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Saturday, January 4, 2025

Putting some context to mental health in T&T

by

20150324

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


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