In 1984, the World Health Organization defined optimal health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
Last year, the British Virgin Islands, Montserrat and Dominica held elections and mental health did not figure either in the campaigns, plans, policies or programs. With elections this year scheduled for Guyana, St. Kitts & Nevis, St. Vincent & the Grenadines and Trinidad & Tobago, and next year in Jamaica, The Caribbean Voice urges all political parties to inform their nations about their mental health plans, especially where they stand with respect to the following:
– integrating mental health into the physical health care system;
– establishing psych wards in every hospital;
– training all health care workers in basic mental health care;
– including mental health coverage under all health insurances;
– having psychologists in all hospitals and counsellors in all schools;
– having gatekeepers’ training nationwide;
– addressing agro-poison suicide;
– having suicide, domestic & sexual abuse units in all police stations;
– having safe houses across each nation;
– creating laws to try abusers even when victims refuse to press charges and/or to testify;
– establishing detox rehab programs in the public health sector, accessible by all;
– establishing registries of sex offenders – only Trinidad & Tobago, Jamaica currently have. A bill in the Bahamas parliament has been under discussion since last year but has not yet passed. Online petitions are seeking to get St. Vincent and the Grenadines and Guyana on board. The Child Care & Protection Agency in Guyana had announced a 2019 launch of a registry of sexual abusers of children, but the launch has not yet taken place. Also, Grenada and St. Lucia had announced plans to enact legislation since 2017 but to date, that has not been done. Meanwhile, activists and advocates have also been calling for a sex registry to be established in Dominica;
– raising the age of consent to 18 years;
– decriminalizing suicide where that has not been done which is in most of the Caribbean except Anguilla, Antigua & Barbuda, Bermuda and the Cayman Islands;
– having an across the board support network for abused victims and suicide survivors;
– creating mental health apps to allow citizens everywhere to easily and quickly access services and assistance;
– establishing peer mediation programs in all high schools;
– establishing national programs focusing on perpetrators and potential perpetrators to help address domestic and sexual abuse;
– incorporating mental health, including suicide, all forms of abuse, self esteem and coping skills in all schools’ curricula, handled by appropriately trained teachers;
– establishing special education classes with trained teachers in all schools;
– making all public buildings accessible by the disabled;
– establishing early intervention programs in all schools to screen for mental health and learning disabilities;
– having psycho social support for all teachers, health care workers and police officers;
– inclusion of mental health in occupational health and safety regulations and training;
– establishing poison control centres, where they don’t exist, to tackle suicide by ingesting of poisons. To date, only Trinidad & Tobago has one, which operates out of the University of the West Indies;
– getting the mentally ill off the streets and into treatment centres;
– setting up licensing protocols for clinically trained counsellors and regulations to prevent quacks setting themselves up as counsellors;
– providing government support for NGOs and CSOs offering services in mental health, bereft of political or other unrelated considerations;
– updating all mental health laws to bring them in line with current research, information and practices. Guyana (1930), Antigua & Barbuda (1957), Belize (1957), St. Kitts & Nevis (1956), St. Lucia (1957), Turks and Caicos (1904) and Trinidad & Tobago (1975) really do need urgent updating of mental health laws and ordinances.
– creating national campaigns to eliminate the stigma around mental health;
– making rape a non-bailable offence;
– getting all child workers off the ‘jobs’ and into schools;
– making it mandatory for all convicted abusers to report to the closest police station on a monthly basis;
– having mandatory psychological evaluation for all mentally ill, whether actual or perceived, who appear in front of the courts;
– establishing mechanisms making it easy for abused victims to report to magistrates and judges if police do not take their complaints, do not act on complaints quickly or ridicule them when they go to report abuse;
– creating and passing legislation to protect the elderly from abuse and make detection of elder abuse and law enforcement a priority;
– establishing a viable network of support nationally, for caregivers for the mentally ill and the disabled.
According to the World Health Organization, mental health budgets, as a percentage of overall health budgets in the Caribbean have not surpassed ten per cent in any nation. Suriname leads the way at nine per cent, Barbados at seven per cent, Jamaica and St. Vincent & the Grenadines at six per cent, with all the rest at four per cent or less.
With respect to treatment, there are no mental health institutions in Anguilla, the British Virgin Islands, Dominica, Montserrat, St Kitts and Nevis, and Turks and Caicos. Only psychiatric beds located in general hospitals exist in Anguilla, Dominica or St Kitts and Nevis while Montserrat and Turks and Caicos only have outpatient treatment facilities. Only Antigua and Barbuda, Jamaica, Suriname, and Trinidad and Tobago have day treatment facilities while only Barbados, Guyana, Jamaica, and Trinidad and Tobago have residential facilities. Most critically, only Jamaica (25) and Trinidad & Tobago (8) have community residential facilities.
Considering costs and resources necessary to establish mental health care infrastructures parallel to physical health case infrastructure, the World Health Organization has been advocating that for small economies like the Caribbean nations, it is more affordable, cost effective and efficient to integrate mental health care into the current physical health care systems.
And considering that optimal health is impossible without good mental health, Caribbean nations need to pull themselves forward into the modern era by placing mental health care on an equal footing with physical health care.
In 2018, a Lancet Commission report on mental health said that mental disorders are on the rise in every country in the world and will cost the global economy $16 trillion by 2030. While the actual figures are not available for Caribbean nations, there is no doubt that a more caring society will be a less violent and more productive society and thus, it is incumbent upon all governments to entrench mental health care at all levels, in all plans, programs and policies.
The Caribbean Voice