In keeping with the world movement in mental health reform that focuses on community interventions, Barbadian mental health practitioners are looking to reduce the number of persons residing in the Psychiatric Hospital by having more emphasis on community-based care.

According to Senior Consultant Psychiatrist at the Psychiatric Hospital, Dr. Ermine Belle, to date this has been a great struggle.?? She was at the time addressing a group of community mental health nurses at the Pan American Health Organisation, last Wednesday.

Dr. Belle told a group of community mental health nurses attending a recent workshop, that a study done some time ago indicated that two thirds of the persons at the hospital could actually be transitioned back to the community with the appropriate support, medication and care. However, this would only be possible through the expansion of the community outreach programme along with the provision of housing for persons released by the hospital.????

??"This can only be done if there is adequate and appropriate housing. That is going back to your home, going into a group home where you are supervised or going to a halfway house where you are given independence.?? All of these things are possibilities," she stated.??

Dr. Belle pointed out that this shift to increased community interventions should also result in reaching persons who might otherwise be overlooked.

"Because of our experience in the island, we realised that we were missing persons who needed to be touched by mental health services… We have got to be able

to deliver this service at the point at which it is needed.?? We’ve got to be right there in people’s homes, at the polyclinics, and, everywhere possible to try to address the issues of mental health," the health official emphasised.

She further revealed that stigma towards persons who live with a mental disorder was also a persistent problem.????

"We don’t want to go back to ???the closed doors’. We don’t want to remain at the ???green gates’.?? We want to be able to have people have their intervention and to be able to, at the end of the day, fit back into society in a way that is meaningful.?? They can go back to work, they can carry out their functions at home and they can feel like a real part of our society.?? The community mental health intervention is the only way to achieve this properly," she stressed.

The Senior Consultant Psychiatrist disclosed that during the 1960’s and 70’s the hospital had done "particularly well" in reducing the numbers in the institution.?? However, in recent times, substance abuse had resulted in an escalation of warded persons, particularly males.?? "When I went to work at the hospital the female population was higher than the male.?? It was actually 2:1.?? Now I think it has completely turned around," she observed.

The legislation which guided the work of the Psychiatric Hospital was also deemed as antiquated, since it did not address community mental health interventions.

"We have a long way to go… but a great effort has been made in recent times to address the community mental health aspect of the legislation and that facet has been worked on and it is now at the stage where the Solicitor General’s Office is looking at it

in the hope that it will be integrated into the legislation of the country," Dr. Belle divulged.

Health Minister Donville Inniss, who also spoke at the start of the one-day workshop praised the community mental health nurses for their contribution to society.??

"There has always been a need for someone in the community to identify and to help address the concerns of those whose thought processes and behaviours may seem different from the norm… Today, Barbadian society and families are crying out for interventions that address a range of complex behavioural and societal ills," he remarked.

The public mental health programme has a wide catchment area catering to all age groups and all levels of emotionally disturbed persons.?? Referrals are obtained from persons stationed at organisations across the country, including hospitals, schools, general practitioners, outpatient clinics, churches, the Probation Department, Child Care Board, Welfare Office, Juvenile Liaison Scheme and the Royal Barbados Police Force.?? There are also some self-referrals and calls from concerned family members.

The genesis of the community mental health programme stemmed from the creation of an outpatient department at the Psychiatric Hospital in 1968.?? In 1970 the first Psychiatric Social Worker was appointed and in 1971 the first District Nurse went into the rural parish of St. Andrew.?? By 1975 the District Nurses programme was expanded to also service four parishes – St. Lucy, St. Joseph, St. John and St. Philip.?? However, a series of studies carried out during the 1980’s showed that there was a need for more outreach programmes.??

To this end, a prison outpatient’s clinic was started and mental health services were added at all polyclinics in the late 1980’s.?? There are now 16 community mental health nurses who carry out psychiatric social work in the community.

The duties of the nurses include the compilation of data related to individuals within their catchment area, assessment of the mental, physical and psychosocial needs of individuals in the community, the sharing of health education, the arrangement of clinics in the community, the administration of medications prescribed and the planning, implementation and evaluation of community outreach programmes.

Efforts to decentralise mental health care have also seen, over time, the establishment of a halfway house, a ward and an outpatient’s clinic at the Queen Elizabeth Hospital and a Psychiatric Hospital Outpatients Clinic.

For more information on public mental health care contact the community mental health nurse at the polyclinic in your area or call the Psychiatric hospital at 425-8680.??

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