JAMAICA GLEANER Editorial | Grab PM Browne’s gift

In a significant display of humanity and personal courage, Gaston Browne, the Prime Minister of Antigua and Barbuda, recently delivered a significant blow even as he offered a gift on behalf of those – and their families – who suffer from mental illness and the stigma and discrimination that often accompanies their condition.

The Caribbean Community (CARICOM) must seize this gift and make full use of it.

In a church in St John’s, the capital of Antigua and Barbuda, Mr Browne delivered a largely unvarnished but tender eulogy to his mother, in which he spoke of her struggle with an ultimately “irreversible psychosis”; her periods in and out of the Antigua psychiatric hospital (then popularly known as Crazy House); and how her illness exacerbated his and his siblings’ extreme childhood poverty, even though their mother, during her periods of well-being, worked diligently and honestly to provide for them. And there was also, as is often the case with mentally ill people in the absence of support systems, the exploitation, including sexual, she endured.

“I share these experiences of my mother … not to dwell on the past, not to blame anyone, and I do so without any bitterness,” Mr. Browne said at her memorial service. “That experience, as horrible as it was, took place at a different time in our society’s understanding of tolerance.

“In our current society, this experience should serve as a means to create a more empathetic and supportive environment for mentally ill individuals. It should also call upon the men in our country to consider the psychosocial impact of their abusive and irresponsible behaviors toward women and children.”

For most individuals and families, Mr. Browne’s revelation would have been an extraordinary exposure of an extremely sensitive, and usually painful, period in their lives. The scabs may have been easily irritated.

However, given Gaston Browne’s position as head of government, his public focus on mental health and the challenges faced by those suffering from it carries greater weight. More importantly, he has opened up an opportunity for a broader regional discussion on the issue of the state of mental health and wellbeing in the Caribbean, which should not be squandered.

The timing is indeed opportune: October 10 is World Mental Health Day of the World Health Organization (WHO).

CARICOM states should use that platform to launch the Pasty Richards Initiative (PRI) – named after Mr Browne’s mother – as a regional effort to address mental health issues in the Caribbean and erase the stigma and discrimination surrounding mental illness. The issue should be approached with the same zeal that the region is now seeking to address non-communicable lifestyle diseases such as obesity, hypertension and diabetes, and previous efforts to address HIV/AIDS.

The PRI should include in-depth assessments of CARICOM members’ performance in developing mental health action plans (2013-2030), in line with WHO proposals, and how the region can pool its capacities to assist those whose projects are stalled.

Current data on the number of people in CARICOM states living with mental disorders, or the economic cost of mental illness in the region, are not readily available. Last October, the CARICOM Secretariat announced that it had commissioned a survey, in collaboration with UNICEF, the United Nations children’s agency, to assess the state of mental health among young people in the community.

However, available evidence shows that in many countries, and certainly Jamaica, it is higher than the global average.

Based on WHO data, in 2019, before the onset of the COVID-19 pandemic, 970 million people, or about 13 percent of the global population, suffered from some form of mental disorder. These problems were more common in women (52.4 percent) than in men.

Of those with mental disorders, the highest percentage (31 percent) had anxiety disorders, followed by depressive disorders (29 percent), while 4.1 percent and 2.5 percent, respectively, suffered from more serious bipolar disorders and schizophrenia.

Notably, the Americas, which includes the Caribbean and CARICOM states, was the WHO region with the highest level of mental disorders – 15.6 percent. It was followed by the Eastern Mediterranean at 14.7 percent and Europe at 14.2 percent.

In Jamaica, government health officials say that one in five (20 percent) of the population has or will develop a mental disorder at some point in their lives. However, other earlier research by the late psychiatrist Professor Frederick Hickling, a pioneer in community-based treatment for people with mental health problems, suggested that in Jamaica’s high-stress environment, the figure could be as high as 40 percent.

In 2010, it was estimated that mental illness, broadly defined, cost the global economy an estimated US$2.5 trillion in direct care costs and lost productivity. That figure was expected to rise to US$6 trillion. Yet countries spend on average less than two percent of their health care budgets on mental health, while more than 70 percent of mental health spending is still consumed by psychiatric hospitals, such as the one in Antigua, where Ms Richards used to be periodically sent, and Bellevue in Kingston, whose character has changed considerably in recent decades.

In the case of Jamaica, the J$2.8 billion allocation to Bellevue in the current fiscal year represents two percent of the government’s proposed current expenditure on health. However, there is no disaggregation of total expenditure on mental health, assuming there is expenditure outside of Bellevue programs.

The bottom line is that in stressful societies like ours, depressive and anxiety disorders, which are less costly to treat, are much more common than other conditions. But stigma and discrimination often mean that most people with diagnosed, or diagnosable, mental illnesses go untreated. The result is the waste of worthy human lives, which ultimately leads to serious losses for societies and national economies.

CARICOM should work to end this waste.

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