We review the past, present and future state of mental health care in the Kingdom of Saudi Arabia (KSA). The past is reviewed prior to the modern era, discussing early explanations and treatments for mental health illness up through the establishment of the first mental hospital in the 1950s, tracking advances in mental health care over the past 60 years. The present is explored in terms of the current need for mental health care based on the prevalence of mental health problems in KSA. We also discuss the role of the family in caring for the needs of the mentally ill today. Finally, we look forward into the future, discuss the current education system that will produce the next generation of mental health professionals, examine areas of mental health care that need improvement, and provide a research agenda to guide the continued development of the mental health care system in KSA. Our goal is to present a blue print for the development of a state-of-the-art mental health that may serve as a model for other countries in the Middle East, while taking into account the political, cultural and religious factors that are unique to this region of the world.

BackgroundThere is evidence that mapping mental health systems (MHSs) helps in planning and developing mental health care services for users, families, and other caregivers. The General Administration of Mental Health and Social Services of the Ministry of Health over the past 4 years has sought to streamline the delivery of mental health care services to health consumers in Saudi Arabia.ObjectiveWe overview here the outcome of a survey that assessed the Saudi MHS and suggest strategic steps for its further improvement.MethodThe World Health Organization Assessment Instrument for Mental Health Systems was used systematically to collect information on the Saudi MHS in 2009–2010, 4 years after a baseline assessment.ResultsSeveral mental health care milestones, especially provision of inpatient mental health services supported by a ratified Mental Health Act, were achieved during this period. However, community mental health care services are needed to match international trends evident in developed countries. Similarly, a larger well-trained mental health workforce is needed at all levels to meet the ever-increasing demand of Saudi society.ConclusionThis updated MHS information, discussed in light of international data, will help guide further development of the MHS in Saudi Arabia in the future, and other countries in the Eastern Mediterranean region may also benefit from Saudi experience.

Based on the World Health Organization's Mental Health Atlas, the first Mental and Social Health Atlas in Saudi Arabia describes the historical background of mental health and social services in the country and identifies several deficiencies in the system including infrastructure and logistics and lack of epidemiological data. There is now great progress in strategic planning for developing and improving mental health care services across the nation, with suggestions to develop psychiatric services for identified special populations, to establish community mental health care services, to improve research and training in mental health, and to update mental health annual information systems using advanced information technology.

Objectives To present background information for the Saudi National Mental Health Survey (SNMHS) on the Saudi mental healthcare delivery system and previous epidemiological research on the prevalence and treatment of mental disorders in the Kingdom of Saudi Arabia (KSA). Methods Archival information and the results of a literature review are presented. Results KSA is the largest sovereign nation in the Middle East and the largest free market economy in the Middle East and North Africa. A national mental health policy has been in existence since 2006, but mental health spending still is less than in most other high‐income countries. The Ministry of Health has recently begun developing a new healthcare system based on a patient‐centered model of care that will integrate care of mental disorders with care of physical disorders. Previous epidemiological research on mental disorders in KSA has been limited, making the SNMHS important for policy planning purposes to obtain accurate estimates of prevalence, treatment, and barriers to treatment. Conclusions The SNMHS will provide valuable information for policy planning purposes on the burden of untreated mental disorders in KSA and barriers to treatment.

Objectives To estimate lifetime prevalence of mental disorders in the Saudi National Mental Health Survey (SNMHS). Methods The SNMHS is a face‐to‐face community epidemiological survey in a nationally representative household sample of citizens ages 15–65 in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was used to estimate lifetime prevalence of common DSM‐IV mental disorders. Results Estimated lifetime prevalence of any DSM‐IV/CIDI disorder is 34.2% and lifetime morbid risk is 38.0%. Anxiety disorders are by far the most prevalent (23.2%) followed by disruptive behavior (11.2%), mood (9.3%), eating (6.1%), and substance use (4.0%) disorders. Synthetic estimates of cohort effects suggest that prevalence of many disorders has increased in recent cohorts. Onsets typically occur in childhood for a number of anxiety and disruptive behavior disorders and in adolescence or early adulthood for most other disorders, although age‐of‐onset distributions for drug abuse is much later (median age of 31) than in CIDI surveys carried out in other high‐income countries. Conclusions Lifetime mental disorders are highly prevalent in Saudi Arabia and typically have early ages‐of‐onset.

Several challenges exist in carrying out nation-wide epidemiological surveys in the Kingdom of Saudi Arabia (KSA) due to the unique characteristics of its population. The objectives of this report are to review these challenges and the lessons learnt about best practices in meeting these challenges from the extensive piloting of the Saudi National Mental Health Survey (SNMHS), which is being carried out as part of the World Mental Health Survey (WMH) Initiative. We focus on challenges involving sample design, instrumentation, and data collection procedures. The SNMHS will ultimately provide crucial data for health policy makers and mental health specialists in KSA.

The aim of this cross-sectional 1-year study was to estimate the prevalence and to identify the risk factors for suicidal and self-injurious behaviours among patients with depression. A convenience sample of 557 out-and inpatients diagnosed with mood disorders was selected from 3 treatment settings in Riyadh, Saudi Arabia. Eligible patients completed data on sociodemographic variables and the Columbia suicide severity rating scale risk assessment version. The reported prevalence of attempted suicide in the previous week was 36.6%, interrupted suicide attempt 29.8%, aborted suicide attempt 34.6% and self-injurious behaviour without suicide intent 7.7%. Concerning suicide ideation, 47.2% reported suicidal thoughts, 36.6% suicidal thoughts with methods but without a specific plan and 35.4% suicidal intent without a specific plan. Male sex, joint family type, literate education, being in employment, smoking and physical co-morbidities were significantly associated with all types of suicide behaviour. Évaluation des comportements suicidaires et automutilatoires chez des patients atteints de dépressionRÉSUMÉ La présente étude transversale sur un an visait à identifier les facteurs de risque des comportements suicidaires et automutilatoires chez des patients atteints de dépression et à estimer leur prévalence. Un échantillon de commodité de 557 patients consultant ou séjournant dans trois établissements de soins de Riyad (Arabie saoudite) après avoir reçu un diagnostic de troubles de l'humeur a été sélectionné. Les patients éligibles ont fourni des informations concernant des variables sociodémographiques puis ont rempli la version d'évaluation du risque de l'échelle Columbia de la gravité du risque de suicide (Columbia Suicide Severity Rating Scale). La prévalence rapportée au cours de la semaine précédente était de 36,6 % pour les tentatives de suicide, de 29,8 % pour les tentatives de suicide interrompues, de 34,6 % pour les tentatives de suicide avortées et de 7,7 % pour les comportements automutilatoires sans tentative de suicide. Concernant l'idéation suicidaire, 47,2 % des patients ont rapporté avoir eu des pensés suicidaires, 36,6 % des pensées suicidaires associées une méthode mais sans projet particulier, 35,4 % l'intention de se suicider sans projet précis. Être de sexe masculin, faire partie d'une famille élargie, être alphabétisé, avoir un emploi, consommer du tabac, souffrir de comorbidités physiques étaient des caractéristiques fortement associées à tous les types de comportement suicidaire.‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫عرش‬ ‫التاسع‬ ‫املجلد‬ ‫الثالث‬ ‫العدد‬ 249

Data about psychiatric problems among young people are scarce in the Gulf countries. This retrospective review of records describes the pattern of child and adolescent psychiatric disorders among patients consulting 3 child psychiatric clinics in Saudi Arabia during the year 2008. Most patients were referred from the public health sector (92.8%). Psychotropic drugs were prescribed for 86.2% of patients and psychotherapy for 55.2%. Maternal perinatal complications and other psychosocial stressors were noted in almost 45.8% of cases. Family history of psychiatric disorder was reported in 31.5% of patients. Psychiatric comorbidity was noted in 40.5% of cases while physical diseases were noted in 29.9%. The outcome was classified as unstable at the last consultation in 17.9% of cases. In a linear regression analysis the only factors significantly associated with unstable outcome were a higher load of symptoms (OR 2.64) and perinatal complications (OR 2.84). Health and Social Services, Ministry of Health, Riyadh, Saudi Arabia (Correspondence to N.A. Qureshi: qureshinaseem@live.com Profil des troubles psychiatriques chez des enfants et adolescents consultant en établissements de soins psychiatriques pour enfants à financement public en Arabie saoudite RÉSUMÉ Les données sur les problèmes psychiatriques des jeunes sont rares dans les pays du Golfe. Le présent examen rétrospectif des dossiers médicaux décrit le profil des troubles psychiatriques des enfants et des adolescents qui consultaient dans trois établissements de soins psychiatriques pour enfants en Arabie saoudite pendant l'année 2008. La plupart des patients venaient du secteur public de la santé (92,8 %). Des médicaments psychotropes ont été prescrits à 86,2 % et une psychothérapie à 55,2 % des patients. Des complications maternelles périnatales et d'autres facteurs de stress psychosociaux ont été observés dans presque 45,8 % des cas. Sur l'ensemble des patients étudiés, 31,5 % avaient des antécédents familiaux de troubles psychiatriques. Une comorbidité psychiatrique a pu être observée dans 40,5 % des cas et physique dans 29,9 %. À l'issue de la dernière consultation, 17,9 % des cas ont été classés comme instables. Dans une analyse de régression linéaire, les seuls facteurs significativement associés à une évolution instable étaient le nombre élevé de symptômes (O.R. 2,64) et les complications périnatales (O.R. 2,84). General Administration for Mental ‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫عرش‬ ‫الثامن‬ ‫املجلد‬ ‫الثاين‬ ‫العدد‬113