In my column of April 8, “How does T&T develop consensus for mental health reform?” I said, “Frustratingly, I think the imperative may be to first get government plagued by comparable ignorance to buy-in to the urgency that is mental wellness and mental health reform in a climate charged with so many other louder and possibly more ‘attractive’ subjects and attainable demands.”
It’s my hope that whoever forms the next government would recognise that whatever it pronounces in the name of mental health would amount to nought until political will is shown by financial commitment to mental health/wellness/illness.
That only $6m is allocated to the mental wellbeing of T&T (outside St Ann’s Hospital expenses of almost $100m) is unconscionable. But until one recognises the travesty that figure represents I may well be talking madness.
While Health Minister Dr Fuad Khan has made a sprint belatedly to elevate the conversation, he’s not committed money to match his mouthing. And much of his better focus came late in his term to realise his intentions for the mandatory reform. In fact, his best efforts came about, in my view, when he was faced with the idea of having to win back office.
Khan is noted as saying, “St Ann’s Hospital is in a dilapidated state. Mental health has not been put on the front burner until we came into office.” But not even the conversation about St Ann’s has progressed properly even though he proposed it early in his tenure.
The recurring idea of the sale of St Ann’s Hospital in support of community facilities or as Khan said “less stigmatised buildings” versus an upgrade has received no national consensus, as it should, but continues to be bandied.
And while undecided about T&T’s lone psychiatric hospital and without a penny for the necessary determination for sale, refurbishment, or the possibilities within mental health national reform, Khan has presided over the billion-dollar Couva Children’s Hospital.
His health ministry has spent $16,423,903.12 as cost for the provision of the master plan for the 25-year upgrade of the Eric Williams Medical Sciences Complex, Port-of-Spain General Hospital and the San Fernando General Hospital. Each structure is earmarked for redevelopment, with an aim of “creating modern, state-of-the-art facilities.” That $16m is not the refurbishing cost. It is the cost for developing the refurbishment plan.
When that announcement was made last May, Khan said a master plan for the St Ann’s Hospital would also be sought as the institution is currently in “a total mess.” Then in July he went back to suggesting the sale of the hospital.
What mental health/illness needs here, and I speak apart from any insights that could be afforded by the elusive T&T Mental Health Plan 2000, not as yet accessible in online searches, is for whoever the health minister is after next month to make comparable funding parallel to the financial commitment of the children’s hospital, and spending for other major initiatives. That could impact my representative cynicism. That would signal priority.
Still, any attempt at reform must take into consideration the United Nations position, “Nothing about us, without us.” It may entail spending $16m for developing a master plan but we, the State, professionals, clients, families, healthcare workers, private sector, civil society, government honchos, all, must form the collective voice of that reform.
The principle of full participation must be put into practice in which all voices are heard as we strive for a truly inclusive society. The aim is to move mental health from the margins to the mainstream of our health agenda. This is not a small-scale exercise of shifting around a few dollars.
Only last week, Khan’s ministry hosted a two-day consultation in Port-of-Spain. The theme, I’m told, was Models of Mental Health Care—building capacity and improving quality. With a perfunctory invitation to the event at the end of day one, and not coming from the planning officials, I depended on the notes of participant/end-user Nicole Cowie, who indicated the event had among its goals: to present and review existing models of mental health care within (RHA) regions; to develop/revised regional mental health service delivery plans; and, to collate regional plans into a national mental health service plan.
I’m given to applauding any effort that could help the discourse but always I’m hoping that we are deliberate in ensuring the widest consultation/participation. The creators and producers of any consultations or plans and programmes in T&T should know that in countries with successful mental care systems the outreach by the state is all-embracing.
As I wrote in April, reform “is a monumental but attainable task, which requires precise research, political will, excellent creativity, prominent voices, an adequate budget and more.”
It also requires that those within the (failed) system include clients of the system, their families, NGOs and everyone advocating for mental health/wellness in T&T in the discourse. Fair funding by the State remains the overarching national priority.
• Read Caroline’s April 8 column at http://www.guardian.co.tt/lifestyle/2015-04-07/how-does-tt-develop-conse....