Why doesn’t SVG have a full-time government-employed psychiatrist?

THE LONGERWE take to secure the long-term services of a government psychiatrist, it’s inevitable that we’ll be seeing more extremely upsetting headlines like:

● Police shoot, kill mentally ill man…

● Baby dead allegedly after being thrown from 1st floor apartment

● Murder of 1 year old baby sends Rose Hall residents into frenzy.

The absence of adequate mental health services in a country undermines its overall mental and, by extension, public health. Without timely and appropriate psychiatric intervention, many treatable mental health conditions, especially in our youth, often mushroom out of control. This frequently culminates in:

● Lifelong disability

● Substance abuse

● Reduced productivity

● Unemployment

● Underemployment

● Homelessness

● Unhealthy family dynamics

● Poor general health

● Premature death

● Murder

● Violence

● Domestic violence

● Crime/ Burglary

● Suicide

● Penal incarceration

● Permanent confinement in our mental hospital

● An overall increase in the cost of healthcare

● Increased cost to the criminal justice system

● Community disruption

● Stigma and shame for families.

To deliver basic mental health care, at minimum, the following professionals must work in tandem:

● Mental health nurses

● Social Workers

● Clinical Psychologists

● Psychiatrist(s) – A medical doctor The psychiatrist is the only member of this team who can prescribe medications. While many mental health cases can be managed without medicines, however, the psychosis, more often than not, requires the administration of medications as an integral part of their overall management.

Kudos to the nurses, social workers, psychologists, doctors, and others working tirelessly to provide mental health services here in SVG.Your efforts have not gone unnoticed or unappreciated.

What are psychotic illnesses?

Persons with such mental illnesses generally experience hallucinations (auditory, visual, olfactory, gustatory, tactile), delusions, confused thinking and speech, and a warped perception of reality. The more common types are schizophrenia, bipolar disorders, and psychotic depression.

In the UK, there are 2532 new cases of psychosis per 100,000 every year. In SVG, with the liberal use of marijuana, these numbers are likely to be significantly higher.

Psychotic illness can begin from age 12; new-onset psychosis is rare after 60. The majority of instances begin between the late teens and late twenties.

Approximately 3% of people will develop a psychotic disorder over the course of their life.

There are several studies conducted over the last six decades that have shown that individuals with psychotic disorders without access to appropriate treatment are up to ten times more likely to commit violent crimes, including murder, compared to others in the general population.

In countries with adequate psychiatric services, psychotic individuals commit approximately 10% of all murders.

It must be emphasized that the vast majority of persons with psychosis, including schizophrenics, will not be violent.

Those with psychosis who are more likely to carry out murder:

● No or inadequate access to psychiatric care

● The longer their psychosis goes untreated

● Heavy alcohol or drug consumption

● Absconding follow-up

● Poor medication compliance

● Previous history of violence

● Onset of psychosis in childhood or early adolescence ● Schizophrenics.

A psychiatrist’s role in managing psychosis:

● Assessing the patient and arriving at a diagnosis

● Investigating for contributing morbidities

● Determining the management of the patient

● Prescribing medications

● Conducting psychotherapy and other forms of therapy (e.g. electroconvulsive therapy, transcranial magnetic stimulation)

● Reviewing the patient periodically to determine if treatment adjustments and or additional treatments are necessary.

The aim of the psychiatrist:

● Improve the life of the patient both qualitatively and quantitatively

● Reduce socially unacceptable behaviours

● Facilitate the reintegration of the patient into their family, school, workplace, and society

● Achieve maximum functionality – in the home/ classroom/ workplace/ etc.

● De-institutionalize.

At-risk mental state

If certain behaviour patterns are identified by family members, teachers, and others, in time, such persons can be assessed using specific diagnostic tools (CAARMS/ SIPS). If necessary, relevant interventions can be made, thereby mitigating the onset and or severity of future psychosis. Such pre-psychotic behaviour may include:

● Excessive worrying or fear

● Changes in eating habits

● Low self-esteem

● Mood swings/ changes

● ● Withdrawing from others

● Disturbed sleep patterns

● Difficulty concentrating ● Substance abuse

● Self-harming behaviour

● Suicidal thinking. A psychiatrist is an integral part of the team for managing such at-risk individuals.

Failure to treat the first psychotic episode expeditiously and appropriately may result in:

● Reduced chance of personal recovery

● Poor general health

● Reduced chance of economic independence

● Poor social functioning and educational outcomes

● Unemployment/ Underemployment

● Increase in the incidence of relapses

● Increased chances of being institutionalized

● Increased interaction with the criminal justice system

● Murder

● Suicide

● Early death. The absence of a fulltime government-employed psychiatrist is yet another glaring deficiency in our public healthcare system. The consequences to us as a people and a country are outlined earlier in this article.

Amazingly, we could sink $750,000 into the staging of a cricket festival, but couldn’t divert the same funds to employ a psychiatrist or two. Totally unacceptable!!!

Author: Dr. C. Malcolm Grant – Family Physician, Family Care Clinic, Arnos Vale.

Former tutor in the Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados.

For appointments: clinic@familycaresvg. com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp) Disclaimer:The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.