A new look at mental health

Adieu St Ann’s, or perhaps, should we say good riddance?

St Ann’s — more formally known as the St Ann’s Psychiatric Hospital — is over a century old. Undoubtedly, there are many hard-working, professional medical officials there. But in the public’s imagination, the hospital has long come to embody the old approach to mental illness.

We welcome the plan, announced by Health Minister Terrence Deyalsingh during the Budget debate, for the decentralisation of care away from St Ann’s to a new facility, together with a network of supporting satellite services. Such a plan, the outcome of two years of consideration according to the minister, is long overdue.

For too long, the State has adopted a backward approach: following a model which treats patients only at the end of psychoses and long after the disease has progressed.

But mental illness is exactly what its name implies: a disease—one that is manageable, curable, even preventable once risk factors are understood and preventive measures taken. Patients don’t need cages and injections. They need a support network and greater awareness.

According to the acting CEO of the South West Regional Health Authority (SWRHA), there are more than 16,000 names registered at SWRHA psychiatric clinics. And that’s just one zone alone. Thousands more are suffering in silence in the shadows, afraid, unable or reluctant (understandably) to access treatment by the State.

Reviews of the situation have long painted a dire picture. For example, a 2013 report by the World Health Organisation (WHO) which examined mental health systems in Latin America and the Caribbean (including TT) found the entire region wanting in terms of financing, planning, training, intersectoral collaboration, research and awareness.

The report observed a telling fact. Our rate of psychiatric or mental health services at general hospitals is low: just 0.2 per 100,000 of the population.

The system assumes mental health issues are reserved for a specific facility, instead of a regime of overall treatment and intervention across the hospital network. At the same time, this country has one of the highest suicide rates (14.4 per 100,000 of the population) in the region. That’s crazy.

The plan outlined by the minister appears to be a good one. The State needs to be sensitive to the needs of the mentally ill in tailoring new facilities. This means ramping up care at the level of the community and not just regarding mental health issues as a hazard or inconvenience.

It may well be that there will still be a role for the St Ann’s Psychiatric Hospital premises in the new, revamped disposition. But we hope the reforms usher in a new era in which we can say goodbye to the old paradigm which that facility has come to symbolise.