Financial hardship and housing scarcity are fuelling a surge in mental health struggles among Barbadians, prompting calls for stronger social support rather than more psychiatrists.
Expressing grave concern about the rate at which Barbadians are struggling with depression and anxiety triggered by such challenges, Consultant Psychiatrist attached to the Psychiatric Hospital Dr Joy Sue told Barbados TODAY that these are among the top mental health conditions she is required to treat.
She said: “The most common conditions that I see are persons who have depression and anxiety, or both. And then, on the other extreme, we get a lot of persons who have what we formally call dementia or major neurocognitive disorder. We get a lot of elderly people with dementia as well. Those are probably three of the more common conditions that I see in the clinic setting.
“We also have a lot of people who come, who don’t have a formal diagnosis; they are just struggling with a particular problem . . . . Maybe they are just grieving because they have lost a loved one; and, since we now have a psychologist, a lot of persons now see the psychologist for follow-up. So, the psychologists are seeing quite a number of people as well.”
Dr Sue explained that a lot of those who see the specialist are not on medication, but are receiving counselling support for their problems: “We are seeing an increase in people coming who are struggling. A lot of it is related to financial problems.
“So, even if you have persons coming forward and they are saying that they are having a relationship problem, it may not be a simple relationship problem; [but] the problem with the relationship might be complicated by the fact that the person doesn’t have financial freedom. So, then they feel tied to a relationship that is not working out.”
Sue, a prominent voice in the country’s mental healthcare community focusing on reducing stigma, also stressed that a lack of housing options is prominent among complaints by patients.
“A lot of persons don’t have good housing. They don’t have housing options; and [so] they are forced to remain in a situation that is not good… for their mental health because they don’t have anywhere else to go.”
She cited an example where many referrals she gives to her social worker for assistance are for housing needs, noting that at times the Welfare Department would help people with housing, such as paying a portion of the rent.
“But that is becoming increasingly difficult too,” she added, “because it’s hard to find landlords who are willing to accept part of the rent from welfare, because they fear the rent wouldn’t be paid on time; and then, a tenant who probably has to rely on… welfare would not look like a reliable tenant to someone.
“People find it even harder now to find places… because welfare doesn’t have a list of places. You have to find a landlord that is willing to accept the rent from them. And then the onus is on you. So, it’s very difficult for people.”
The challenges faced by people are compounded when children are involved: “I am seeing a lot of people who have children, some very young, coming forward. And it is even more complicated when you have children involved in a situation like that. So, you are in a situation where a partner may be abusive — and I don’t necessarily mean physically abusive — a lot of partners can be psychologically or verbally abusive. So, it’s not a healthy situation for your kids, but you might not have options as to where to go.”
She noted that most of these clients do not have means either because they are unemployed or working in low-paying jobs which ill-afford any flexibility as to what they can do: “They can’t necessarily rent a place on their own. They don’t have the family support that used to be there; or the family members are not in a position to help them either.”
The psychiatrist also stressed that even though some clients experienced improved mental health, there remain major difficulties in rooting out the underlying problems for many people seeking counselling.
She said: “Some of them have been [helped]; but you must appreciate that these situations can be difficult; and it depends on the social support that is available in the community. And honestly, there is not much out there right now. So, it can be difficult to navigate these kinds of situations. You want to be able to help more, but you don’t have the options available to offer people.”
She continued: “If a person comes to me and they are depressed, I can give them medication and they can improve their mood, and that can improve their ability to deal with certain things and cope with certain things, but it may not change the underlying situation. You still need options out there to change the underlying situation that causes the depression. A lot of people don’t have those options.”
While she could point to at least one former client who reported success in turning her life around by ridding herself of her stressors, the mental health expert said this may be the exception, not the rule.
Many of her clients have been taking advantage of the government’s Special Needs Grant, a programme administered by the National Insurance and Social Security Service (NISSS), that provides financial support to individuals with specific disabilities, she noted.
Sue said: “That has been helpful for a lot of people; that was one option that wasn’t available before. So, several of my clients who have autism, I have written letters for them to get that sorted, and that has been helping some families. As you can appreciate, there are some persons, due to their mental health conditions, who can’t work at all.”
She also dismissed any notion that Barbados needs more psychiatrists to help deal with the growing incidence of mental health problems, suggesting that a strong and structured social support system may be crumbling.
“I have always said mental health in Barbados is kind of top-heavy. We have more psychiatrists in this small country per population than most other countries. Most of our Caribbean neighbours… They have very few psychiatrists, but they do better than us, because of how their programmes are set up. So, not everybody who has a mental health concern is coming to see a psychiatrist.”
She explained that in other countries, general practitioners would deal with more common mental health conditions such as depression with psychiatrists being reserved for more serious cases like bipolar disorder or schizophrenia.
In Barbados, however, “we kind of run a top-heavy service where there is not the best use of personnel”, said Dr Sue.
“How things are set up now is not the best use of personnel. There are certain reasons for that I understand. But, no, I don’t think adding more psychiatrists will necessarily solve the issue, especially since the issues are social. I think we need more social support.”
She gave as an example the fact that when she started working at the Psychiatric Hospital, there were two halfway houses which no longer exist.
“Certain things went backward,” she said. “We had houses at one point in the community that were assigned for our patients; when they go into hospital and they come out, they could live in these houses. But bit by bit, because of how society is, relatives or whoever, eventually kicked the persons out of the houses. The houses were no longer there. All kinds of things happened… so, we had certain social things and we have gone and we have taken steps backward. We don’t have those social supports anymore. We don’t have group homes… because that was a kind of group home… halfway houses we don’t have those things anymore.”
She expressed concern that now, when patients who are ready to be discharged from the hospital, have nowhere to go because relatives don’t want them and there is nobody else to take them in.
Even where these people may have had a home, it may be dilapidated, she said.
“There is no easy solution to that,” Dr Sue declared.
emmanueljoseph@barbadostoday.bb
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