Mental health to come under spotlight on Sunday’s Big Issues show

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By Barbara Arrindell

On the Big Issues show this weekend we’ll discuss the possibility of implementing a different type of management structure at the Clarevue Psychiatric Hospital. Clarevue is the only psychiatric hospital in Antigua.  

For everyone to be able to follow the discussion and participate we are sharing sections of the law and sections of a policy document and World Health Organisation (WHO) report that we’d like you to be aware of.

The Mental Treatment Act is dated 1 October 1957. This Act is enshrined in the Revised Laws of Antigua and Barbuda 1992, Chapter 274.

 It uses the following terms and defines them as follows:

(b) any idiot, that is to say, a person so defective in mind from birth or from an early age as to be unable to guard himself against common physical dangers;

 (c) any imbecile, that is to say, a person in whose case there exists from birth, or from an early age, mental defectiveness not amounting to idiocy, yet so pronounced that he is incapable of managing himself or his affairs or, in the case of a child, of being taught to do so;

(6) any feeble minded person, that is to say, a person in whose case there exists mental defectiveness not amounting to imbecility yet so pronounced that he requires care, supervision and control for his own protection or for the protection of others, or in the case of a child, that he by reason of such defectiveness appears to be permanently incapable of receiving proper benefit from instruction in an ordinary school;

The Antigua & Barbuda National Mental Health Policy, Ministry of Health 2013, notes that “the Act does not address: access to the least restrictive care; rights of mental health service consumers, family members and other care givers; accreditation of professionals and facilities; mechanisms to oversee involuntary admission and treatment practices; mechanisms to implement the provisions of the mental health legislation”.

The policy document also highlights the following:

“Human Resources: The human resources cadre in mental health is limited and concentrated in the mental hospital, with multiple tasks and limited opportunities for continuous education. Primary care practitioners and other non-specialised staff are not involved in mental health care provision. All mental health services in the public sector are provided by the Medical Superintendent and staff of the Clarevue Hospital, primary health care physicians, community mental health nurses, and ancillary staff. There is no occupational therapist assigned to either the Clarevue Hospital or the primary health care centres. However, there is one social worker assigned to the Clarevue Hospital.”

“Financing of Mental Health services: In 2012, the Ministry of Health’s budget on mental health services is EC$4,576,333, representing approximately 5% of the total projected annual health budget. The appropriation for the Clarevue Hospital is subsumed under “mental health services,” and is not listed as a line item therein. For 2011, the revised budgetary allocation for mental health was higher at EC$4,672,717.

“Human Rights: The Government of Antigua and Barbuda is party to Human Rights Conventions and other international treaties and agreements germane to human rights and is committed to ensure the protection of human rights of persons with mental disorders.

“Management and Coordination: There is no mental health policy to set priorities, reduce the burden of mental disorders in the population, and protect the human rights of persons with mental illness. There is no mental health plan to define and monitor objectives, strategies, timelines, and resource requirements for delivery of mental health services. The present national mental health policy has been developed in response to the inadequacies of our current system in meeting the mental health needs of the Antiguan and Barbudan population and represents an attempt for the first time to coordinate and deliver care through national community-based activities and not only through the Clarevue Psychiatric Hospital as a stand-alone institution.”

2. Vision: Antiguans & Barbudans will have access to a mental health system that provides scientifically based support and treatment, promotes mental wellness and recovery from mental ill health.

3. Mission: To provide an integrated approach to the delivery of high quality mental health care that is evidence-based, with an equitable mental health care system that upholds human rights, is community focused and delivered by trained professionals, working with dedicated, and motivated personnel.

4. Values and principles: The following values and principles shall guide the national mental health policy and plan for Antigua and Barbuda: a. equity and accessibility services shall be affordable and accessible to all people, regardless of age, gender, race/ethnicity, sexuality, geographical location, socio-economic status, religion, health status and mental or physical disability. Mental health services shall have parity with and be integrated within general health services at the primary, secondary and tertiary levels.

The above was taken from the Antigua and Barbuda National Mental Health Policy – Ministry of Health 2013.

That policy appears to have been written in response to a WHO report of 2009. Among other things the WHO report gives information on training and legislative provisions.

Training in mental health care for primary care staff

The majority of the primary health care physicians in Antigua and Barbuda were educated in countries such as Cuba, the United States, and the United Kingdom. Data were not available with respect to the number of hours devoted to mental health in their respective training programmes.

None of the primary health care physicians had at least two days of refresher training in any aspect of psychiatry/mental health. Three percent of the training hours for registered nurses was devoted to mental health. None of the primary health care nurses had at least two days of refresher training in psychiatry/mental health.

Similarly, none of the non-doctor/non-nurse primary health care workers received continuing education training in mental health. The primary health care setting was the first point of contact and treatment of new clients with acute mental illness as well as those requiring follow-up and supportive care.

All primary health care centres are physician-based and none had assessment and treatment protocols for key mental health conditions. Referrals were made from the physician-based primary health care centres.

There were no legislative provisions concerning: a) legal obligation for employers to hire a certain percentage of employees that are disabled; b) protection from discrimination (dismissal, lower wages) solely on account of a mental disorder; c) financial provisions concerning priority in housing and in subsidised housing schemes for people with mental disorders; and d) protection from discrimination in allocation of housing for people with severe mental disorders.

Join us on Sunday as we discuss mental health care, Hurricane Beryl and the impact that sugary drinks are having on our society.

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