Objectives To promote mental health through public education and sensitization; To eliminate the stigma associated with mental illness; To improve the efficiency in the delivery of mental health care; To provide for more equitable access to care       

Objectives (Cont.) To empower citizens to be active participants in the Management of their health Encourage healthy lifestyles by the sharing of information and the provision of technical assistance to the communities     

To reduce the long-term unit cost of mental health care  To contain the aggregate cost in the medium and long-term   To reposition the focus on mental health care from institutional to community base care   To contain the aggregate cost in the

Objectives (Cont.) To encourage public and private sector cooperation in the delivery of mental health care To fully integrate mental health care into the primary health care system; ·    To encourage and prepare persons affected by mental illness to return to the society and to engage in meaningful economic and social activity.

Mental Health Reform The reform process benefitted from information from various sources 1986 - Facility Assessment Study 1996 - Health Sector Rationalization Study 1995 - PAHO technical cooperation in Health A new vision for Caribbean Health 11 1999 - Psychiatric Hospital Strategic Plan 2000 - Needs Assessment 2000 - Service Mapping exercise

Development of Framework Plan Based on the recommendation made in the Psychiatric Hospital Strategic Plan, the Ministry of Health developed a strategy for the reform of the Mental Health Services and a project proposal for the physical development of the Psychiatric Hospital. Requested PAHO technical assistance in costing the various options

Development (Cont.) August 2000 – Jose Miguel Caldas de Almeida, Coordinator of PAHO’s Regional Mental Health Programme visited Barbados to review the options for the development of the physical plant. Recommendations: Acute psychiatric care should be viewed within the context of an overall of mental health plan, with careful attention being paid to the size of the acute care unit and the strengthening of the community mental health services.

The recruitment of a consultant to advise on the reorganization of the mental health services within the framework of a plan

Development of Current Plan January - Recruitment of consultant, Dr. Colin Rickard, Planning Director of Royal Free Hempstead NHS Trust With the input from a number of local stakeholders the plan was completed in Sept 2001

Proposal for The Reform The Mental Health Services Main Components: Reposition the major focus of mental health care from Institutional to community base Care. Emphasis on health promotion Development of a communication strategy for public education and sensitization and interagency collaboration

Review and update current legislation to facilitate the change of focus and to address the civil and human rights of the patients. Refurbishment of current physical facilities to accommodate 300 patients Appointment of a project coordinator for the implementation of the project. Development of the necessary human resources to support the programme

Six-year plan to be implemented in two phases Phase 1. Pilot Project Plan For Implementation Six-year plan to be implemented in two phases Phase 1. Pilot Project Development of the infrastructure for the main Programme. To test operational policies &inter-agency workings Develop a costing model for the main programme

Full expansion of the programme Main Programme Duration – four years Full expansion of the programme

Achievements Human resources Training of the first batch of six Community Mental Health Nurses completed. The second batch is currently being trained at the BCC Accelerated training especially in nursing Over 70 persons currently being trained at the BCC

Continuous Quality Improvement programme started Interagency collaboration Mental Health Officer assigned to the court to assist the magistrate in assessing the mental health of defendants and broadening the sentencing options. Public Education and Sensitization Community outreach programme started Publication of a magazine “Brain Wave,” 1500 copies distributed. This will be an annual publication

Mental Health Practitions visit school, churches and other communities groups to give talks or Mental Health. Seminars conducted by PAHO for police and prison officers Project Coordinator There has been no formal appointment to this position but a social worker from the ministry has been assigned to coordinate the processes.

A draft revision of the Mental Health Act has been completed and is currently being reviewed by the Legal and Human Rights division of PAHO

The Ministries of Health and Education are The Ministries of Health and Education are conducting a survey on Mental Health Issues Among Primary School Children Workshops being planned for the sensitization and education of health care workers A five year plan to renovate the Psychiatric Hospital has begun. This is designed to make the plant more clients friendly and improve its therapeutic value.

Facilitating Factors Private sector involvement in the area of substance abuse Training being conducted at BCC and UWI Incorporation of the mental health plan into the National Strategic Plan for Health PAHO’s Support

Challenges Housing Stigma Human resources