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St. Maarten – “There will be no more budget cuts to the subsidy for the Mental Health Foundation,” Public Health Minister Cornelius de Weever said yesterday in answer to a question from this newspaper at a press conference where Virginia Asin-Oostburg, head of Collective Prevention Services (CPS) presented the National Mental Health Plan 2014-2018.

Last year, the Mental Health Foundation lost around 200,000 guilders of its annual subsidy, while the government increased the subsidy for the rehab center Turning Point. Minister De Weever has now assured that the MHF will not have to fear another round of budget cuts in the 2015 budget.

The Minister tasked Asin-Oostburg in 2012 with the development of the National Mental Health Plan. The plan contains five strategic objectives for the next four years.

The first one is the development and implementation of mental health policies, plans and legislation. This provides “a legal framework for promoting and protecting the human rights of people with mental disorders,” the plan states. Part of this objective is the revision of the KZ-law (crudely translating into the ordinance that regulates “the supervision of lunatics”).

The second objective is to improve the response capacity of mental health services and to provide comprehensive quality care in community-based settings. The plan states that this implies “the delivery of services that are culturally appropriate, equitable, and free from discrimination based on gender, race or ethnic group, sexual orientation, social class or other conditions.”

This objective includes as a first step offering mental health beds at the St. Maarten Medical Center and the creation of a mental health referral system between entities like the Mental Health Foundation, Turning Point, White and Yellow Cross and the SMMC.

The third strategic objective is the implementation of programs aimed at promotion and prevention and at alcohol and substance abuse, “with particular attention to life cycle.” The plan states that the early stages of life present an important opportunity to work on prevention: “Up to 50 percent of mental disorders in adults begin before the age of 14.”

The fourth strategic objective is to strengthen information systems, scientific evidence and research. The plan notes that only a few countries in the world have existing scientific research and produce data. “To provide scientific evidence for interventions for the promotion, prevention, and treatment of mental disorders research should encompass scientific activities ranging from discovery to service delivery, taking national priorities into account.”

The fifth strategic objective is to strengthen and improve stakeholder-collaboration.

The first steps towards a plan for addressing mental health in St. Maarten go back to 2002, when a report stated that only 31 percent of the population had health care insurance. The rest simply could not afford such insurance. The same report stated that 6 percent of the population experienced psychological problems and that 16 percent reported mental health issues that required professional consultations.

A report from the World Health Organization from 2012 notes that St. Maarten does not have a national policy on alcohol, while alcohol consumption has been on the increase between 2005 and 2010. With 54.5 percent, beer is the preferred alcoholic beverage on the island, followed by spirits (31.9 percent) and wine (12 percent).

The national mental health plan notes that there is no documented information about suicide in St. Maarten, but undocumented information from residing psychiatrists indicate “that suicide is a major challenge that is seriously neglected because there are no proper data about suicide and suicide attempts.” The age group 18-35 is the most affected by suicide, the report states.

The World Health Organization profiled St. Maarten in 2013 with its Assessment Instrument for Mental Health Systems. As strong points, this report mentions that the island has four residing psychiatrists making it possible to treat patients in crisis-situations locally. Another positive is that three quarters of the population has social insurance that makes psychotropic medication available to them free of charge.

A weak point is according to the WHO-report that the ordinance that regulates – in the terms of the report – “the supervision of lunatics” does not promote the eradication of stigma and discrimination. “Cooperation with other sectors need strengthening, especially with schools,” the WHO notes. “There is little attention for youth with mental health issues, even though St. Maarten has a resident child psychiatrist.” Clarity on how human rights are protected for people with mental health disorders is another challenge, according to the WHO-report.

The report furthermore describes the country’s mental health infrastructure as “not coherent and still too fragmented.”

The vision the authors of St. Maarten’s National Mental health Plan present paints a rosy picture of the situation the country wants to achieve by 2018. “In 2018 mental health problems and substance use problems will be more socially accepted and open to debate,” the document states. “There will be fewer thresholds to seek for help for these problems in the near environment informal care and, if necessary, professional care.”

The vision foresees that inhabitants will take responsibility for promoting and guarding their own and each other’s mental health, thereby ending the taboo on psychiatric disorders.

Equal access to quality mental health care and substance abuse care is another part of the vision. This will position St. Maarten as a regional center for Saba, Statia and the Caribbean region and open up possibilities for medical tourism.

The most optimistic part of the vision is this one: ‘By 2018 the quality of mental health care will be supported by up to date legislation and regulations, by a coherent staff, a training and (mandatory) refresher course policy, and by a monitoring and research system aimed at quality development.”