Minister of Health, Donville??Inniss????

Steps are being taken by the Health Ministry to change perceptions towards mental ill health.

This was intimated today by Minister of Health, Donville Inniss, as he addressed a workshop on Mental Health 101.?? It was conducted by the National Mental Health Commission at the headquarters of the Pan-American Health Organisation in Dayrell’s Road.

Minister Inniss said: "We accept the fact that the development of mental health services in Barbados has lagged behind most other health services, and there is a need to reorient ingrained perceptions of mental illness which are discriminatory in nature, and to reposition mental health from institutional to community-based care."??

To this end, he revealed that his Ministry was in the process of adopting international standards for mental health care by designing plans for the reorientation of mental health services to community based services.

According to him, such services would incorporate the tenets of international human rights and standards on mental health.?? He indicated they would involve among others, providing accessible and equitable community-based services, to offer timely assessment and intervention, integrating mental health services into the mainstream health system to include them as basic components of health care, and providing humane emergency care for persons who are suicidal, dangerous to others or unable to care for themselves.

It would also mean promoting the dignity and human rights of the mentally ill through humane mental health legislation which applies the ??????least restrictive alternative" to treatment, while ensuring the safety of the sufferer and others.

Elaborating on the first of these principles – providing accessible and equitable community-based services – Mr. Inniss noted that in Barbados the care of persons suffering from mental illness was provided almost exclusively at the Psychiatric Hospital.

He added: "This standard of care is not generally accepted for the treatment of other medical conditions. Usually, it is expected that if a patient is admitted to the general hospital, that the person has exhausted all other levels of care, beginning with preventative care; followed by care provided by the patient’s general practitioner either in the public or private setting; followed by care provided in specialist clinics, again either in the public or private setting.??

"Unfortunately, the majority of admissions to the Psychiatric Hospital do not follow this protocol.?? Too many patients are admitted directly to the hospital, without preventative care or management in the primary or secondary care settings. ??

Several reasons were offered by Minister Inniss for this deficiency. These included the seamless level of care which had been developed in the management of physical conditions but not yet transcended to mental healthcare and because of the stigma attached to mental illness, many persons refused to seek early medical attention. The latter resulted in individuals having no alternative but to be admitted to the Psychiatric Hospital for more intensive care, after their condition had deteriorated.

Referring to admission statistics to confirm this situation, Minister Inniss pointed out that during the period January to November of 2009, a total of 1023 patients were admitted to the Psychiatric Hospital.?? He explained that 834 were re-admissions, while 189 were first admissions. The average length of stay for each patient was 146 days.

The Health Minister opined: "The extremely high numbers of re-admissions speak to the absence of comprehensive medical management outside of the hospital setting and of the inability of patients to exercise some degree of self responsibility and be active participants in their care, as is generally the case with persons suffering from other chronic diseases.????

"The average length of stay, 146 days, might be medically necessary for some patients, but this extended time spent in the hospital reflects in part the reluctance of family, support groups and the community to accept that mental illness is a condition, like other medical conditions, that can be controlled and managed outside of the hospital setting with the support of family and the community."

While also lamenting that the situation spoke to an inherent prejudice evident at both community and institutional levels, Mr. Inniss stressed: "We must, therefore, make a concerted effort to break the prejudice and related stigma to ensure that quality care is available to all persons, especially, the more vulnerable groups within our society."

He, therefore, recommended that in order to do this successfully, it would be necessary to eliminate the high degree of fear and misinformation which characterised the field of mental health.?? "This requires education, not only for the community at large, but also for members of our medical professions," concluded the Health Minister.

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