REVEALED: Gulf CEOs, entrepreneurs are facing a hidden mental health crisis – expert

The crisis is not new but it’s accelerating at alarming rates, according to specialists treating high-net-worth Gulf clients overseas.

“We are seeing a lot of medication issues, especially amongst women,” Dr. Sarah Boss, Clinical Director at The Balance Rehab Clinic – which operates facilities in Mallorca, Zurich, London and Marbella – told Arabian Business. “A lot of people from the Middle East come with the diagnosis of being bipolar.”

What Boss sees is a pattern repeating with disturbing regularity. High-net-worth clients from the Gulf arrive heavily medicated, often carrying prescriptions for multiple drugs with dangerous interactions. The diagnosis is frequently bipolar disorder but the actual problem is usually something else – often stemming from a dysregulated nervous system battling stress, overstimulation and a fast-paced lifestyle.

“They feel like they have problems of mood swings and they’re really irritable, but that comes from a dysregulated nervous system that makes us feel one day hyper and the next day drained. That’s usually not bipolar,” Boss explained.

The pharmaceutical dependence reflects broader self-medication patterns across the region. Patterns include the use of sleeping pills at night and stimulants in the morning. Shopping addictions are also common. Individuals are resorting to compulsive behaviour that temporarily relieves the underlying problem, which is an inability to disconnect, to slow down or to exist without constant stimulation.

“We see a lot of dysfunctional addictive behaviour,” Boss said, describing patterns common among Gulf clients. “A lot of kind of self-medication, for example, with sleeping medication or with stimulants in the morning, or smoking, or alcohol.”

The pattern represents a failure in the approach to mental health, she said. Their physicians have often interpreted symptoms as bipolar disorder, and prescribe medication accordingly – and wrongly. The result is a spiral that deteriorates the situation further.

By the time clients reach the rehab centre overseas, the team faces the challenge of determining what symptoms represent genuine psychiatric conditions and what the side effects from a combination of medications are.

“Often they’re taking more than three substances, we have so many interactions possible and so many side effects that we don’t even know anymore what comes from the medication and what was really there before,” Boss said.

The root cause is rarely the diagnosed condition, he says. It is usually a result of the nervous system being subjected to unrelenting pressure without adequate rest or regulation.

The Balance founder Abdullah Boulad understands this all too well. He was working in private equity and maintaining the relentless pace that successful people often mistake for productivity when his life collapsed. He kept pushing until his cardiovascular system quit, leading to a heart attack.

“It was a wake-up moment,” he said. “That was the start of trying to understand why.”

That breakdown led into psychology and holistic medicine, and eventually to founding The Balance. “I was pushed from one place to another, one specialist to another,” he recalled. “I didn’t get the right, proper help when I needed it.”

“I was running other centres before, and I felt there was a lack of humanity in what had been done, a lack of compassion. It was too functional, too institutionalised,” he explained.

The mental health stigma in the Gulf remains profound to the extent that families here often opt to send members to centres overseas rather than seeking local treatment. For high-net-worth individuals, the implication of information becoming public can seem high-risk.

The Balance operates at a one client per facility rule. Staff do not use last names, even internally among therapists. No one outside the organisation knows where the treatment houses are located and critically, the locations (Mallorca, Zurich, London, Marbella) allow clients to appear as if they’re on vacation rather than in rehab.

His Lebanese background is helpful providing cultural context. “I have full understanding of the cultural background in the Gulf,” he said, adding The Balance has declined clients when reputational or medical risks outweigh potential benefits. “We try to protect our clients on all levels,” he said.

The need for this level of discretion, and the willingness of families to send members thousands of kilometres away rather than seek local care exposes the gap in regional mental health infrastructure and cultural acceptance.

“This world gets so incredibly busy and so fast, with social media, with the smartphone, with this over-stimulation the whole time,” Boss said. “Our brains are not made to be able to cope with so many things and so much light and noise and sounds and information and distraction.”

Symptoms manifest predictably across nearly everyone Boss treats, from severe sleep problems, eating disorders, anxiety and focus issues. Anhedonia is also commonly present which is the inability to experience pleasure despite material success.

“A lot of people nowadays say, ‘I can’t enjoy anything, not even a good meal or time with my family, because I can’t disconnect,’” Boss explained.

Boss points to something lost that most people do not recognise as missing – genuine downtime. Those moments when the brain produces alpha waves, associated with creativity and recovery, rarely exist.

“We don’t have spare time anymore. For example, when we had to wait for something, like an appointment somewhere, what we used to do, like in a waiting room or at a bus station, we used to sometimes just look somewhere and just disconnect. That’s gone.”

“Now everybody thinks they are so efficient. In every moment we have, we take out the phone, we check emails, and we know from studies already that this is horrible for the brain,” she said.

Boss conducts EEGs on patients and sees exhaustion even in people who do not consciously recognise it. They’re operating on depleted neurological reserves, pushing through with stimulants and willpower until collapse becomes inevitable. “If we do EEGs with people nowadays, we see how tired our brains actually are, even though we might not notice it.”

Children today sleep one hour less than children did a century ago, Boss explained. “How can that happen? We still have the same brain. It’s not like we need an hour less. That has a high cost to it.”

The cost manifests in widespread ADHD symptoms, though Boss distinguishes actual ADHD from symptoms any sleep-deprived, overstimulated person would display. “Everybody that doesn’t sleep enough has ADHD symptoms, because we’re tired, we have a tired brain.”

The Balance’s approach differs from traditional psychiatric treatment precisely because it moves away from pharmaceutical dependence. The clinic employs neuromodulation techniques and technology-based interventions with what Boss describes as “level A evidence” from the World Health Organisation.

The clinic also uses body-based treatments extensively. Boulad himself maintains a weekly schedule of somatic work, massage, acupuncture, craniosacral therapy or sound baths. “I have at least one session a week body treatment. If I miss one week, I feel it. I feel something is missing. My nervous system, my body tension, my stress level is different.”

The treatment philosophy rejects single-intervention approaches. “I get very often asked, ‘I tried this 10 times but it didn’t help. Or, I tried this 10 times and didn’t help.’ Yes, of course, because you cannot eat 10 carrots as a comparison and then think you have a great meal result out of it,” Boulad says. “The carrot needs to be together with the fish.”

When clients arrive, the initial focus is establishing safety without overwhelming people coming from crisis situations. Boss coordinates everything, building a complete picture before determining treatment direction.

“It’s really important also in the first assessment to get an idea in which direction we go,” Boss explained. The approach is personalised based on personality and preferences.

The team deliberately avoids asking patients to repeat their stories to multiple staff members. “We don’t want them to feel like seven people know the same story,” Boss said.

For Gulf clients, the challenge is maintaining progress after returning to the environments and pressures that caused the breakdown. The Balance continues care remotely rather than transferring clients to local therapists.

“Usually we continue with all our clients from the Gulf online,” Boulad said. “If you start the process with one therapist or two therapists or a team who knows you well, of course you can do a handover but it’s never the same.”

For celebrity and high-profile clients, relapse prevention requires extensive preparation for returning to trigger-filled environments.

The Balance receives frequent inquiries about opening additional locations. Boulad’s answer is consistently no. “Every couple of months we are asked, don’t you want to open a place here? Don’t you want to open a place here? My answer is always no, no, not now.”

The reason is quality control. “It’s not just about a house, a nice house or luxury villa. That’s not what we offer. We offer a team, a team which is functioning together to provide individualised care and this takes time.”