Providing Mental Health Care to Women in a Middle Eastern Context: A Qualitative Study in Saudi Arabia

Abstract

In Middle Eastern countries the authority of male guardians means women often endure significant social and gender inequalities, which can contribute to mental health problems, and impact on the mental health care received. This exploratory, qualitative study investigated mental health care delivery to Middle Eastern women in Riyadh, Saudi Arabia. Nurses (7), psychiatrists (3) and clinical psychologists (3) from a mental health hospital, student nurse interns (6) from a public women’s university and mental health care service users (5) and their family members (7) from a charitable organisation underwent semi-structured interviews. Their mental health beliefs, views and perceptions regarding the provision of mental health care to Middle Eastern women were explored. Transcripts were analysed using grounded theory, underpinned by the theory of intersectionality. Social identities of culture, religion and gender emerged as particularly important intersecting influences. Social class was less prominent. Gender inequalities and family control significantly impacted on women’s mental health and the care they received. Women violating cultural norms risked psychiatric labelling, and being interned, whilst those with genuine mental health problems were stigmatised and sometimes rejected by families. Most health care professionals voiced frustration over cultural norms, which compromised the care they provided. Nevertheless, they respected service users’ behaviours to earn trust and facilitate a therapeutic relationship. They appeared to be subconsciously tailoring the biomedical model of care to ensure appropriate and effective, culturally competent and culturally safe care. Gender inequalities, marital stress, polygamy, supernatural beliefs, folk/faith healing, lack of knowledge, compassion fatigue and custodial versus therapeutic care also emerged as important themes. These findings informed recommendations for best practice in the care of women with mental health problems in Saudi Arabia.