The Ministry of Health is moving from a predominantly institutional-based health care system to one that is more community-based.

Health Minister, Donville Inniss made this point today, as he addressed participants of a one-day workshop for Community Mental Health Nurses at the Pan American Health Organisation.????

He stressed that this was deemed a more holistic and sustainable approach to mental health care, since timely community-based interventions could allow the affected individual to continue to be productive and to remain with his/her family.?? ??

"Going into the environs of your existing or potential patients, where, perhaps they are more comfortable, provides an enabling environment from which you, the service provider, and the patient, can discuss, implement and monitor interventions. It also allows for a more holistic approach to mental health issues by involving families, friends, communities and other health care providers. This is far more acceptable and sustainable than placing someone in a psychiatric institution, unless absolutely necessary," Mr. Inniss noted.

A community health programme was also more sustainable from a financial perspective, since, according to the Health Minister, some $35M was being spent for care in public and private mental health institutions.

"Now, we cannot charge a user fee for mental services but we can certainly do much better with the dollars advanced in this area… Right now it costs taxpayers approximately $165 per person per day to maintain a patient at the Psychiatric Hospital, whereas it would cost less than $25 per person per day to manage an individual in the community via our community-based programmes," Mr. Inniss outlined. ??

The Minister praised the management of the Psychiatric Hospital and the members of the Mental Health Commission and thanked them for their sterling work in this critical area. He, however, called for more to be done on the prevention of mental illness and the elimination of stigma in this area.

??"Many of the challenges associated with mental health in Barbados as in the rest of the world lies in the stigma associated with it.?? This stigma is in many regards considered to be a hidden aspect of the burden of mental illness in Barbados… As community mental health practitioners, your task is one that will be greatly challenged by the stigma associated with your work and your patients. However, I urge you to press on as your society desperately needs your services," Mr. Inniss stated.

The prevalence of substance abuse, and abuse coupled with unemployment and underemployment, early childhood mental health issues were highlighted by the Health Minister as some of the factors that could be causing mental breakdowns and deviant behaviour.

Pointing to the recent spate of suspected suicides in Barbados, Minister Inniss observed that there were clearly many situations in our communities, which, if left unattended, could well lead to an increase in attempted suicides, general deviant behaviour and myriad mental health challenges. He stated:?? "Our mental health challenges, like so many of our public health challenges are community based and hence, our interventions must be primarily in the community."??

Also speaking at the function was Senior Consultant Psychiatrist, Dr. Ermine Belle, who explained that the programme started on a much smaller scale with the creation of an outpatient department in 1968.?? In 1970 the first Psychiatric Social Worker was appointed and by 1975 the District Nurses programme was expanded to service four parishes.?? There are now 16 community mental health nurses who carry out psychiatric social work in the community.????

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