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Mental Health System in Anguilla
– Reported, February 10, 2012
Anguilla has a mental health policy and a legislative Act. There is no mental health unit in the Ministry of health. There was no national mental health plan that sets out the goals, actions, priorities, timelines, and financing strategies for the promotion of mental health, preventing mental disorders, and treating people with mental illness. The Health Authority of Anguilla is responsible for the financing of health care services. Mental health services are subsumed under community health. Allocation and expenditure for the delivery of mental health services are not delineated in the community health budget, except for the remuneration for nurses salaries. However, commencing in 2009, the financing mechanism will be restructured to emphasize the budget for mental health services. Although there is no social insurance scheme, persons with mental illness have free access to psychotropic medications. The mental health policy and legislation do not include the promotion of human rights to protect the basic rights of the mentally ill. No human rights review body exists and none of the mental health service delivery facilities has had an external human rights review. Mental health workers are not trained in the procedural safeguards to protect the rights of mentally ill persons.
There is no mental hospital. The locus of care is in the primary health care setting.Approximately 82% of persons with mental illness were treated in three clinics serving distinct catchment areas. The overwhelming majority of mentally ill persons were diagnosed as having schizophrenia. Access to mental health services is even across the country. Psychotropic medicines are available but there was no risk-benefits assessment of the effects of long-term use of psychotropic medications. The training of primary health care workers in the detection and treatment of mental disorders, pharmacology, and psycho-social rehabilitation has low priority and was non-existent.
There is 8 staff working in the area of mental health which included a medical doctor, not specialized in psychiatry. None of the physicians working in Anguilla has at least two days of refresher training in any aspect of mental health. There is no resident psychiatrist but a visiting psychiatrist from Barbados provided consultant services. The social worker is attached to the Department of Social Welfare and provided part-time services in mental health, as needed.
The mental health nurses launched sporadically public education and awareness campaigns. They educated the general public and target groups about the nature of mental health to reduce discrimination against, and intolerance for mentally ill persons. There are no systems in place to provide timely, accurate, and relevant mental health information. The available mental health indicators are not sufficient to inform efforts to improve mental health services through program planning, monitoring, and evaluation. There was no research on mental health published in indexed journals.In Anguilla, the community-oriented approach to mental health has had a significant impact on the lives of persons with mental illnesses, their families, and other care givers.
In the absence of a resident psychiatrist, only two mental health nurses form the nucleus of therapeutic and supportive care. The lack of a national mental health plan, focused funding, and an acute inpatient psychiatric setting within the general hospital, structured social supports, additional human resources, are ongoing concerns. Diagnostic and therapeutic services depend heavily on consultation and liaison services with a psychiatrist who is based in Barbados.
Although there is limited public education campaigns, the public remained largely uneducated about the magnitude of the problem. There are no publication or public briefings to inform of the prevalence, types, and effects of mental illness. There were no educational programs for primary health care workers to prepare them for the role of mental health workers.
In order to put the information above into context, the situation in Anguilla is being compared to that which exists in six Eastern Caribbean countries. Anguilla is among: two of the six countries with a mental health policy; three of the countries without a mental health plan; three without a mental hospital; and among two countries where it was difficult to estimate the total budgetary allocation for mental health services. All six countries have either draft or enacted mental health legislations. Anguilla is one of two of these countries that depend on the services of a visiting consultant psychiatrist. In the referenced six countries there were: no user/consumer or family associations; no work on human rights; no refresher training for mental health professionals; no mental health information system; and no research or published articles on mental health.
There was no mental health authority in the country or a director of mental health programs. Two mental health nurses and the visiting consultant psychiatrist formed the core of the mental health service delivery system in Anguilla. Community mental health services are organized in terms of catchment/service areas.
Mental health outpatient facilities There were no outpatient facilities exclusively for treatment of persons with mental illness. Primary health care services were provided in the three health districts through four health centers and one polyclinic. Core mental health services were provided in three of these health centers. The mental health nurses and the primary health care physicians managed the assessment and treatment of persons with mental health illness. During scheduled visits to Anguilla, the visiting consultant psychiatrist reviewed assessed patients, and reviewed/updated case notes. Emergencies were referred to the Princess Alexandra Hospital. In the absence of a mental hospital or other inpatient facility, Her Majestys Prison continued to be used as a place of safety for the mentally ill.
There were no outpatient mental health facilities or services exclusively for children and adolescents. In 2007, three children were assessed and treated in the community health centers. A social worker was assigned on a part-time basis to the health centers and a few mentally ill patients received psychosocial intervention. Psychosocial counseling was 16 also carried out by the two mental health nurses. These nurses conducted home visits and assisted their clients through the social service administrative processes. In 2007, a total of 128 clients were assessed, treated, and counseled in the three community health centers. Forty-seven percent (60) were females. Six percent (8) had mental and behavioral disorders due to psychoactive substances; 51% (65) had schizophrenia and other related disorders; 12% (15) had mood affective disorders; 15% (19) had neurotic, stress-related and somatoform disorders; 1% (1) had disorder of adult personality and behavior; and 16% (20) had other mental illnesses.
Credits: World Health Organisation
More Information at: http://www.who.int/mental_health/anguilla_who_aims_report.pdf
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