Mental Health Services and Community Engagement in Jamaica: A Health Promotion Approach to Community Bliss

Background:  Mental health and wellness are critical components of the normal and effective functioning of individuals. Over the last three decades many middle and high-income countries have seen an increase in life expectancy and paradoxically an increase in disabilities. Disabilities such as mental disorders account for 14% of the global burden of disease and a whopping 75% of those most affected live in low-income countries where the majority of them are unable to afford and access the care and services they need.

Program background:  In Jamaica, the distribution of mental health service was primarily centralized in the country’s capital up until 2010. The purpose of this study is to demonstrate how a change to a decentralized model of administering mental health care radically assisted with treatment and follow up care to those in need of mental health services. Under the auspices of the Ministry of Health Jamaica, a group of Mental Health Officers (MHOs) and one psychiatrist spearheaded a program to educate and unite community members, caregivers and patients who suffer from mental disorders.

Evaluation Methods and Results:  The research team designed a program called Community Bliss. It was established and executed on the tenets of Cultural Therapy developed by Fred Hickling in the 1970’s and guided by the the principles of Primary Care Psychiatry. One of the main objectives of this approach is to shift the locus of power from the care providers to the patients and/or community members. From 2010 – 2011 a total of 19 communities were involved in the intervention. This resulted in an increase in national mental health education initiatives from 67 to 219. Discussions and observation revealed that the community-led components of the intervention were well-received by the audience. Subsequent to the intervention, there was a 10% increase in clinic service usage and a two-fold increase in mobile service utilization.

Conclusions:  Since the implementation of the program, there has been a threefold reduction in admission to the sole mental health hospital in the country. Additionally, there has been an increase in knowledge about mental illness, treatment and care by those affected by the disorder and those who reside in communities with them. The intervention demonstrated that through systematic engagement in the internal cultural structures of the communities, health education processes and myth debunking strategies were infused with popular cultural forms of music, dance and drama which helped to build rapport among all stakeholders.

Implications for research and/or practice:  The successful outcomes of Community Bliss demonstrated that interventions at this level have the potential to strengthen the patriotic ties with high levels of collective engagement in the daily lives of patients. Additionally, community members are critical players in disseminating information about mental health promotion and secondary messages might also be disseminated through such inividuals. For example, general information about wellness, parenting strategies and coping with severe mental illness were discussed with community members. The approach proved to be successful in generating and developing community-led strategies for caring for the mentally ill and their caregivers.