Belize advances towards a community-based approach to Mental Health
"We still have to win the argument with the public"
Innovative developments in Belize regarding the strengthening of that country's human resources and capacity for mental health reform and delivery of services are clear indicatives that the Caribbean nation's Health Ministry is advancing in a creative manner at making sure that services are provided in accordance with the community-based mental health vision. This is an approach that is been progressively adopted by Member States of the Pan American Health Organization in the Region.
With limited human resources for mental health, the Psychiatric Nurse Practitioners (PNPs) in Belize have played an instrumental role in meeting the direct needs of the communities in which they serve. WHO defines a Psychiatric Nurse as a graduate of a recognized, university-level nursing school with a specialization in mental health. They are registered with the local nursing board (or its equivalent) and work in a mental health care setting.
In Belize, the entire range of mental health services is managed by the PNPs under the supervision of the psychiatrist. The nurses have also "provided ongoing counseling for survivors of domestic violence, including rape and child abuse, HIV/AIDS counseling and others," says the WHO Atlas: Country Profiles on Mental Health Resources.
"I am not certain, specifically, as to what it is that other countries are doing in terms of developing and securing their staffing needs in mental health," said Dr. Jorge Polanco, Director of Health Services with the Ministry of Health, Local Government, Transport and Communications of Belize, based in Belmopan City, the capital. "I do know, however, that just like other countries, Belize has suffered from a shortage of nurses in particular. As Mrs. Sandra Jones (from the PAHO/WHO Country Office in Belize) has indicated, the most that we had at one time (in Belize) were two psychiatrists. And now we only have one," he said. "This is why at the ministry level and in close partnership with other sectors of the country such as education, we have engaged very seriously in the development and implementation of a training program that has focused, and still does, in providing new and expert Psychiatric Nurse Practitioners capacity into the overall health system."
This, Dr. Polanco said, is an on-going capacity effort that is being extraordinarily successful. "It certainly does reflect the commitment and wisdom of the Ministry as well as the universities."
The referred country profile on mental health resources developed and published by WHO indicates that Belize spends less than 3% of the total health budget on mental health. The report also states that the country has adapted a community based approach to mental health. And that, PAHO experts argue, is precisely a key component at the heart of the reform itself throughout the Americas. "Mental health (in Belize) is a part of the primary health care system," the WHO country profile says.
A diverse reality
Belize is a very diverse English-speaking Caribbean country with a total population of almost 300.000. The major ethnic groups living in the country are the Mestizo, the Creole, the Garifuna, the Maya and the East Indian, among other smaller groups of mainly Chinese, Syrians and Lebanese descent.
The country profile indicates that there is a non-governmental organization involved on issues pertinent to mental health developmental and advocacy matters. "The Mental Health Association is dedicated to raising awareness about issues related to mental well being, improving mental health services, promotion, prevention and rehabilitation, while advocating on behalf of those with mental illness and their families." (The Consumers Association is another well-known NGO also working on these topics in Belize.)
Alcohol consumption is high. Clinical depression is a common disorder. In 2005, 12,318 patients were seen at various psychiatric units throughout the country. That number increased to 14,556 a year later. In 2005, psychotic disorders accounted for the majority of seen cases. Visits related to childhood disorders and abuse totaled 303 and 141 respectively. According to data from the Belizean National Health Information Unit, that trend continued during 2006.
At a meeting in Dr. Polanco's office in the capital Belmopan, the PAHO/WHO Sub-Regional Advisor for Mental Health, Substance Abuse and Rehabilitation for the English Caribbean countries, Dr. Dévora Kestel, acknowledged that within the Caribbean context, Belize is definitely one of the countries executing the implementation of proven solutions for mental health. These solutions and implementations, she added, are making a real difference in the lives of those living with mental illnesses.
Dr. Kestel mentioned to Dr. Polanco and the other participants at the meeting that Belize has indeed produced a training model for nurses that is working. "They have new tasks and responsibilities and this is recognized by the Ministry. The consequently up-graded posts are being created and that encourages the motivation amongst the candidates," Dr. Kestel said.
Dr. Polanco indicated that the work that has been carried out in Belize with regards to capacity training in mental health has been guided by a clear vision and with human rights and equity in health in mind.
"This is about perseverance", added Dr. Claudina Cayetano, also present. Dr. Cayetano is not just the only physiatrist in the country working hand in hand at the Ministry. She is also a passionate and pivotal player of past and current efforts in mental health reform and development that are shaping the new Belize mental health landscape of services and capacities.
"All of the changes for the better that I have witnessed over the years and nowadays are due also and in a substantial way thanks to the Pan American Health Organization technical cooperation and assistance," she said.
Dr. Polanco argued that one of the challenges for the public health sector is that health professionals get the training they need to spot mental health related issues and conditions "prior to letting these from worsening and/or happening in the first place due to a lack of capacity and training."
Going back to the issue of ministerial commitment, all participants at the informative session with the top Belizean health ministry official agreed that concrete developments in the country's human resources for health capacity and mental health reform, although on-going in nature, are clear indicatives that the ministry is in full support of a new and more effective way of providing and delivering health services. The ministry, he added, fully supports the community-based mental health services approach.
In closing, the Chief of the ministry's Planning Unit, Dr. Peter Allen, said that in Belize "we still have to win the argument with the public because, let us not kid ourselves: there are still attitudes and fear out there" in regards to mental illnesses and disorders.