Dealing with mental health in any country is rough. From the beginning, just finding a therapist who checks your personal boxes, the trauma of explaining to an outsider your thoughts and emotions, dealing with medication and trying to find what dosage works for you, the process is tedious and exhausting. Take that process, multiply it by 5, and you have some awareness of the Jamaican situation when it comes to mental health and treating it.
Jamaica is in an interesting position. A majority of us suffer from some disorder according to a renowned late shrink, and the State, on the face of it, has acted. Mental health medications are part of the National Health Fund (NHF) suite of drugs, which are heavily subsidised; mental health units are operating in health centres; and advertisements abound telling people to talk to a therapist if they need to.
Despite all this, more needs to be done. Anyone who has interacted with a health centre knows that, in theory, they are brilliant, but in practice, it is a daunting experience. Be it the hours spent waiting to see a doctor, the dearth of medical staff, or the lack of amenities for visitors or the fact that the mental health unit is open for one day, there is much to be desired.
Health centres as the primary point of health care are failing, but it is no fault of the staff who are underfunded, underequipped and understaffed. It would seem to an outsider, a person who only uses the system, that at the very least more medical personnel are needed at these places.
It cannot be that a person, who has a job or is in school, has to wait upwards of 4 hours to be seen and get their medication. From a productivity standpoint that is a losing formula and remains, anecdotally, a reason that people stay away from health centres, only going when things are at their worst point.
It is only slightly better in the private care arena. Sure, one can find psychiatrists and psychologists, but booking them is problematic — sometimes you are scheduled months in advance when you need immediate care — and the cost of visiting privately is prohibitively expensive even if you are one of the lucky few with health insurance.
Private care ultimately is not the way to go in the long term; everyone knows this, but the public system leaves a lot to be desired.
It is possible for the public health clinics to run smoothly. All that is needed is an increase in nurses and other medical personnel. That, though, is easier said than done.
The idea of public health clinics being the first responder in the community for mental health falls at the first hurdle if people are put off from attending. The idea of doctors and nurses entering communities dies on the operating table if they are understaffed. This is the reality faced not just by the mental health patient, but the pregnant mother, the aged and infirm elder, and the baby. A system that, on paper, looks good but which struggles to do the basics.
More medication covered by the NHF would be nice, but increasing the number of psychiatrists and psychologists is what is needed. There is a major shortage in both the public and private settings and its impact is real. Maybe the ministry could look into having those private clinicians practice part-time in the public setting to cover the shortfall of doctors. That would, at the very least, allow for talk therapy, a key part of the therapy that is now lacking from the public setting.
All in all, mental health, like so many other things in this country, only gets lip service and no real action. People are wandering the streets, flunking out of school, having relationships implode, all because the system is failing them. More staff are needed, and more specialised clinics are needed if this is to be truly tackled, but like everything else, I only see it getting worse before if it gets better.
