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UWI TODAY
– SUNDAY 14 OCTOBER, 2018
T&T is the only country in the Caribbean
to establish
guidelines for ethical reporting on suicide. In a region
where mental health illness carries weighty stigma, the
launch of these guidelines was progressive. Still, statistics
gathered by the Pan American Health Organization
(PAHO) show a significant gap in funding allocation for
mental health locally.
Dr Taraleen Malcolm, T&T-based PAHO NCDs
& Mental Health Advisor, shared these statistics at the
International Mental Health Symposium “No Health
Without Mental Health” hosted by the UWI School of
Nursing on September 26 and 27.
Malcolm presented the day two keynote address,
“Emerging Trends & Issues in Mental Health,” on behalf
of Dr Claudina Cayetano, PAHORegional Mental Health
Advisor.
According to Malcolm, in T&T 3.7% of the total
health budget is allocated to mental health. However, in
Latin America & the Caribbean, mental health disorders
account for 22.2% of the burden of disease. As Malcolm
put it, the treatment gap is overwhelming and requires
urgent attention.
Studies have shown a global disparity between
treatment for physical disorders and treatment for mental
health disorders.The disparity is even further exacerbated
when countries are divided into high income and low and
middle income categories, Malcolm explained. In high
income and low&middle income countries, diseases like
diabetes had 94% and 77% treatment rates respectively.
Meanwhile, depression had treatment rates of 29% in
high income countries and 8% in low & middle income
countries.
Barriers to the provision of mental health treatment
exist globally in both high income and poorer countries.
So although T&T is a high income country, the healthcare
sector still faces challenges such as insufficient financial
and human resource allocation and the centralisation
MEDICAL SCIENCES: MENTAL HEALTH SYMPOSIUM
HUGE
FUNDING GAP
for MENTAL
HEALTH
TREATMENT
of services making mental health care inaccessible to
patients.
The need to focus on community-centered mental
health care services is key to closing the treatment gap.
Malcolmnoted that of the 3.7%of the T&T health budget
spent onmental health, 94%goes tomental hospitals.The
location of mental hospitals – which tend to be in urban
areas – makes accessibility an issue, explained Malcolm.
“Financial resources and geographical locations
limit access to services. You have situations where you
have general hospitals that do not admit or treat people
with mental health disorders and then you have poor
accessibility at the primary care level that forces people to
either not receive care at all, or access care at centralised
psychiatric institutions,” she said. “We have been talking
about community-basedmental health services for years,
but still two-thirds of all available beds are in mental
hospitals.”
Other barriers to mental health care provision
outlined by Malcolm were: the inability to integrate
mental health into primary care services due to a lack
of clinical supervision and understaffing; the lack of
investment in tertiary psychiatric institutions; the
tendency of people in leadership roles to lack public
health training; and the lack of political will to advocate
for better mental health services.
Mental health issues are often characterised as
isolated, but Malcolm pointed out these issues affect all
corners of society. “The burden and impact of mental
health are large and widespread and can be felt at all
levels. It can be felt at the individual level in terms of
disability and premature mortality; at the societal level
with the issues of discrimination in the community; and
at the economic level which is the cost to the individual,
the cost to the family and the cost to society.”
According toMalcolm, bridging the treatment gap is
a case of striving to achieve universal access to heath care.
Suicide Prevention
The National Media Guideline for Responsible
Reporting on Suicide was launched on September 10,
World Suicide Prevention Day. The guidelines were
developed by PAHO and adopted by the Ministry of
Health. At present, media houses that implement the
guideline will do so voluntarily. However, Malcolm
said the Ministry and PAHO are working with the T&T
Publishers and Broadcasters Association towards official
incorporation into the code of conduct. “For now, we are
hoping that people will recognize the importance of it
and put it into practice,” she said.
Malcolm added that a trend of “copycat suicides”
prompted the creation of ethical guidelines.
“It’s not that we’re telling the media not to report,
but how should you report it? Is it the front page? The
main headline? What should the headline be? We also
included in that guideline a requirement to provide a
message of hope and also contact information for hotlines
so persons who are in that situation knowwhat resources
are available.”
The guidelines are just one strategy implemented by
PAHO to provide tools for professionals.The organisation
also launched a free, online course last month for primary
health care providers, “Preventing self-harm/suicide.”
The course, which is available in the Caribbean, teaches
early detection techniques, behaviour management,
identification of risk factors and includes modules on
stigma and discrimination.
Another regional initiative supported by PAHO is the
Intentional Self Harm Alert System in Belize. The alert
systemis part of theBelize computerisedhealth information
system, anational, electronic patient record system. Patients
suspected of or with previous cases of self-harm are closely
monitored through the system. According toMalcolm, this
initiative presents a prime opportunity for South-to-South
sharing between Belize and T&T.
The University of theWest Indies School of Nursing
(UWISON) in collaboration with the London South Bank
University, Pan American Health Organisation andWorld
Health Organisation (WHO) hosted a two-day International
Mental Health Symposium geared toward capacity building
efforts on key issues of mental health on September 26
and 27 at the Hilton Trinidad and Conference Centre, Port
of Spain. There were four broad areas of focus: solutions,
policy, skills training and prevention. UWI Today reports on
the feature address given by Dr Taraleen Malcolm on behalf
of Dr Claudina Cayetano of PAHO.
By
Zahra Gordon
Zahra Gordon
is a poet, freelance writer and communications lecturer
