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The present study implies that psychiatrist services are very poorly utilized but there are several reasons that may be worthwhile to speculate. In the Ministry of Health, Oman, as of the end of the yearthere are 34 registered mental health professionals in a population of nearly three and a half million people scattered aroundsquare kilometers[ 45 ]. Most of the services are dispensed within general tertiary hospital, plus two specialized centers located in the capital. According to official algorithm of allopathic care for people with mental illness, the first point of contact will be primary health setting. Most common psychotropic medications are readily available in the primary health care [ 46 ].
However, due to the lack of awareness and suitable health education and a lack of a close and relatively informed and consistent relationship with health care givers, people with mental illness may under utilize such option [ 46 ]. Instead, there is tendency to seek primary care at tertiary centers. Apart from the teaching hospital, the multidisciplinary infrastructures often essential for psychiatric service have remained rudimental due to lack of suitable manpower. Psychiatric services 'fashion' itself to follow Anglo-American model with strong neurogenetic determinism conceptual outlook and clinical framework. Another factor that may contribute to under utilization of the allopathic services may be related to perceived status of traditional healers.
By virtue of their intricate knowledge of social dynamism of their respective society, traditional healers are likely to be perceived in the eyes of community as offering intervention that is compatible with their view of socio-cultural teaching [ 11 ]. Another factor that is likely to have direct bearing on the patterns of utilization is with the cultural value system in Oman. Traditional value systems in Oman are those that have affinity to collectivistic orientations [ 20 ]. In cultural setting, children are brought up in an environment that ushers them into collective mindset, as development of selfhood is generally discouraged, so is expression of emotions.
Depending on the level of education, difficulties are attributed to sensate agents and distresses are communicated in "somatopsychic" rather than "psychic" ways. As traditional Omanis attribute ill-health to external agent, there would be interrelated implications for psychiatry. When a social distress occurs, an individual is likely to frame his or her difficulty to external forces Jinn, Hassad, Ain or Sihr. It is not surprising that many psychiatric problems are first attended by traditional healers who are sought to exorcise to malevolent spirit.
In term of health policy, there is need to contemplate how to integrate allopathic and non-allopathic approaches for the wellbeing of people with mental disorders as seen from the findings of this study. In support of this view, it has been common observation that the first point of contact among people with any psychological distress is via traditional means, including reading Koran and exorcism [ 48 ]. However, following a prostrated 'healer shopping', if their condition is intransigent and impervious to traditional healing systems, the next set of recourse, which is freely available in Oman, is via the extensive network of allopathic health care system.
There is also a strong possibility that that sufferer of mental illness may concurrently transverse between these two health care systems. However, since this aspect could not be disentangled in our analysis, it complicates the issue of access of service and pattern of utilization.
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Other contributing factors may be socio-cultural patterning. In it well known that in many traditional societies, distress that are akin to psychiatric disorders are not perceived in psychiatric parlance, as intra-psychic conflict. Therefore distress is not viewed to be precipitated by trajectory of one's behavior and one's self and intervening environmental conditions. As psychiatric attempt to heal the 'self', in a society where development of the self is not recognized, it is difficult to see how 'self', as conceived in western psychology, would allow itself to be healed if it does not exist in the first place. This view, within the present context, constitutes one of the reasons that may mitigate poor mental health service utilization which in Oman is based on the exclusive western allopathic model.
More studies to collaborate the factors leading to under utilization of mental health services are therefore warranted. Limitations It is essential for us to highlight some of the inherent limitations of these types of studies. School based rather than community surveys have inherent limitation. Firstly, it is possible that there are some students who were either absent or not in mainstream education because of their mental illness and therefore not present in the schools surveyed. Secondly, this study suggests that the mental health services utilization is low.
It is possible that during the initial stages of mental illness the signs and symptoms are often quite non specific making it difficult for the sufferers to realize that they are in need of help [ 34 ]. It is also possible that many sufferers of mental illness may not seek medical attention because the disorder may be construed as an act of fate or may be simply hidden to avoid social stigma. Thirdly, it is essential to consider the potentially biased recall of mental health service use as a limitation in this study. Mood disorders, by their very nature, come to be noticed earlier and this accounts for the relatively increased proportion making contact in the year of onset of MDD and any mood disorder.
This also hold true for cxm month service usage of availing any treatment amongst those having any mood disorder xex 34 ]. Another obvious limitation of this study is that it relies heavily on diagnostic tool. Although all items in the assessment measures were translated to achieve conceptual equivalence in the Omani dialect, their usefulness could still be hampered by certain subtle linguistic and conceptual misunderstandings which might not have been apparent during translation and piloting [ 49 ]. This is pertinent to the view that there is no universal phenotypical presentation of emotion. Future studies should carefully address the issue of culturally sensitive measures.