The mental health system – restructure and reorient

Once again, the issue of mental health in St. Vincent and the Grenadines is getting quite a bit of attention in the local media. I have written on this topic on various occasions, because it is one of immense public health importance.

Mental health is an important issue and ought to be central in all health systems. Mental health services should not be confined to just the Mental Health Centre, but must be incorporated in the primary care setting and in the community where systems must be in place to facilitate the rehabilitation of persons with mental health disorders.

Mental health is not about crazy people. The World Health Organization (WHO) defines mental health as a state of well-being, in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

This definition of mental health sheds a positive dimension on mental health.

According to the WHO’s definition of health, it is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

This definition of health highlights that mental health is a key contributor to overall health. Individually, one cannot be healthy if their mental state is not in balance with the biological and social aspects.

This same definition can be applied to the health system. If mental health is not an important part of the health system, then the population will not be a healthy one.

As such, the health system should pay attention to the delivery and availability of mental health services. With all the criticism that is looming over the mental health services, this is an opportune time for the Ministry of Health to do an in-depth assessment of the mental health service and to identify existing gaps in the delivery of mental health services in St. Vincent and the Grenadines.

The analysis of these gaps can help to inform options to restructure and reorient the delivery of mental health services in the country.St. Vincent and the Grenadines is not the only country plagued by issues related to the delivery of mental health services. In fact, many developing countries face similar problems.

However, there are recommendations that can help to better the delivery of services as we move forward. First, there must be a situational analysis of where we are now.

I recommend that this be an independent assessment highlighting not only the gaps, but also areas that we are doing well in and must be kept. Secondly, there must be increase in prevention, treatment and recovery services.For this to take place there must be an expansion of the mental health workforce.

This does not necessarily mean an increase in psychiatrists, but the training of health providers to be able to attend to mental health issues before they become grave issues.There are many tools available such as the WHO mhGAP that nurses and family physicians can utilize.

The public must also be educated on mental health issues. A good way to start is to incorporate aspects of mental health into the school system and to strengthen mental health education and promotion activities expanding it to the workplace.

Mental health in the workplace is a must and should not be an option.Finally, there is the need to invest in research to understand the factors impacting on mental health in the country so as to put in place evidence-based care that is individualized and effective.

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 a lecturer of medical ethics. He is the Head of Health Information, Communicable Disease and Emergency Response at the Caribbean Public Health Agency (CARPHA). He is also a member of the World Health Organization Global Coordination Mechanism on the Prevention and Control of NCDs.    (The views expressed here are not written on behalf of CARPHA nor the WHO). You may contact him at adamsrosmond@- gmail.com