The Mental Health Crisis in the English Speaking Caribbean

By Leroy A. Binns Ph.D.

 

Mental health is a complex phenomenon which is defined by social, environmental, biological and psychological factors and dependent on the utilization of appropriate health treatment to offset neuropsychiatric disorder namely depression, anxiety disorders, schizophrenia, dementia and epilepsy.

Presently an estimated 1500 million people worldwide suffer from some form of neuropsychiatric disorder including mental, behavioral and substance disorders. The World Health Organization (WHO) confirms that a third may be affected by more than one neuropsychiatric ailment while three-quarters of those afflicted live in developing countries.[1]

 The Dilemma

Within the Caribbean, an archipelago of approximately 17 English speaking islands along with Belize and Guyana major categories of mental disorders in adults include 1) psychoses – schizophrenia and schizophrenia like disorders, bipolar disorders and major depression and neuroses – anxiety, minor depression and phobias and substance abuse. In the case of adolescents mental disorders appear in the form of suicidal behavior, conduct disorders, substance abuse and attention deficit/hyperkinetic disorders whereas in children conditions include conduct and development disorders.

A study of schizophrenia in Jamaica in 1993 highlighted an incidence rate of 1.1 per 10,000 in a population of 2.5 million while in Trinidad and Tobago rates were recorded at 3.4 per 1,000 in Afro-Trinidadians and 1.2 per 1000 per Indo-Trinidadians. A similar examination in Barbados, an island of 250,000 conducted in October 1995 showed an incidence rate of 2.8 per 10,000. Unfortunately these findings demonstrate a prevalence of schizophrenia contrasting with a 1986 WHO study of 10 countries with varying scales from 0.7 per 10,000 in Denmark to 1.4 per 10,000 in the United Kingdom.

The issue of suicide is also of grave concern to the region. Research indicates suicide rates in 1971 at 2.3 per 100,000 in Barbados, 1.4 per 100,000 in Jamaica and 7.0 per 100,000 in Trinidad and Tobago. In 1988 there was a sharp increase in the number of deaths attributed to suicide; 17 per 100,000 in Trinidad and Tobago many of which were dual crises commonly defined as homicides/suicides to 40 persons per 100,000 in Jamaica. In short the mortality rate from suicide for males in the region was 7.1 per 100,000 in 1980 and 8.6 per 100,000 in 1990 in 1990 whereas the rates fro females stood at 2.6 and 2.9 during the same period.

Oftentimes the use of marijuana is associated with psychosis and neurosis. Although the extent of the problem surrounding the utilization of liquor is unknown most studies confirm that its repetitive use contributes to varying forms of depression manifested through incidents of motor vehicle accidents, family disputes, poor job performance and sexual abuse. In Trinidad and Tobago in 1986 34% of the persons admitted to psychiatric institutions were substance abusers while in St Vincent and the Grenadines the users accounted for 8%. These and other figures have undoubtedly increased with the growing consumption of cocaine and crack cocaine among adolescents and adults alike.

Psychiatric disorders are common among the elderly but there is limited information with regard to the diagnoses or frequency. Nonetheless the major problem facing this age group is loneliness often accompanied by depression. A 1992 survey of the elderly in Jamaica revealed a 14% prevalence of mental impairment. Furthermore 50% of the mentally impaired were without a caregiver and were forced to address their basic concerns. In the case of adolescents and children the data pertaining to mental health disorders is also sparse nevertheless it is documented that many teens with attention-deficit/hyperkinetic disorder and younger youths with conduct and development disorders are treated and wrongfully diagnosed as being mentally retarded.[2]

Contributing Factors

Issues associated with mental health crisis affecting the mostly agricultural based economics include psychosocial and psycho-cultural determinants such as unemployment, poverty, child abuse/abandonment, violence and homelessness.

A correlation between socioeconomic factors such as acute unemployment and mental/cognitive illness has been over represented among persons in the lower socioeconomic strata in the region. In Barbados the former stood at 24.3% in 1993, in Trinidad and Tobago 19% in 1996 and in Jamaica 16% in 1994. Moreover just a couple years shy of the 21^st century over 25% of the population in Guyana and Jamaica are unemployed. Youth unemployment in particular between the ages of 15 to 24 demonstrates an unacceptable rate of 47% partly due to low levels of literacy – some 50% of Caribbean youth are deficient in formal skills training programs. As a result, poverty and its offspring, mental suffering are at disproportional levels. It is evident in Guyana and Jamaica that approximately 20% of the resident population gained economic security overseas and 40% of the local populace live below the poverty level while an undocumented but large portion of inhabitants are classified as mental outcasts.

In a society comprised of 48% of adolescents and youth, multiple unions are common among Afro-Caribbean families many of which were visiting unions and common-law unions. A sample of Jamaica men revealed 44% were in visiting/friendship relationships while 41% were in common-law relationships. As frightening is another on teenaged Guyanese and Jamaican females underscoring the fact that in recent years 20% of live births were to mothers between the ages of 15 – 19 years of age. Therefore in many instances West Indians families are described as matrifocal with 22.4% of women in Guyana, 27% in Trinidad and Tobago, 33% in Jamaica, 42% in Barbados and 45.3% in Grenada heading households. Such especially illustrations involved teenaged mothers and absentee fathers often exacerbate fragmentation of the family structure as child rearing becomes the responsibility of extended family members. Further youthful neglect may also rise from migration which separates families for prolonged periods.[3]

With relatively high levels of unemployment and underemployment, increasing income inequality and the marginalization of males, youngsters have resorted to gang violence with one in 11 adolescents reporting their participation in gangs while 10% admitted to past gang involvement. Violence among adults is also heartening. Jamaica the island with the third highest murder rate in the world experienced the slaying of 505 people in the first half of 1999 (a total of 185 fell victims in May and June) and over 615 to date this year. In addition the US Virgin Islands with a murder rate second only to Jamaica in the region saw its average rise from 9.0 per 100,000 in the 1970s to 20 per 100,000 in the 1980s due to increased theft. Antigua, Barbados, Dominica, Guyana and St Kitts have also been recognized by a longitudinal study on lawlessness in the Caribbean for significant increases in serious crime.

Limited data is made available on homelessness but the evidence is overwhelming throughout the region. The proliferation of migrants from rural to urban communities produces a burdening effect on cities. Montego Bay, Jamaica’s second largest city and tourist paradise is plagued with a growing number of homeless demented citizens who have made the metropolis their permanent home. The same is true of Georgetown the capital of Guyana where the abandoned turn to the streets in search of refuge. The problem is insurmountable as both governments offer little beyond “lip service.” In relation to the former it was alleged that in 1999 the St James Parish Council under the direction of the mayor of Montego Bay transported and dumped the disabled in the dark of night on unfamiliar turf in the parish of St Elizabeth. Such regrettable behavior has not gone unnoticed as the subjects have been returned to Montego Bay and an inquiry is underway to address the matter.[4]

Solutions

Social stigma towards the mentally ill and the mental health services provided, limited use of the mental health services, shortage of funds, scarcity of ideas and research and the lack of facilities and qualified staff are elements that contribute to the ongoing dilemma.

In an attempt to confront ignorance some strategies of significance should embody training lay personnel in counseling and in early detection of psychological ill health, tutoring primary care professionals in basic mental health care, amalgamating mental health care with the existing primary health care regime and prioritizing mental health care.

There is also a need for comprehensive national health policies and considering the region’s cultural and racial similarity a Caribbean health policy which will incorporate campaigning to foster the adequate use of medical assistance. Other essential should encompass the use of proactive non-governmental and other private sector agencies working in tandem with national governments to procure monetary aid to advance mental health care and frequent association with mental health professional organizations to promote research and epidemiological studies.

Equally important is a desire to create new medical centers and “professionalize” the workforce. According to a 1997 publication released by the Pan American Health Organization (PAHO) countries such as the British Virgin Islands, Cayman Islands, Montserrat, Turks & Caicos Islands and St Kitts and Nevis are without psychiatric hospitals and medical practitioners responsible for mental health. In addition the larger islands such as Jamaica, Guyana, Barbados and Trinidad and Tobago each have 1 psychiatric hospital and fewer than 15 psychologists and a comparable number of psychiatrists in government service – most of whom are concentrated in urban areas. The region is also lacking an institution to train psychologists. Thus far even through under consideration, the University of the West Indies does not offer graduate degrees in Psychology only courses on the subject matter within some departments according to their respective needs.

The decisive endorsement of improved mental health care by Caribbean governments which embodies fiscal, educational, medical and legal resources could aid in redefining and reorienting the provision of health relief by expanding its present boundaries.[5]

Endnotes

1. WHO, “Mental Health.” 1996, pp. 1.

 

2. Hickling, F.W. and Rodgers-Johnson, P. “The Incidence of First Contact Schizophrenia in Jamaica.” West Indian Med J 1994; (suppl 1) pp. 12.

Sartorius, N., Jablesky, A., Korten, A., “Early Manifestations and the First Contact Incidence of Schizophrenia in Different Cultures.” Psychol Med 1986; 16: 909 – 928.

PAHO, “Health Conditions in the Caribbean.” 1997, pp. 204 – 207.

 

3. Caribbean Youth Summit Release, “Facing the Challenges.’ 1998, pp. 1 – 2.

Roopnarine, J. “Caribbean Fathers: Much Maligned.” The American Psychological Association 1995; pp. 1-2.

 

4. Caribbean Youth Summit Release, “Region’s Youth Facing Increased Stress.” 1998, pp. 1.

Kovaleski, S. “Murder Madness Bedevils Jamaica.” Washington Post. July 27, 1999, pp. A13.

McElroy, J. “A Study on Serious Crime in the Caribbean.” 1999, pp. 7 – 9.

 

5. Satyanarayana, C. “Strategies in Developing Mental Health Services in the Caribbean.” 1996; Editorial Psychiatry on Line 1996, pp. 1 -2.

PAHO, “Health Conditions in the Caribbean.” 1997, pp. 210 – 212 & 216 -217.

 

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