Mental Health – a forgotten domain in health care in SVG?

The World Health Organization (WHO) defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

As we can see, from this definition, if a country wants to have healthy people living in a healthy environment, as is reflected in the motto of the Ministry of Health, Wellness and the Environment, then the issue of mental health must be addressed. Mental health is one of the domains that must be present in order to ensure the state of complete health.{{more}}

Lack of Understanding about Mental Health

Unfortunately, a comprehensive understanding of the importance of mental health does not exist in the Vincentian society. Mental health is often talked about after the issue has gotten to a point where there is no turning back. We saw a clear demonstration of this in the case of the young man who murdered four persons weeks ago. Too often our young people are labelled “crazy” and they deteriorate without professional help. Most times the initial signs that would signal that there is a mental issue are ignored.

Lack of Mental Health, Health Promotion

The health care system is to be partially blamed for this. There is the need for a robust health promotion programme that addresses mental health issues. People suffer from issues such as anxiety, depression, post-traumatic stress disorders, among others, and they do not have anywhere to turn. They go to counsellors and to a brother or sister for support. Although this support system exists, there is a need for a structured and well-organized system that focus on prevention. The health system ought to do this.

There is an ethical obligation for health officials to provide the mental health services that are needed.

The Doomed Mental Health Asylum

Mental health ought to be incorporated into the primary health care system. Community doctors and nurses must be equipped with the necessary skills to detect, treat and follow up patients at the level of the community. Not all cases should see the doors of the doomed mental health asylum. Most mental health hospitals have a fearful stigma attached to them and so the health system should really try to minimize admission to these institutions, especially when admission may seem to be just locking away the “crazy” person and not providing the necessary treatment for care and reincorporation into the society.

The Lack of the Psychiatrist

St Vincent and the Grenadines, like other developing countries, lacks medical specialists. The psychiatrist is the lead expert in this field. Other than treating patients, the psychiatrist informs the Ministry on what programmes should be put in place to address mental health issues.

The lack of a psychiatrist is indeed a significant issue and must be addressed. Not having a psychiatrist at a 200-bed institution is akin to having a ship sail without a captain. The blame should not be placed on the Ministry for the lack of this. Finding psychiatrists is a difficult task, because not many physicians will go into this field because of the associated risk. Another issue is the compensation package, that is offered may not attract a specialist and so there may be the need to review this urgently or otherwise we may have to get one from a region who is willing to work for the current package, but may not be able to understand the Vincentian situation. This can create more problems while trying to solve a problem.

Conclusion

Mental health must be accorded the highest level of attention in health care delivery in St Vincent and the Grenadines. There is need for a strong health promotion programme that addresses mental health. Mental health must be strengthened at the primary health care and there is an urgent need for a psychiatrist.

Dr Rosmond Adams, MD is a medical doctor and a public health specialist with training in bioethics and ethical issues in medicine, the life sciences and research. He is the Head of Health Information, Communicable Diseases and Emergency Response at the Caribbean Public Health Agency (CARPHA). (The views expressed here are not written on behalf of CARPHA).

Dr Rosmond Adams is a medical doctor and a public health specialist.

He may be emailed at:adamsrosmond@gmail.com