Garber-Epstein, P., & Roe, D. (2021). Cultural adaptation of the Illness Management and Recovery Intervention among Israeli Arabs. Psychiatric Services, 72(7), 848–852. https://doi.org/10.1176/appi.ps.202000175

Dardas, L. A., Shoqirat, N., Abu-Hassan, H., Shanti, B. F., Al-Khayat, A., Allen, D. H., & Simmons, L. A. (2019). Depression in Arab adolescents: A qualitative study. Journal of Psychosocial Nursing & Mental Health Services, 57(10), 34–43. https://doi.org/10.3928/02793695-20190528-01

Hickey, J. E., Pryjmachuk, S., & Waterman, H. (2016). Mental illness research in the Gulf Cooperation Council: A scoping review. Health Research Policy and Systems, 14(1), 59. https://doi.org/10.1186/s12961-016-0123-2

Miller, P. M., Bener, A., Ghuloum, S., Commons, M. L., & Burgut, F. T. (2012). Differences and similarities in cross-cultural perceptions of boundaries: A comparison of results from two studies. International Journal of Law and Psychiatry, 35(5), 398–405. https://doi.org/10.1016/j.ijlp.2012.09.004

Vogel, D. L., Zhao, N., Vidales, C. A., Al-Darmaki, F. R., Baptista, M. N., Brenner, R. E., Ertl, M. M., Liao, H.-Y., Mak, W. W. S., Rubin, M., Schomerus, G., Şahin, E., Topkaya, N., & Wang, Y.-F. (2024). Interdependent stigma of seeking mental health services: Examining a new scale across eight countries/regions. Journal of Counseling Psychology, 71(5), 356–368. https://doi.org/10.1037/cou0000757

Alrashdi, D. H., Alyafei, A. H., Alanazi, S. A., Meyer, C., & Gould, R. L. (2024). Cultural adaptations of third-wave psychotherapies in Gulf Cooperation Council countries: A systematic review. TRANSCULTURAL PSYCHIATRY, 61(2), 209–228. https://doi.org/10.1177/13634615241227691

Amer, M. M. (2013). Counseling and psychotherapy in Egypt: Ambiguous identity of a regional leader. In R. Moodley, U. P. Gielen, & R. Wu (Eds.), Handbook of counseling and psychotherapy in an international context. Routledge. https://doi.org/10.4324/9780203864906

Amer, M. M. (2015). Counseling and psychotherapy in Egypt: Omar’s story. In R. Moodley, M. Lengyell, R. Wu, & U. P. Gielen (Eds.), International counseling: Case studies handbook (pp. 13–21). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781119222781.ch2

Beiman, S. Z. (2015). Counseling and psychotherapy in Israel: Lee’s story. In R. Moodley, M. Lengyell, R. Wu, & U. P. Gielen (Eds.), International counseling: Case studies handbook (pp. 243–249). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781119222781.ch31

Birashk, B. (2013). Counseling and psychotherapy in Iran: Flourishing perspectives. In R. Moodley, U. P. Gielen, & R. Wu (Eds.), Handbook of counseling and psychotherapy in an international context. Routledge. https://doi.org/10.4324/9780203864906

Birashk, B. (2015). Counseling and psychotherapy in Iran: Javad’s story. In R. Moodley, M. Lengyell, R. Wu, & U. P. Gielen (Eds.), International counseling: Case studies handbook (pp. 235–242). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781119222781.ch30

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REFERENCES

Jacoby, R. (2013). Counseling and psychotherapy in Israel: Milestones, disputes, and challenges. In R. Moodley, U. P. Gielen, & R. Wu (Eds.), Handbook of counseling and psychotherapy in an international context (pp. 397–408). Routledge. https://doi.org/10.4324/9780203864906

Khoury, B., & Fayad, Y. I. (2015). Counseling and psychotherapy in Lebanon: Zeina’s story. In R. Moodley, M. Lengyell, R. Wu, & U. P. Gielen (Eds.), International counseling: Case studies handbook (pp. 251–257). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781119222781.ch32

Khoury, B., & Tabbarah, S. (2013). Counseling and psychotherapy in Lebanon: Towards a Lebanese framework of psychology. In R. Moodley, U. P. Gielen, & R. Wu (Eds.), Handbook of counseling and psychotherapy in an international context. Routledge. https://doi.org/10.4324/9780203864906

Masalha, S., & Nashashibi, R. G. (2015). Counseling and psychotherapy in Palestine: Shaden’s story. In R. Moodley, M. Lengyell, R. Wu, & U. P. Gielen (Eds.), International counseling: Case studies handbook (pp. 259–265). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781119222781.ch33

Nashashibi, R., Srour, A., & Srour, R. (2013). Counseling and psychotherapy in Palestine: Between occupation and cultural colonialism. In R. Moodley, U. P. Gielen, & R. Wu (Eds.), Handbook of counseling and psychotherapy in an international context (pp. 419–429). Routledge. https://doi.org/10.4324/9780203864906

Poyrazli, S., & Balkis, M. (2015). Counseling and psychotherapy in Turkey: Ceren’s story. In R. Moodley, M. Lengyell, R. Wu, & U. P. Gielen (Eds.), International counseling: Case studies handbook (pp. 267–273). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781119222781.ch34

Poyrazli, Ş., Doğan, S., & Eskin, M. (2013). Counseling and psychotherapy in Turkey: Western theories and culturally inclusive methods. In R. Moodley, U. P. Gielen, & R. Wu (Eds.), Handbook of counseling and psychotherapy in an international context (pp. 419–429). Routledge. https://doi.org/10.4324/9780203864906

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Thank you for your participation.