Jetty Constansia (left) and Christine Alvarez are in charge of Mental Health Caribbean’s (MHC’s) outreach programme
T. EUSTATIUS–Delegates attending the Mental Health Symposium were in no doubt as to the need for improved care and services on St. Eustatius. But before this can be done, through Quill Foundation, Kenneth Cuvalay intends to carry out a population study.
“Without these data, funding for expanding health care will be difficult. Mental health issues are more common than we imagine. They may affect adults and children alike. A person struggling with mental health may experience depression, anxiety, relationship problems, grief, addiction, ADHD or learning disabilities, mood disorders or other symptoms,” said Cuvalay.
“That is why it is essential to engage with therapists, psychiatrists, psychologists, social workers, nurse practitioners or physicians to manage illness through therapy, counselling or medication,” he said.
Professionals working directly with mental health patients in the Dutch Caribbean addressed the conference. Jacco Vaders, who has taken over from Cuvalay as Windward Islands Clinical Manager for Statia and Saba at Mental Health Caribbean (MHC), shared his experiences in mental health care on Saba.
As a senior psychiatric nurse, Vaders has acquired a fair amount of expertise, first in the Netherlands, and then for the last six years in St. Maarten and Saba.
“On Saba, care tends to be on a smaller scale, and because it is a small community everybody gets to know each other. Cooperation between police, probation office, carers, right up to Government and Governor is well organized,” Vaders said.
“Resources are always stretched and often it is a question of doing more with less. On Saba, as in Statia, for example, we do not have specialized schools. Children with special needs attend the same schools. This is not always the best solution.”
Psychiatrist at Mental Health Foundation of St. Maarten Sachin Gandotra agreed that more could be done in the Dutch Caribbean. However, he cautioned against importing foreign structures and dogma.
“Whereas we have some small set-ups and only limited data, we have to move on,” Gandotra insisted. “As health care professionals, we have to adopt a flexible approach to treatment. Even in my native India, we have been working hand in glove with faith healers. Results have been impressive,” he observed.
Clinical Director of Turning Point Foundation Judith Arndell addressing the Mental Health Symposium
Director of Dr. J. Enterprises and Clinical Director of Turning Point Foundation in St. Maarten Judith Arndell, shared some experiences on the role that religion, voodoo and the supernatural play in the lives of many with mental health issues. These aspects play a strong role in Caribbean culture, she explained.
Religion is a powerful medium that gives a sense of purpose and guidance through its belief systems, prayers and rituals. Whilst religion has a place in promoting sound moral values, forgiveness and dispelling anger, if applied too rigidly, some doctrines may cause undue pressure, guilt and stress when one endeavours to live up to the demands and expectations, Arndell said.
Various speakers underlined other factors, such as gender, genetics, and socio-economic status that influence mental health issues.
Poverty was singled out as a major variable. When challenged by a question from the audience that poverty can also motivate poor people to succeed, child and adolescent psychiatrist from St. Maarten Cheryl Ferero commented: “This is a common misconception. Poverty is not an excuse, but a real experience and what we experience may influence mental health.”
Psychiatric issues are usually referred to a house doctor for diagnosis in the first instance. Physician at St. Eustatius Department of Public Health Gerwin Schobbe explained how doctors throughout the world use a standard test.
“Developed in the United States, DSM-5 has proved successful. Nevertheless, in looking at individual psychiatric problems, doctors need to appreciate the big picture of culture and community.”
According to his colleague Teresa Leslie, influences may often be rooted in the colonial past and continuing discriminatory practices. Via a video link to Puerto Rico, anthropologist Leslie stated that worldwide 450 million persons suffer from mental illness.
“Community and individuals are influenced by history in the long term. The colonial past has left a racially-structured society that can result in disenfranchisement. As a result many may not feel empowered in their lives and suffer from a lack of aspiration.”
Leslie questioned how this mind-set may influence mental health, and urged health care professionals to be reminded of this wider picture in their daily practice.
Whatever the cause of mental illness, it can be prevented or at least mitigated in the same way as physical illness. On Statia, Jetty Constansia and Christine Alvarez of MHC have launched an outreach campaign for schools and the community.
Their posters, flyers, theatrical role play and presentations point out the consequences of, for example, substance abuse and other sources of addiction.
“Awareness is the first step,” Cuvalay told symposium delegates. “Prevention has to be top priority and that means an open conversation must begin to increase knowledge among the community. Increased knowledge will increase awareness and this will make prevention efforts all the more successful.”