Editorial | Mental health – The other epidemic

It might have happened earlier, as much as five months ago, when this newspaper first raised the likelihood of the coronavirus’ impact not only on the physical well-being, but also the mental health of Jamaicans. Nonetheless, the project announced last week by the health minister, Dr Christopher Tufton, to provide mental health support in communities is as welcome as it is important.

Even before the onset of the COVID-19 epidemic in Jamaica in March, the island faced a mental health problem, for whose sufferers there is too little empathy, and to which the policy response, even now, remains inadequate. Indeed, three years ago, a task force charged by Dr Tufton to consider approaches to mental health in Jamaica concluded, as the minister reminded Parliament last week, “that one in four Jamaicans may develop a mental illness at some point during their lifetime”.

Stated differently, up to 25 per cent of the country will, at some point, have to contend with a mental condition. That is more than double the World Health Organization’s (WHO) estimate of the world’s population suffering from mental illness. Yet, the finding is significantly below some other estimates of the scale of the problem in the island. For instance, a decade ago, a study by the late psychiatrist Professor Fred Hickling and psychologist Dr Vanessa Paisley estimated that 40 per cent of Jamaicans suffered from some form of mental health condition. Another survey in 2008 found that a fifth of Jamaicans between the ages of 15 and 74 suffered from depression.

Professor Hickling caused a further raising of eyebrows in a 2016 letter to this newspaper in which – in response to a World Bank initiative to bring mental health to the mainstream of global economic discourse – he said that if the whole gamut of mental health conditions was taken into account, including psychoses, personality disorders and dementia, “the prevalence of mental illness in our little island would exceed 70 per cent”.

NOT SURPRISING

From whatever end of the spectrum these numbers are viewed, Jamaica has a big problem with mental, neurological and substance use disorders. It is equivalent to, or significantly higher than what occurs in conflict zones, where the average, based on WHO analysis, is 22 per cent. Perhaps Jamaica’s situation ought not to be surprising.

We have several times referenced the observation of The University of the West Indies (UWI) social anthropologist Herbert Gayle, of Jamaica’s existence, with respect to its homicide numbers, well within conflict-zone territory. As Dr Gayle pointed in a series of articles, three years ago, on the island’s crisis of social dysfunction and criminal violence, academicians usually categorise countries with homicide rates upwards of 30 per 100,000 in the realm of civil-war status. With around 1,300 murders a year, Jamaica’s homicide rate now hovers at around 47/100,000. It has exceeded 60 per 100,000.

In this environment, it is not unlikely that post-traumatic stress disorder (PTSD) will mingle with a host of psychoses and other problems to create the mental health epidemic which Professor Hickling, and others, suggested is enveloping Jamaica. And it is upon this foundation that COVID-19 descended when the first case was confirmed here in March.

As this newspaper warned in April, and Dr Tufton has now acknowledged, “as the number of COVID-19 cases and related deaths increase … the prevalence of mental illness will also increase”. There are already more than 7,000 confirmed COVID-19 cases in Jamaica and nearly 130 deaths. More than half the deaths were people 70 or older. Old people die from the disease.

The elderly, however, are not only victims of the physical ravages of the disease. They also suffer the anxieties that come with their vulnerability and the social isolation flowing from the measures to protect them. Yet, it is not only the old who are victims of the psychological impact of this virus. Entire communities have had their lives upturned. Large numbers of people have lost, or are struggling to maintain, their livelihoods. Even the young complain of new kinds of loneliness.

USE YOUNG PEOPLE

Against this backdrop, the project launched by Dr Tufton to enhance the psychological support skills of health workers, and to train volunteers to help respond to mental health challenges of vulnerable people in communities, should be fast-tracked. So, too, must the plan for “neighbourly check-ins” and other support services for the elderly. While embracing these initiatives, we repeat our earlier suggestion for the use of young people in the Jamaica National Service Corps, vetted and trained by the Jamaica Defence Force, to provide support and companionship to the elderly.

More important, Dr Tufton should use this initiative as a launch pad for a wider assault on what, from the data, is Jamaica’s other public health epidemic: mental illness. Fighting that problem must include a frontal attack on the discrimination and stigma associated with mental illness. It demands, also, a greater appreciation by the Government that, left unattended, mental illness extracts a cost from the society and the economy, just as other diseases do. By the way, as COVID-19 is highlighting, it is the same people who suffer from diabetes, hypertension, cancers and a host of other diseases who also have mental health problems.