Minister de Weever at opening Transforming Care congress: “Taboo mental health must be addressed”POSTED: 09/30/13 1:07 PM
These absences became even more painful through the presence of Hubert Benjamin Hughes, the Chief Minister of Anguilla who wants to lead his country to independence from the United Kingdom. He declared even that he is a cousin of Minister de Weever, and marked his presence at the opening of the congress as a historic moment.
Adding more salt to the wounds was the presence of a 20-strong delegation from Aruba that financed its trip to St. Maarten through fundraising activities.
Remarkably absent also were representatives from the Public Prosecutor’s Office. The police force on the other hand, was represented by Chief Commissioner Peter de Witte.
The three day congress will kick off today at the Westin and conclude on Wednesday.
Public Health Minister De Weever addressed the meeting via a pre-recorded video-message. We are aiming for a country where everybody has a space, where prosperity is fairly shared and where we protect and improve the institutions that bind us together,’ the minister said. “No one left out, no one dismissed. We cannot succeed as a country if we dismiss people, leave people out or if we marginalize them.”
The minister said that mental health challenges affect all – rich and poor, old and young, regardless of education levels or denomination. “A mental challenge can strike anyone; it undermines the welfare of this country and it also affects our competitiveness in the region. It puts a huge strain on our public services at a cost of hundreds of thousands of guilders per year.”
The minister added that a widespread and important challenge like this would be something everybody talks about and that it would be at the top of the political agenda. But that is not the case: “For too long we have maintained an almost complete silence about mental health. This is an economic challenge and holds back prosperity. We cannot allow this silence to continue. That taboo needs to be addressed.”
The minister gave an example of a man who came to his office and said; “Connie, if you have a physical illness you get messages, flowers and fruit baskets. But when you struggle with mental illness nobody knows how to react.”
De Weever noted that drugs and alcohol are often used to mask mental illness. “We have to work together instead of building castles and islands,” he said. “The taboo on mental illness must end. We have to put our differences, our egos and our bureaucracy aside and put our clients first.”
By 2030 one in four citizens will be suffering from severe depression or anxiety, the minister said. “Each of us will be impacted by some form of mental illness, directly or indirectly. Only 39 percent of the countries in the Caribbean have a mental health policy and of those, only 25 percent have a workable plan to address mental health challenges. These are alarming stats that show how inadequately we have addressed these issues.”
Anguilla’s Chief Minister Hughes opined that “a lot of young people are too comfortable these days” and that this state of mind leads to irresponsible behavior, fueled by cocaine and marijuana addictions and a lack of recreational activities.
Claire Elshot addressed the audience briefly in her role of president of the recently established Mental Health Caregivers Patients Association. “We are there to solve the stigma and the problems that affect families and caregivers,” she said, acknowledging the presence of her board members Minerva Pinto (treasurer) and Myriam Haar (secretary), as well as Glenda Groeneveld.
Dr. Felix Holiday, chairman of the board of the Mental Health Foundation, said that the congress’ objective is “to work together to increase expertise of all who work with patients, to improve the lives of patients, to prevent criminality and community disruptions and to increase the cooperation between organizations in St. Maarten and abroad.”
“Cooperation leas to economic advantages and prevention,” Dr. Holiday noted, adding that one of the main pillar of success for the development of mental healthcare in St. Maarten is the fact that management and staff continue to focus on quality care efforts for their patients.
To guarantee quality care the MHF-board “ensured that the foundation’s financial management is solid.” The instruments to control this are multi-annual and annual budgets, control systems and accountability through financial reporting and social annual reports.
The purchase and renovation of the old Sylvia Hotel in Cay Hill was a big step towards local mental health care. “We are able to admit patients locally and we don’t have to fly them out to curacao anymore. Patients no longer need to go via a police cell or prison for treatment abroad, separating them from their families.”
Dr. Holiday said that cooperation with stakeholders is one of the most important measures for guaranteeing quality care. Those stakeholders include the police, the Public Prosecutor’s Office, the Capriles Clinic in Curacao, SVP-CN (the foundation for addiction care and psychiatry in Caribbean Netherlands), the White and Yellow Cross, the prison and the Dutch Parnassia Group.
The Mental Health Foundation also works closely with Turning Point, the Social Welfare and Labor Department, the Foundation for Judicial Facilities SJIB. The Court of Guardianship and general practitioners and specialists.
“While the stigma is decreasing, jobs are found for patients of the foundation, families are offered methods to approach their challenged relatives through psycho-education and they are aware of how to prevent a crisis,’ Dr. Holiday said.
The president of the board noted that increasing drug abuse among young people is on the rise and that this subsequently causes mental and physical abuse – not only between adults, but also from adults versus children. “With this cooperative effort we sincerely hope to prevent more abuse in the future,” Dr. Holiday concluded.
Dr. Edsel Kwidama, a member of the three-strong board of the Parnassia Group – the largest provider of mental healthcare in the Netherlands – said that mental health disorders including addiction “really warrant the attention from governmental organizations. It is a vulnerable topic with many masked prejudices and stigmatization,” he said.
Mental health is a major cause of concern according to recent reports from international health organizations. “The burden of disease is very high. Due to the social and emotional consequences with regard to disability and impairment for the affected individual and his family, but also for society as a whole in terms of the financial burden.”
Dr. Kwidama noted that by 2020 – a bit more than six years from now – mental health related prevalence and its costs are expected within the top three alongside cardio vascular disease.
“One of the reasons is that mental health disorders express themselves relatively early in life and persist over the life span. A disease like Alzheimer for instance starts relatively late in life and had a short disease period.”
Dr. Kwidama said that governments are quite familiar with the impact of mental health and addiction issues on the feelings of public safety. “Strange or even aggressive behavior leads to anxiety and insecurity and at times is too easily blamed on persons with mental health problems. Restriction, control and seclusion are quite often the reaction, introducing a vicious circle leading to recidivism and chronicity.”
There is another effect as well: high cost, “because a small number of patients can disrupt the service system dramatically. So instead of treating, constraint is used with subsequent costs.”
Dr. Kwidama said that there are other aspects to be considered as well: a lot of patients that suffer from anxiety disorders, alcoholism or another addiction suffer behind closed doors because they are ashamed to come out with their burden.
“St, Maarten is like all societies confronted with the question how to deal with these challenges given the reality of dwindling financial capacities. What are priorities and what choices to make?” Dr. Kwidama said. “Best practices can help but in the end the plans must fit within the cultural and social context of St. Maarten.”
Dr. Kwidama offered one clear lesson though: “You can spend a dollar only once. The time that various service providers offer overlapping and costly services paid by public money is dwindling rapidly. This means that collaboration is of paramount importance.”
Drs. Roel Hermanides, a member of the supervisory board of SVP-CN in the BES-islands told his audience that “improving mental health care improves social-economic development. “In the Netherlands organizations are thinking in terms of hospitals to tackle mental healthcare. In the islands it is different. We combine for instance the care in the prison in Bonaire with our facilities.”
Drs. Hermanides said that the mental health care community in the BES-islands needs “the services and the power of thinking of St. Maarten to improve our services.”