By Annan Boodram – The Caribbean Voice
In 1984 the World Health Organization (WHO) 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 and Nevis, St Vincent and the Grenadines and Trinidad and Tobago, and next year in Jamaica, and Saint Lucia, 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;
- Mental health coverage under all health insurances;
- Psychologists in all hospitals and counselors in all schools;
- Gatekeepers’ training nationwide;
- Addressing agro-poison suicide;
- Suicide, domestic & sexual abuse units in all police stations;
- Safe houses across each nation;
- Laws to try abusers even when victims refuse to press charges and/or to testify;
- Establishment of detox rehab programs in the public health sector, accessible by all;
- Establishing registries of sex offenders – only Trinidad & Tobago, Jamaica currently has. [A bill in The Bahamas parliament has been under discussion since last year but 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 Saint Lucia had announced plans to enact legislation since 2017 but to date that have not been done yet. 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;
- Across the board support network for abused victims and suicide survivors;
- Creating mental health apps to facilitate citizens everywhere to be able to easily and quickly access services and assistance;
- Peer mediation programs in all high schools;
- 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, 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;
- Early intervention programs in all schools to screen for mental health and learning disabilities;
- Psychosocial 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 centers, where they don’t exist, to tackle suicide by ingesting poisons. To date only Trinidad and Tobago has one, which operates out of the University of the West Indies;
- Getting the mentally ill off the streets and into treatment centers;
- Setting up licensing protocols for clinically trained counselors and regulations to prevent quacks from setting themselves up as counselors;
- 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 and Barbuda (1957), Belize (1957), St Kitts and Nevis (1956), Saint Lucia (1957, Turks and Caicos (1904) and Trinidad and Tobago (1975) really do need urgent updating of mental health laws and ordinances.
- National campaigns to eliminate the stigma around mental health;
- Making rape a non-bailable offence offense;
- 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;
- 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 the 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 WHO, mental health budgets as a percentage of overall health budgets in the Caribbean have not surpassed ten percent in any nation. Suriname leads the way at nine percent, Barbados at seven percent, Jamaica and St Vincent and the Grenadines at six percent with all the rest four percent or less.
With respect to treatment, there are no mental health institutions in Anguilla, British Virgin Island, 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 and Tobago (8) have community residential facilities.
Considering the costs and resources necessary to establish mental health care infrastructures parallel to physical health case infrastructure, the WHO has been advocating 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.