The UAE has taken positive strides to make treatment for mental health and neurological disorders more accessible. Madhukar Tanna, CEO of Pharmax Pharmaceuticals, the first domestic company dedicated to the manufacture and commercialisation of high-quality branded generic pharmaceuticals located in Dubai Science Park, takes a closer look at how the increased availability of domestically-manufactured affordable medication can further destigmatise these conditions and ensure patients are receiving the treatment they require:

According to the World Health Organisation (WHO), mental health disorders, including neurological illnesses, account for a significant proportion of the total global burden of disease and are the leading cause of years lived with disability worldwide. In fact, one in four people in the world will be affected by mental or neurological disorders at some point in their lives. Of these, only one third will seek treatment.

These health issues know no borders, and the occurrence of mental health and neurological diseases is as high in the UAE as in other parts of the world. While comprehensive reports on the incidence of mental health diseases in the UAE are not easy to come by, WHO predicts depression will become the second-highest cause of disease burden by 2030. Available figures suggest up to four per cent of the population could be suffering from clinical depression, with a further 15 per cent experiencing mild depression. Arguably more disturbingly, a recent WHO survey shows 13 per cent of UAE school students aged between 13 and 15 have considered attempting suicide.

Residents of the UAE may be more at risk from mental health conditions than those of other countries. According to World Population Review statistics, 90 per cent of the UAE population is expatriate, working away from home and, in many cases, family. What further compounds the issue is that many blue-collar workers in the emirates come from economically-challenged backgrounds and may not be educated, especially with regards to mental health. When faced with long working hours, inadequate foreign language skills to fully integrate into society and insufficient time to socialise or exercise, many expat workers in the UAE become isolated, leading to depression and the belief they have no one to speak with about how they are feeling.

The UAE is leading the way in the region and was one of the first countries in the GCC to publicly address mental illness. In recent years, the country has launched a number of initiatives to improve patient access to treatment and destigmatise mental illness, including the announcement in June 2018 that people who try to commit suicide should be seen as victims and not criminals. This marked a dramatic shift from UAE law, in which suicide attempts are punishable by a prison term of up to six months or a fine of up to Dh5,000, or both.

The Dubai Health Authority also launched the first comprehensive mental health strategy for Dubai, ‘Happy Lives, Healthy Communities’, which is working towards successful implementation, active community participation to remove the stigma attached to mental health illnesses and empowerment of patients. The multi-pronged approach includes initiatives such as promoting a healthy start to life, parenting programmes, school-based interventions, support for children of parents with mental illness, workplace and occupational stress interventions, recovery-oriented approaches and interventions for older people. These steps have succeeded in creating a greater sense of community, in which people are becoming more accepting of mental health conditions in general.

While the UAE is making significant progress in improving mental health literacy, there is still much to be done. Barriers patients may face when seeking treatment for mental health and neurological diseases include the stigma associated with mental disorders and duration and cost of medicines. Furthermore, patients requiring treatment may be reluctant to seek medical advice due to a lack of awareness of mental health problems within communities, fear of stigma, discrimination or other sociocultural factors, and insufficient recognition that mental disorders are responsive to effective treatment. Long-held cultural and beliefs in the region remain a challenge to overcoming the stigma surrounding mental health.

Even if patients seek out medical advice and are prescribed a course of treatment, WHO highlights poor treatment adherence. Factors leading to patients not taking medication as specified include side-effects, the long-term nature of many severe mental disorders and resultant implications for duration and cost of services and availability of medicine.

In a recent study led by Dr Nabeel Al Yateem, assistant professor at the University of Sharjah’s department of nursing, 641 healthcare professionals working in UAE-based hospitals and schools were interviewed about their knowledge of mental health conditions. Fewer than half were able to identify the symptoms of three major mental illnesses: post-traumatic stress disorder, psychosis and depression with suicidal thoughts.

Domestic pharmaceutical manufacturing companies, such as Pharmax, are working to raise awareness of mental illness and neurological disease in the region. Through discussing the medications they offer for the treatment of chronic mental illness, they are shining a light on commonly overlooked symptoms, bringing the prevalence of mental and neurological disease to the forefront. Locally-based pharmaceutical companies are playing a vital roll in the up-skilling of healthcare professionals as they introduce their ranges to healthcare providers in the UAE.

Local pharmaceutical manufacturers are pioneering the supply of affordable, high-quality, branded generic medication. Despite being equivalent to named brands in use, dosage and active ingredients, generic drugs are often significantly less expensive. The benefits of having access to more affordable medication are two-fold: firstly, patients who are unable to afford long-term treatment because the cost of patented brands is prohibitive may be more able to purchase medicine with a lower price-point. Secondly, a number of insurance companies in the region are adding mental health treatment to their table of benefits. Lower-cost therapies are more likely to be approved for the long-term treatment of chronic mental illnesses.

The inclusion of coverage for mental health and long-term neurological treatment in health insurance standard tables of benefits lags behind other countries. This means that the medical insurance provided to most expatriate workers by their employers does not cover treatment such as counselling and a wide-range of medicines prescribed for mental health conditions. While treatment can often be added to policies, the costs are high and prohibitive for most policyholders. However, by providing more affordable treatment options, local manufacturers of generic medications are reducing the costs to medical insurance providers, which is encouraging some to include treatments. While UAE nationals have full cover for psychiatry and psychology therapy and medication, expatriates still have limited cover. However, the signs are encouraging, and with governmental support and local support, it is likely the UAE’s health insurance providers will continue to increase cover, enabling patients access to the treatment they so desperately need.

In addition to providing more affordable alternatives to patented originator brands, domestic pharmaceutical manufacturers, such as Pharmax, are investing in complex generic medications, which offer improved routes of administration. Drugs can be taken in a variety of ways – by swallowing, inhalation, absorption through the skin, or intravenous injection. Many drugs have side effects, which can vary significantly from person to person in terms of type and severity. For example, oral medications may cause nausea or drowsiness and injections may cause rashes and pain. Pharmax and other UAE-based pharmaceutical manufacturers are exploring alternative administration routes and are forging partnerships with global drug delivery technology providers to develop improved methods of administration to improve the patient experience. Adherence to treatment plans is low for mental health patients due to common side effects such as weight gain, disassociation and confusion. If side effects could be reduced, for example, by administering medication locally rather than systemically, or by enabling lower doses while achieving the same results, patient compliance could increase, resulting in improved long-term medical outcomes.

The number of domestic pharmaceutical manufacturers in the UAE has grown dramatically, increasing from 14 to 18 between 2014 and 2017. This number is expected to reach 36 by 2020, according to Dr Ameen Hussain Al Amiri, Assistant Undersecretary for Public Health Policy and Licensing at the UAE Ministry of Health, while addressing a workshop organised by the ministry and regulatory experts from the European Medicines Agency. The growing number of local companies providing medication is having a positive impact on the country’s awareness. These local manufacturers are increasing the availability of knowledge resources by way of speaking at conferences and exhibitions, posting via social media channels, interviews with the media, marketing and working with medical care providers and health insurance companies. UAE-based manufacturers are invested in raising the profile of mental health conditions and ensuring patients can access treatment.

In collaboration with government bodies, medical health practitioners, charities and community groups and forward-thinking health insurance providers, domestic pharmaceutical manufacturers are making headway in breaking taboos. This is the first step in achieving a more compassionate society in which people suffering from mental health conditions and long-term neurological illnesses are supported and treated rather than being marginalised. This greater sense of inclusion will encourage people to seek help when required and ensure that affordable medicine is available, leading to earlier diagnosis and treatment, enabling patients to go on a lead happy, healthy and more productive lives.

 

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About Pharmax Pharmaceuticals:

 

Pharmax Pharmaceuticals provides access to affordable, branded generic medication. Committed to exceeding the expectations of healthcare providers, practitioners and patients, Pharmax offers a diverse range of medications across a wide range of therapeutic areas. Headquartered in Dubai, UAE, Pharmax is a GMP-licensed international manufacturer and distributor of high-quality medications into most regulated markets globally. Pharmax is committed to maintaining a culture of quality and its state-of-the-art facility meets stringent local and global regulatory standards. www.pharmax.ae.

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