Of T&T, the World Health Organization (WHO) (2007) report on the mental health system says, "Little change has been realised by the mental health system over the last 20 years in terms of perception of mental illness as just another disease or illness."
Correcting misperception is among many issues that the WHO considers attainable but for which T&T has not as yet set as priority.
Intending to present a mental health manifesto in the coming weeks, I find it necessary to set the backdrop of mental health in T&T, weighing in on what appears to be a lack of will or interest, which I suspect is the result of ignorance and of ignoring the seriousness of this global dilemma.
There are many factors against which my discourse is based; today I am trying to present some general and historical perspectives. No government in T&T has ever prioritised mental health services and the quality of care lags behind international best practice. So, even though we have signed international conventions, and produced research, what we read sounds much better than what actually obtains.
The WHO-AIMs 2007 assessment was used to collect information on the mental health system in T&T with the goal of using the information to improve the mental health system and to provide a baseline for monitoring change. This, the document says "will enable T&T to develop information-based mental health plans with clear baseline information and targets" and "will also be useful to monitor progress in implementing reform policies...mental health promotion, prevention, care, and rehabilitation."
Like many academic studies, organisational research, and internationally funded scholarship, documents like these beg for political will in realising their usefulness in subject countries. And while there is no current evidence available to me on the progress, I can safely judge that very little much has come of anything here.
Listed among the main weaknesses in our system were:
�2 Lack of vigorous awareness campaigns to facilitate "Buy in" for the general public.
�2 The need for closer collaboration between other actors in the health sector and the mental-health team.
�2 Lack of resources–human, financial and material resources for the efficient and effective running of the mental health system.
�2 Absence of a research culture that would encourage other health professionals and professionals in general to gravitate towards mental health.
Here are some supporting facts on a number of areas of concern in the sector as it relates to mental health. Notwithstanding improvement/increases/�decreases since 2007, these still present a credible scenario:
1. About 25 per cent or 330,000 people from T&T's population of 1.3 million are living with mental health issues. That statistic suggests there's at least one person in every household living with one of almost 300 defined mental illnesses.
2. The first piece of mental health legislation was revised in 1975. At present it is the only available legal act regulating mental healthcare provision.
3. The Ministry of Health of T&T is the mental health authority body in the country.
4. There is a mental health policy/plan (Cabinet approved 2000) and an emergency/disaster preparedness plan for mental health.
5. There is currently no mental health council or authority overseeing mental healthcare, policy, policing, etc.
6. Consequently, there is no co-ordinating body to oversee publication and awareness campaigns in the field of mental health, a much-needed intervention to treat with education as we confront stigma and discrimination.
7. There is one mental hospital–the St Ann's Psychiatric Hospital; 31 outpatient facilities, two community-based psychiatric inpatient units.
8. Of the $2.8 billion allocated to the MoH (in 2006) only $103 million or four per cent of healthcare expenditure was devoted to mental health or care of the mind.
9. Of the $103 million for mental health, 85 per cent ($97.5 million) were allocated to the St Ann's facility; a mere $6 million covers "all other mental health expenditures."
10. The biggest share of mental health expenditure is for payment of salaries/wages.
11. The patients admitted to St Ann's Psychiatric hospital belong primarily to schizophrenia and related disorders and mood disorders (45 per cent), two illnesses/disorder from among 300.
12. Mental health services are not covered by social insurance.
13. At the present time, there is no legislative or financial support for employment, provision against discrimination at work, provision for housing, and provision against discrimination in housing for people with mental disorders.
The 2007 report stated the total number of human resources working in mental health facilities as follows: 23 psychiatrists, 19 other medical doctors (not specialised in psychiatry), 433 nurses, four psychologists, 27 social workers, four occupational therapists, 76 other health or mental health workers (including auxiliary staff, non-doctor/non-physician primary healthcare workers, health assistants, medical assistants, professional and paraprofessional psychosocial counsellors). �2To be continued