Description
Please look at the attach documents, instructions are there. Also there is a sample document there, to be used as a guide for this assignment.Charts are also needed.
1 Justification and Background
- Mental Health Globally
The World Health Organization defines Health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Despite this definition, mental health is still neglected compared to other ‘existing more important health issues’ in developed and developing nations (Ngui et al., 2010).Neglected mental health needs results in a negative effect on the economy due to an increase in absenteeism from work or school, unemployment and health expenditure (Ngui et al., 2010).Absence or neglect of mental health policies leads to lack of funding, less research, poor services and infrastructure for the poor and underserved communities (Ngui et al., 2010).
The incidence and prevalence of mental disorders have increased worldwide and has resulted in significant social, human rights and economic burden (Ritchie & Roser, 2020), and is the largest contributor to years lived with disability (American Psychiatric Association, 2020). It is estimated that 792 million (10.7%) people live with mental health disorders and 11.9% are females and 9.3% are males (Ritchie & Roser, 2020). Most common disorders affecting people across the world include anxiety, depression, autism, schizophrenia, amongst others. It is estimated that the global burden of mental illness accounts for 32.4% of years lived with disability (YLDs) and 13.0% of disability-adjusted life-years (DALYs) (Vigo et al., 2016). Disability and mortality from mental illness is said to be underestimated by more than one-third (Vigo et al., 2016), cases of unreported mental disorders remain high in areas of low-income generation due to inadequate mental health care and poor infrastructure (Ritchie &Roser, 2020).Poverty, instability, discrimination are high risk factors for developing mental disorders.
The economic burden of mental disorders will cost the global economy US $16 trillion by 2030, primarily due to the early onset of illness and loss of productivity (Patel et al., 2018). Therefore, the World Health Organization has devised a plan to achieve effective management of mental health disorders to ensure the implementation of strategies that would assist in preventing these disorders and promoting of mental health treatments among more (Ritchie &Roser, 2020).
Most parts of the world have achieved great milestones in dealing with mental health problems and embracing mental health as a necessity. There is a significant need for the Caribbean states to find a breakthrough in matters mental health.
- Mental Health in the Caribbean
According to WHO-AIMS (2011), approximately 3.8% of Caribbean countries health budget is spent on mental health. Countries such as Barbados, St. Vincent and the Grenadines spends 100% of their budget on their mental health institutions, whilst, Jamaica, St. Lucia, Suriname, Trinidad and Tobago spent 80%. Only three countries: Jamaica, Suriname and Turks and Caicos, have both a policy and a plan (WHO-AIMS, 2011). Centralization of services is still an issue; this results in less available resources for successful implementation of community-based mental care. Lack of epidemiological data appears to be a common problem amongst Caribbean countries, usually data is limited or incomplete. “Data limitations put mental health needs on the backburner for most policy makers and make it difficult for governments and international agencies to devote more resources to address mental disorders” (Ngui et al., 2010). Staff complement in the Caribbean is low. In ten (10) of the Caribbean countries in this study, there were 2 or less psychiatrists per 100,000 people; 1 or fewer psychologists per 100,000 people and in five (5) countries had less than 10 nurses per 100,000 people (WHO-AIMS, 2011).
Jamaica and Guyana are among the Caribbean countries still faced with several social and economic inequalities. The two countries have not made much progress in their attempts to address the mental health provision irregularities faced by their citizens. Some of the major issues currently under consideration in the two states include inadequate staffing of qualified personnel, scarcity of facilities, and inadequate treatment centers into the mental health institutions. The Jamaican culture is quite complex and has not given much opportunity for people to embrace the dynamics of mental health problems as issues of concern. Lacey et al. (2016) indicates that the indifference towards mental health problems caused by the culture has resulted in a significantly higher degree of stigmatization of persons with mental health problems. The victims of mental health complications are afraid of seeking help and in other cases are not aware that mental health problems are treatable.
- Jamaica Mental Health situation
Jamaica gained independence in 1962, and at that time began the process deinstitutionalizing the only mental hospital, Bellevue Mental Hospital in Kingston (Hickling, 2019).Between 1960 and 2015, there has been a population reduction of 87% at Bellevue Hospital, with future plans to close it (Hickling, 2019). In addition to Bellevue hospital, Cornwall Regional Hospital in St. James and the University Hospital of the West Indies have psychiatric units. The other Public hospitals in Jamaica also treat persons with mental disorders. The more specialized psychiatric units provide day hospital care for patients who may not necessarily need admission but require close observation.
Jamaica spends approximately 6% of its health care budget on mental health, which 80% of this budget is spent on the sole mental hospital (WHO-AIMS, 2011), which was previously stated.
The Ministry of Health and Wellness (MOHW) is responsible for Jamaica’s healthcare system.The mental health service is administered through the MOHW and delivered through Regional Health Authorities in Jamaica. The Mental Health Unit is headed by the Director of Mental Health and Substance Abuse, a Director of Child and Adolescent Mental Health is within this unit. The unit operates within the Ministry of Health and Wellness as part of the Health Services Planning and reports to the Chief Medical Officer. Collaboration occurs with the Department of Community Health and Psychiatry, University of the West Indies, Mona in areas of training, research and services. The Mental Health unit takes the lead in the development of legislation, policies and standards, and guides the development of programmes at the levels of service delivery.
Mental health care in Jamaica has been integrated with primary health care. Approximately, all regions in Jamaica have most of the critical psychotropic medications and mental health equipment (WHO-AIMS, 2009). However, child, adolescent, and the forensic component of the mental health service remain a major weakness of the mental service in Jamaica.
Major depression condition is the most predominant mental disorder in Jamaica, however, schizophrenia is the most prevalent mental disorder that is diagnosed and treated. Approximately 79% of the patients that are admitted to mental hospitals are diagnosed with schizophrenia, and most of the people are admitted without their consent (WHO-AIMS, 2009).In Jamaica, people with mental disorders receive outpatient services offered by community-based facilities at a rate of 1034 per 10000 people (WHO-AIMS, 2009).
Community mental health
According to the WHO-AIMS (2011), community-based mental health facilities are facilities located outside of the mental hospitals. The aim of community mental health care is to provide treatment and rehabilitation for people, who have a mental illness, in their local community.“Community mental health services can help reduce social stigma and discrimination by reducing the social isolation, neglect, and institutionalization of people living with mental health problems. Effective community management of mental disorders also helps people realize that people with mental illness can live productive lives, contribute to society, and be integrated with society”(Ngui et al., 2010).
In Jamaica, deinstitutionalization of mentally ill patients from Bellevue Hospital has resulted in the development of community-based mental health care, treatment of patients on the medical wards at general hospitals and development of primary prevention therapeutic programmes (Hickling, 2019). Despite the move towards community-based care, there have been many ongoing challenges associated with the successful implementation of this move. These challenges include: inadequate staffing, poor infrastructure, limited public awareness and education of mental health matters, stigma and discrimination, ‘burn out’ of family members and limited job opportunities for persons with mental disabilities
- Key issues and challenges in community mental health services in Jamaica
According to WHO-AIMS (2009) report on accessibility of resources in Jamaica, there are resources and mental health facilities that can be used to address the mental health challenges in the country. Bodies such as the Regional Health Authorities and the Ministry of Health have been charged with facilitating the availability of the necessary healthcare resources. The main problem limiting access to these facilities is the Jamaican culture that has still not appreciated the prevalence and severity of the impacts of mental health problems in the country. The few available trained personnel can effectively be distributed to mental community health centers and more training of personnel done to achieve the required threshold of personnel. WHO-AIMS (2009) report indicates that Jamaica has only two community-based psychiatric health clinics. Old data? These facilities are overwhelmed with patients and they are existing in the dearth of adequate personnel to provide the quality services needed by the patients. The report further indicates that most of the patients are neglected by the community, their families and receive little care from the staff. WHO-AIMS reports that most of these patients after admission are not visited by their family members and end up being secluded in those institutions. To reduce the stigmatization, WHO-AIMS reports that these patients should be treated within their communities to make it easy for their families to connect with them during the treatment period. This can be achieved when all communities are equipped with mental healthcare service centers.
- Project Justification – Mental Health Challenges
1). Staff – Human Resources
-Lack of Staff
– More psychiatrists, medical officers, mental health officers, social workers, psychologist, and occupational therapists
– Not many persons are desirous of working with mentally ill patients
– ‘Burn out’
-Accessibility of Training
- Lack of refreshers courses or BLS training
- Need for psychiatric conferences to keep abreast of what is happening
- Most are done in other parishes not convenient for all
- Need for short courses for persons who are working in the field who are unable to venture to Kingston to become certified
- For rural hospitals to be included in the training of Psychiatrists, should not be restricted to Kingston and St. Andrew hospitals.
-Lack of Hazard / Risk Allowance
- This is important due to the fact that the community team risk their life daily to treat, as well as, transport patients to hospitals for treatment.
-Lack of Personal Protective Equipment
– Gloves, mask, eye shield, gown etc
2).Infrastructure; Coverage
– Lack of appropriate consultation rooms in the clinics
– Confidentiality issues
3). Lack of family and community support in the management of patients
- Families find it hard connecting with the patients because the facilities are secluded and are far from the communities.
Mental health problems are still not recognized as important medical cases that require the attention and support of families.
Homeless persons (are all homeless persons mental patients?)
– Lack of accommodation
– No appropriate location to facilitate treatment and outreach programs for the patients
4). Inadequate mental health services at government health centres
Shortage of medications
- Facilities are under-equipped with resources
Patients’ dissatisfaction
– Uncomfortable attending clinics due to long waiting times
– Stigma
– Poor Insight
– Side effects of medications
Challenges with respect to geographical locations and treating patients
– Difficulty accessing patients who live on the border of various parishes
5). Lack of Funding/ Resources for Mental Health
- There is poor advocacy for mental health advancements
- Organizations are not willing to inject money into mental health management or research on medications.
6). More emphasis needs to be placed on Maternal, Child & Adolescent Clinics
- The need for mental health stability among adolescents is ignored
- Child mental health services should be integrated to ensure children begin receiving mental health care earlier.
- The need to identify issues in women such as post-partum depression
7). Lack of awareness of Mental Health issues in the general population
- The communities are not adequately educated on issues regarding mental health
- The culture is indifferent to mental health as a primary concern
- Communities have limited access to mental health services and facilities
You need to edit and develop this justification section as it is your argument for funding this project. Review, add other issues and explain in more detail the nature of the problem under each of the headings.
Project Brief
Goal
To identify and provide solutions to resolve the challenges associated with community-based mental health care
You need to develop the logframe matrix before you can write this project brief section
| Narrative Summary | Objectively verifiable indicators | Means of verification | Assumptions |
| Goal: | |||
| Purpose: | |||
| Expected results: | |||
You need to use the example I gave you and fill this matrix before you can discuss the project brief and other sections. You need to put this matrix as an appendix and refer to it in the body of this proposal
References
American Psychiatric Association. (2020). Global Mental Health. https://www.psychiatry.org/psychiatrists/international/global-mental-health
Hickling, F. W. (2019). Owning our madness: Contributions of Jamaican psychiatry to decolonizing Global Mental Health. Transcultural Psychiatry, 0(0), 1-13.
Lacey, K. K., Powell Sears, K., Crawford, T. V., Matusko, N., & Jackson, J. S. (2016). Relationship of social and economic factors to mental disorders among population-based samples of Jamaicans and Guyanese. BMJ open, 6(12), e012870. https://doi.org/10.1136/bmjopen-2016-012870
Ritchie, H. &Roser, M. (2020). Mental Health.Our World in Data.https://ourworldindata.org/mental-health
MOHW. (2020). Ministry of Health and Wellness: National strategic plan for mental health 2020 -2025.
Ngui, E. M., Khasakhala, L., Ndetei, D., & Roberts, L. W. (2010). Mental disorders, health inequalities and ethics: A global perspective. International review of psychiatry (Abingdon, England), 22(3), 235–244. https://doi.org/10.3109/09540261.2010.485273
Patel, V; Saxena, S; Lund, C;&Thornicroft G. (2018). The Lancet Commission on global mental health and sustainable development. The Lancet Commission, 392 (10157), 1553-1598. https://doi.org/10.1016/S0140-6736(18)31612-X
UNIATF, UNDP & PAHO. (2019). Care for Mental Health Conditions in Jamaica: The Case for Investment. Evaluating the Return on Investment of Scaling Up Treatment for Depression, Anxiety, and Psychosis. https://iris.paho.org/handle/10665.2/51834
Vigo, D., Thornicroft, G., &Atun, R. (2016). Estimating the True Global Burden of Mental Illness. Lancet Psychiatry, 3, 171-78.https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00505-2/fulltext
WHO-AIMS. (2009). A report of the assessment of the mental health system in Jamaica using the World Health Organization – Assessment Instrument for Mental Health Systems. https://www.who.int/mental_health/Jamaica_who_aims_report.pdf
WHO-AIMS. (2011). WHO-AIMS report on mental health systems in the Caribbean region.https://www.who.int/mental_health/evidence/mh_systems_caribbeans_en.pdf
WHO-AIMS. (2012). WHO-AIMS: Report on mental health systems in Latin America and the Caribbean.
WHO. (2017). Mental Health ATLAS 2017 Member State Profile.https://www.who.int/mental_health/evidence/atlas/profiles-2017/JAM.pdf?ua=1