Mental health: My primary health care responsibility

Julius Timothy

Below is an address given my Minister of Health Julius Timothy to mark World Mental Health Day being observed today.

Today, October 10th, 2011, the Ministry of Health joins the rest of the world in observing World Mental Health Day.  This year, we selected our own Campaign theme which best reflects our current position on Mental Health in Dominica. The theme “Mental Health: My Primary Health Care Responsibility” is a rallying call to all Dominicans.  Our mental health is a most important treasure and we must do everything possible to protect it.  The main goal of this campaign is to improve community services for all our clients.  Therefore, the government’s focus is to empower the District Health Teams, who most often are the first responders to persons with mental health problems.

Evidence put forward by the World Health Organization demonstrates that the economic and social burden of mental disorders on national economies is worsening.  It has recognized for a long time that Mental and Physical health problems are interrelated.  It further warns countries that the treatment gap for mental disorders is too wide and that people living with mental health problems should have greater access to treatment.  They further advised that providing primary care for mental health has many advantages for patients and the country on a whole. It Enhances access to a higher quality of service and Promotes respect for the human rights of persons suffering with mental health problems.

So my government supports the integration of mental health services into Primary care because it is affordable and cost effective.  This new approach will definitely result in good health outcomes for the individuals affected, their families and society as a whole.

Let us look at some of the statistics available that advise our new position.  Recent Caribbean and Latin American studies indicate that a high percentage of people who need mental health care, do not receive this care.

1.    For instance, although 6% of the Caribbean population is diagnosed as either abusing or dependent on alcohol daily; over 70% of these persons do not receive mental health care.
2.    Marijuana and crack use is rampant among the youth population. Yet care is not readily accessible.
3.    Another example is anxiety disorder, in which only 2 in every 5 persons suffering with the disorder receive professional care.
4.    Furthermore, although depression affects 6% of our population, as many as 3 in every 5 depressed persons never receive adequate mental health care.
5.    Imagine that psychoses and schizophrenia, a group of mental illnesses that affects about 1% of all populations throughout the world leaves more than 1 in 3 of its victims without any care.

These persons are more likely left abandoned, homeless, and hungry and wander the streets, or harass visitors and locals.  There is definitely a huge treatment gap.   This year’s campaign theme seeks to address the need to bridge this gap and improve the quality of mental health care.  It is expected that a new approach will result in all health care workers taking full responsibility for our brothers and sisters suffering with mental health problems.  This new disposition will put an end to the tradition of stigmatized mental health care services for Dominicans.

It is widely accepted that the stigma of hospital care is a strong barrier and keeps sick people away from consulting mental health specialist at the Psychiatric Unit.  The Ministry of Health accepts that mental health services in our country need further upgrading.  Persons living with mental illnesses do not receive equitable care for their diseases.  This is a public health problem and the Ministry must find an effective way to improve the quality of care to all Dominicans.  Therefore, this year’s campaign aims to call on all concerned to make mental health care services available at the primary care level.  This includes not only health centers but anywhere within the community such as community homes for children and adults, schools and other national institutions.  We can protect people’s mental health by changing our own negative attitudes.

The Director General of the World Health Organization Dr. Margaret Chan stated:
“Primary care starts with people. And, integrating mental health services into primary care is the most viable way of ensuring that people have access to the mental health care they need. People can access mental health services closer to their homes, thus keeping families together and maintaining their daily activities.”

Dominica has a renowned Primary Health Care System.  Each community has easy access to health centers and health professionals.  This system of care has contributed more than any other system to elevate the standard of the national health system.  Because of this reality, the Ministry has embarked on this campaign of integrating all stable psychiatric patients into the general health center clinics throughout the island. Persons with mental health problems will now be fully accommodated and treated by their District Medical Officers and the rest of the health team.  This changed practice will allow time for the specialist team from the Acute Psychiatric Unit to pay greater attention to persons who are noncompliant with treatment.

In fact, this group of mentally unstable persons is partly responsible for the negative attitude of the public towards all persons with mental illnesses.  The new approach of Assertive Community Therapy will definitely stabilize their lives and that of their communities.

The case for integrating mental health in primary care is essentially a call for District Health Teams to get more involved in the provision of mental health care.  In this year’s campaign specialist team of mental health workers is travelling throughout the island conducting Case Management Workshop with the District Health Teams.  The aim is to empower Primary Health Care Workers to recognize the risk factors for mental illnesses thereby enabling them to provide better treatment and support for the vulnerable patients.

It is important to stress that in Dominica we believe that there is no health without mental health and that mental health is more than the mere absence of a mental disorder.  Therefore, mental health is the foundation for well-being and effective functioning for an individual and for a community.   Mental health and by extension mental illness is determined by multiple and interacting social, psychological and biological factors.

The Ministry of Health recognizes that promoting the mental health of Dominicans is not the sole responsibility of the Ministry.   In November 2011, the final draft of the national mental health policy will be presented at a second national consultation for stakeholders.  The new national mental health policies and programs demonstrate that an integration of mental health in education, labor, housing, justice, community development and welfare as well as other health sectors is the only way forward.

The Community Mental Health Team encourages all citizens of Dominica to join in this campaign to increase awareness that persons suffering with mental health problems may have better outcomes if they seek early consultations with their primary health care providers.

The Ministry is pleased that the quality of mental health services is improving within the health system and recognizes the tremendous efforts of the Consultant Psychiatrist and other Medical Officers, the support services of the Clinical Counselor, the Social Worker, and the Occupational Therapist.  Most significantly, two qualified Psychiatric Nurses recently returned from training overseas and have joined the team of dedicated nurses.  The task of delivering optimum mental health care is not easy but the reward is evident throughout the society.

The activities planned for this years’ campaign includes; a National Consultation for Stakeholders, Case Management meetings with all District Health Teams throughout the Primary Health Care System, Fun & Sports day for Clients, and Media Presentations by mental health care providers.

We therefore urge our fellow citizens to remain supportive to persons suffering with mental disorders.  In this way we can all help to create a healthy and productive Dominica.

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  1. jannne
    October 12, 2011

    I think this man julius timothy needs to come out as health minister. really

  2. Advocate
    October 10, 2011

    There are ongoing efforts in the area of mental health awareness in terms of reducing reducing stigma and discrimination however I am of the humble opinion that Dr. Griffin Benjamin’s mannerism, shovenistic attitude and narcissistic behaviour makes him the ONE thing that is wrong with psychiatry in this country. Unless this man changes his attitude towards his patients/clients, the ruling party and his colleagues there will be little improvement in the area of mental health and the undermining of what little progress has been made in that area over the years if any!

  3. Truth
    October 10, 2011

    Tim if this government does not pull up it’s pants and go to work for the people soon dominica will be a land of paros,drunks, retired people and a cabinet of idiots g. Unemployment is at it’s worse, the government destroyed agriculture ( no doubt about that), nothing has been done to boost tourism and we have over the last 10 years develope a culture of dependency. I am afraid that the mental health of the people is nearing a disaster.

  4. Satelite
    October 10, 2011

    Hello out there! Can you all remember “The Photo of The Day” of that mentally ill woman who was photographed inconsiderately, standing underneath the stop sign at Federation Drive? I spoke about it and about 50% of you out there were in agreement of the photo being taken.
    With the recognition and acknowledgment of World Mental Health Day, I pray that some assistance would reach her and others alike who live among us. As the Minister rightly stated “These persons are more likely left abandoned, homeless, and hungry and wander the streets, or harass visitors and locals.” Please let us be more considerate.

  5. forreal
    October 10, 2011

    i have always seen mental health as a family oriented problem,yes stems from a lark of deep family root,its like this a family that stays together plays together,fathers need to stay with there children and children mothers,in other to take care of their families and make shore they grow up healthy and strong,when the fathers leave,they leave the mothers with a stress and strain,as soon as they the mothers get in a argument with their children,them mothers does say go and look for work for you to do, or go look for your own house for you to stay next thing you know child do not have proper age,child on drugs,child stealing,child developing mental illness,and thats it there,because dominicans do not maintain that tight family up bringing, so people need to be educated on strong family values in dominica,and i mean strong christian family values,but before you all say it,i know some people does inherit mental illness through family genes,but i am just saying that this another example.

    • execute command.
      October 10, 2011

      in other words pay people on time and pay them well….so that they dont have to go and look for a man after working hours to pay the rest of their bills and make THEIR endz meet, me aself tired with PUBLIC WORKS, I GOING AND BEND MY BOTTOM OVER FOR LABIE TONIGHT… SO I CAN PAY MY INTREST THAT GOING UP ON MY HIRE PURCHASE…….OCTOBER 10TH AND NO MONEY YET FOR HONEST HARD WORKING PEOPLE…..SO MY BOTTOM HAVE TO HURT ME??????? AFTER I DONE WORK HARD?????

      • execute command.
        October 10, 2011


    • executive command.
      October 10, 2011

      I am soon to need mental help, for the sake of the situation that PWC puts me in month after month after i work hard for my money i have to go an watch my children in the middle of their eyes……soon i will go temporary insane and execute command on that ACTING GENERAL MANAGER THERE!!!

  6. fitzroy
    October 10, 2011

    We should consider adding Mental illness to the list in the battle against Chronic Non Communicable Diseases.
    Especially as it affects the very pillars of society.
    the productive sector of the population.
    persons who should be producing.

  7. mouth of the south
    October 10, 2011

    that name ‘psychiatric unit’ has to change.. this is a stigma especially in small countries like d/ca… first and foremost when one goes to seek mental health… the environment is essential.. how can one feel comfortable when they have to be seeing or sitting among ‘mad’ people… it breaks the spirit… making one feel that this is how they’ll end up… ain’t there private dr’s who deal with such?? secondly is the medication… those old medications has to go… people not supposed to be getting hooked on drugs… when u take a drug it’s supposed to be enabling a healing process… but when u take it… u feel worse than b4 when u stop… and so u have to keep on taking it to feel better… and it seems u’ll be taking it for the rest of your life… third…. is the lacking in professional people… what i mean by that is the fact that… if u have anxiety problems… and u go in to see the doctor… first u might have to see a nurse etc or nurses… in dominica there’s the threat that ur business will be out in public… fourthly… location is vital… with something so personal as mental health… why would it be so open to the public view?? honestly… i think with simple situations as anxiety etc… u should be treated in the same area as other patients… so as to not raise ‘suspicions’… i hope u understand what i’m trying to say… headaches… bachaches… etc caused by constant worrying/chronic stress or anxiety should be treated as normal illness… no need to have to go to a ‘special’ branch of the hospital for that… u come in… see the dr.. he diagnose u…. u leave…. u comeback for check up and so on.. until u feel u are good and can carry on… this helps boost one’s confidence.. and enable people to realise that it’s a normal reaction to being over-stressed… and not that u are ‘mad’ or something is terribly wrong… u just need the treatment and conseling… and last but not least.. faith in God… that psych unit is the main distraction to people seeking help… once one goes there u are labelled ‘oh mamzel losing it’… or ‘mr mad’…

  8. LOL
    October 10, 2011

    Wasn’t Cancer Treatment your number one priority last week????
    When you get your priorities in order then i will start listening…

  9. Neitzsche > Jesus
    October 10, 2011

    you are in the wrong position and your qualifications have little too no relation with your current capacity. I’m not sure how measurably successful you have been in that capacity, but it is true that health is not in accord with your credentials.

  10. execute command.
    October 10, 2011


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