Psychiatrist Dr Andel Roberts says the fear of confidentiality is a main deterrent in people accessing treatment for mental health issues.
He was speaking on Friday at a professional development workshop for teachers at the Tobago Nutrition & Cooperative Society Building, Canaan.
The event was hosted by the Tobago Teachers' Get-Together as part of its 79th anniversary celebrations. This year's theme was Mental Health: A Critical Pillar of a Sustainable Education System.
A consultant at Scarborough General Hospital, Roberts said Tobagonians have often expressed concern about confidentiality even before an initial assessment is undertaken.
"The issue of confidentiality is real. Tobago is a small place," he said.
Roberts said he has been working in Tobago for the past four years "and one of the things that I hear constantly from people is 'I don't want to talk to you because people will read my file and they will know.'"
He said such fears are real.
"As much as I can guarantee that what we write in the notes is supposed to be confidential, it is a real thing. Somebody on the ward, a nurse or a clerk opens the file and reads it, I really can't do anything about that."
Roberts said in an attempt to minimise the likelihood of people scrutinising his clients' files, he writes in general terms.
"I do not write down specifics because I don't know who is going to read that, and so the fear of your business being on the road is a real fear."
Roberts said the system is not foolproof.
"To some extent, you can't really get around that. It sounds bad but there will always be people who try to usurp that process. What I can say is that when I speak to people, it is always confidential."
The psychiatrist said, however, fears about confidentiality should never prevent people from getting help from mental health professionals.
"Is it really enough to suffer in silence?" he asked. "At the end of the day you have to talk to somebody, is you really have an issue."
Roberts, in his address, lamented there is still too much shame and stigma associated with mental health.
"It is one of those things that is not very well understood because it is taboo. It has a stigma attached to it."
He said such attitudes are counter-productive because the person suffering from the condition is the one that loses out.
"And so, people only see the need to have a mental health intervention when it really hits home. That is, unfortunately, the truth. When it gets bad enough, then you really have to do something about it."
Roberts said people also link mental illness to obeah or some spiritual force.
"For some people, it is always a spiritual problem. People put a jumbie on meh. Is obeah. Is drugs. In our society, that is a belief system. It is always they do meh something. They do meh brother something and that is why he depressed. It is always something spiritual."
Roberts said while spiritual things do occur, "you don't have to neglect an issue because you believe it.
"We really need to take a hard look at ourselves and what is important to us, because what is the point of having everything else if you don't have your whole sanity. If you are not at peace, if you don't feel happy, it does not make any sense."
Roberts urged the teachers to get help, either through the Ministry of Education's Employee Assistance Programme or private mental health practitioners.
"If you realise that you are struggling with something, you have to get help... The onus is on us to take care of ourselves."