WHO report exposes mental health inadequacies
(CNS) More than 4,000 patients were treated for mental health problems in 2013 in the existing outpatient facilities, highlighting the pressing need for government to address the challenges in this area of the nation’s health, according to a new report. But at present government does not have a mental health policy and the much needed residential care facility is still years away.
Cayman Islands Hospital, George Town
Up to 80% of primary healthcare doctors in Cayman make on average at least one referral per month to a mental health professional, illustrating the prevalence of mental health problems in Cayman.
The report has confirmed many of the problems the country has with inadequate mental health provision. It noted that the psychiatric unit at the hospital is far too limited and doesn’t make allowances for children. The work, which was commissioned by the Mental Health Commission of the Cayman Islands, was conducted by the regional arm of the World Health Organisation’s PAHO. It collected data from six outpatient facilities, including the government’s facilities, offering mental health services and the psychiatric unit at the George Town hospital
The majority of the patients that were treated were diagnosed with schizophrenia, mood disorders and neurotic, stress related disorders.
Cayman currently has just one eight-bed inpatient unit facility, which serves all three islands, and one inpatient facility providing treatment for people suffering from alcohol and substance abuse.
Among the findings of the report, the authors revealed that government does not know what percentage of its healthcare expenditures are directed towards mental health. Very little data is recorded or documented about mental health and what information is collected is fragmented.
“There is no formally defined list of individual data items that ought to be collected by all mental health facilities,” the report found. “The government health department does not collect data; the only data available at the government department is data on the patients seen at that facility. No report covering mental health data has been published by the government health department.”
The WHO researchers also revealed that none of the people working in mental health have had any exposure to basic training on human rights protection of patients in mental health facilities. They said that additional mental health professionals are required for treating children and adolescents and more training is required in the area of child and adolescent for health professionals. The report stated that while the supply of relevant drugs was plentiful, there needs to be better oversight of the prescribing patterns of psychotropic drugs by physicians.
It noted that the lack of any forensic inpatient unit meant patients in the criminal justice system are managed at the prisons by mental health professionals. The percentage of prisoners with psychosis and mental retardation is unknown but the prisons have at least one prisoner per month in treatment contact with a mental health professional. A lack of training for those involved in the criminal justice system was noted, with less than 20% of police, judges and lawyers having participated in educational activities on mental health in the last five years.
Cayman is also short of mental health professionals and there are no courses geared towards mental health training. The number of psychologists who graduated last year with at least one year training in mental healthcare is 3.5 per 100,000 population.
Another area in which the country is falling down is equality and protections for those with mental health problems. Although the report commended the new mental health law and the creation of the Mental Health Commission, it pointed out that there is no subsidized housing schemes or protection from discrimination in allocation of housing for people with severe mental disorders.
“There are legislative provisions concerning protection from discrimination solely on account of mental disorders but it is not enforced,” the report stated.
People suffering from a mental illness can seek support from the Department of Children and Family Services and the report found that 20% of people receiving some form of social benefit did so because of mental health related disabilities
Pointing out the obvious need for policy development and a long term care facility, the WHO report made a number of recommendations that government said it is moving to address.
“The Ministry of Health in conjunction with the Mental Health Commission is set to start work imminently on developing a Mental Health Policy,” government officials said. The policy is expected to deal with many of the problems raised by the report, according guidance notes supplied by officials.
Government has also recognised the need for a long term residential mental health facility (LTRMHF) and has formed a committee and approved the necessary funding to develop the request for proposal for an outline business case (OBC), the first step towards developing the facility.
However, despite the numerous shortcomings and inadequate provision, especially for young people and children, the government added that it was a “testament to the work of the Ministry of Health, the MHC, HSA and the other stakeholders in the provision of mental health services, that there are significantly more strengths … than weaknesses within the mental health system in the Cayman Islands.”
Premier Alden McLaughlin, who is also the health minister, said the ministry was reassured by the comprehensive and technical nature of the WHO-AIMS report.
“This is the first time the Cayman Islands has had this type of baseline information, which will be useful in determining the needs of the mental health system of the Cayman Islands,” he said, adding that the ministry would continue to work closely with the WHO and as far as possible incorporate its concerns into the priorities government is developing.
Category: Health, Mental Health
The facility is built already and has many clients. It’s called the Legislative Assembley.
4000 out of a population of how many? Taken in conjunction with the other statistics on the percentages of children subject to sexual and physical abuse, and the numbers of those with a criminal record, we have a huge social problem here.
All societies take time to develop and Cayman is a very young country with a lot to learn and making many mistakes on the way. Mental health even in many countries is a residual service! That said we cannot change the past all we can do is move forward. Take note Cayman that you will be ultimately judged on how you treat your most vulnerable in society.
The lack of mental health care is a worldwide problem.
Many countries are still dumping people with mental problems into jail.
This is tragic and inhumane.
This is also stupid given that caring for a person in a mental health facility is probably cheaper than putting them in prison.
Back in the late seventies, when the school principals began noticing some truly bizarre behaviours in very young children, they suggested that the country needed some mental health professionals to assist with these problems. The response from the Education Department was “Caymanians do not need mental health doctors, this is foreigners trying to downgrade us”. And no, it wasn’t Truman on this occasion. One of the students who was an object of concern later cut the throat of a tourist at Holiday Inn. He (and many of those who teachers were concerned about) have spent most of their lives in jail while the Education officials are enjoying their pensions. Ah so it go.