By Annan Boodram – The Caribbean Voice (TCV)
Mental healthcare is a critical needs sector that has been glaringly brought home during this coronavirus pandemic. Nations across the Caribbean and elsewhere are struggling to provide minimal mental healthcare because the requisite infrastructure, skills, and resources are not in place. And so, in the new normal, post-pandemic, mental healthcare must also not be the same as it was pre-pandemic.
The World Health Organization (WHO) has long stressed the need for mental healthcare to be decentralized and integrated into the primary healthcare system with the necessary tasks carried out, as far as possible, by general healthcare workers rather than by specialists in mental health. This is especially critical in developing nations like Guyana where mental health specialists are in very short supply, but the need for the delivery of mental healthcare is acute. According to the WHO, “by making care workers sensitive to the presence of mental health problems and by equipping them with skills to deal with those problems, much wastage of efforts in general health care can be avoided and health care can be made more effective.
Furthermore, “research has shown that emotional and psychological distress may be an early manifestation of physical disease processes or may itself cause such diseases (the mind/body connection).” Thus, “an important concept in primary health care is that health activities should develop horizontally to involve other sectors working within the community … intersectoral collaboration, involving governmental and non-governmental organizations is important in all areas of health.”
The second component of viable healthcare delivery is social collaboration, which is the pragmatic avenue through which good mental (and overall) health can be effectively achieved, despite the constraints of resources and facilities. This collaboration must include the private and public sector, governmental and non-governmental organizations, mass-based organizations and special interest groups.
This combination of intersectoral and social collaboration will then embrace all possible stakeholders and ensure good mental health across any nation. Gregory Popcak, author, pastor, counsellor, and psychologist, has identified nine components of good mental health, among them:
- Attuned Communication — The ability to pick up on the meaning of subtle, non-verbal, physical cues (facial expressions, tones of voice, posture) that indicate another person’s emotional states and degree of well-being.
- Emotional Balance — The ability to maintain optimal emotional functioning; to be emotionally stimulated enough to be aware and engaged in impacting circumstances and relationships but not so emotionally stimulated to be regularly flooded by one’s feelings and be carried away by them.
- Response Flexibility — The ability to pause before acting on impulses and to wilfully change the direction of one’s actions if doing so is better than the dictates of one’s initial impulses.
- Fear Modulation — Reducing fear. People with anxiety and panic disorders, especially, have a difficult time modulating the brain’s fear responses. They become easily flooded with anxiety where others might just experience nervousness or even excitement.
- Insight — The ability to reflect on one’s life experiences in a way that links one’s past, present, and future in a coherent, cohesive, compassionate manner. Insight helps one to make sense of both the things that have happened in the past and the things that are happening now.
- Empathy — Essentially, empathy is the ability to have insight (as defined above) into other people. Empathy is the ability to imagine what it is like to be another person and to reflect on their experiences in a way that links their past, present, and future in a coherent, cohesive, compassionate manner. Empathy helps one to make sense of other people’s lives, the way they think, and their feelings.
- Morality — The ability to imagine, reason, and behave from the perspective of the greater good. This includes the ability to delay gratification and find ways to get one’s needs met while understanding and accommodating the needs of others.
These aspects of good mental health can go a long way in positively impacting a range of issues that are mental health-related including suicide, gender-based violence, child abuse, alcoholism, violent crimes, and sexual crimes which are all significant issues.
In this approach VIPs, celebrities, sports and entertainment stars, influencers, and shapers of society must step up for advocacy and information dissemination for various issues relating to mental health. We have seen this stepping up to some extent during this pandemic but many more need to be involved and such involvement must be ongoing. This, along with a sustained effort by the government health sector and other stakeholders, is necessary to delink mental health issues from the existing stigma, prejudices, and biases, including benevolent ones.
This collaboration does not have to be a process of reinventing the wheel. Globally many mechanisms have been reaping significant benefits. One such mechanism is the Friendship Bench in Zimbabwe whereby grandmothers are trained in evidence-based talk therapy, which they offer on public benches across communities. Another is the lay counsellor program employed in many nations, whereby selected individuals are trained within communities, to identify warning signs for suicide and various forms of abuse and to take proactive steps to get help for those in need.
It is generally accepted that a correlation exists between a nation’s mental health (as a component of overall health) and its economic growth. According to the WHO, the positive impact that health has on growth and poverty reduction occurs through several mechanisms, such as a reduction of production losses due to fewer worker illnesses, the increased productivity of adults as a result of better nutrition, lower absenteeism rates, and improved learning among school children. This relationship also allows for the use of resources that had been totally or partially inaccessible due to illnesses. Finally, it allows for alternative use of financial resources that might normally be destined for the treatment of ill health.
In effect, it is so important that the collaborative approach to mental health care, be regularized across the Caribbean and the developing world, instead of being applied in a piecemeal, random manner. “The collaborative care model is an evidence-based approach for integrating physical and behavioral health services within a primary care-based model and other settings”. (Unützer, Harbin & Schoenbaum; 2013)
