A resident government consultant psychiatrist is urgently needed

The annual salary of a consultant psychiatrist is less than 0.58% of the $38,000,000 EC$ we are reportedly spending to facilitate the SVG leg of next month’s ICC Men’s T/20 World Cup.

The longer we take to secure a domiciled government psychiatrist, it’s inevitable that there will be more disturbing headlines like:

• “Police shoot, kill mentally ill man…”
• “Baby dead allegedly after being thrown from 1st floor apartment”
• “Murder of 1 yo baby sends Rose Hall residents into frenzy”

The absence of adequate mental health services in SVG undermines our mental and, by extension, public health. Without timely and appropriate psychiatric intervention, many treatable mental health conditions, especially in our youth, mushroom out of control. Culminating in:

• Vagrancy/ homelessness
• Lifelong disability
• Substance abuse
• Reduced productivity
• Unemployment
• Underemployment
• Unhealthy family dynamics
• Poor general health
• Premature death
• Violence
• Domestic violence
• Crime/ Burglary
• Murder
• Suicide
• Penal incarceration
• Permanent interment in our overcrowded mental institution
• Increased overall healthcare costs
• Increased costs to the criminal justice system
• Community disruption
• Families’ stigma and shame

To deliver basic mental health care to a population of 104,000, at minimum, the following professionals must work in tandem:

• Mental health nurses
• Social workers
• Clinical psychologists
• Psychiatrist(s)

Many mental health cases can be managed without medicines, however, the psychosis, often requires the administration of medicines as an integral part of their overall management. The psychiatrist is the only member of this team who has the training, expertise and authority to prescribe anti-psychotic medication(s).

Kudos to our nurses, social workers, psychologists, and others working tirelessly to currently provide mental health services under trying circumstances. Your efforts are highly appreciated. A sincere and profound thank you.

Background to psychotic illnesses

Persons with such mental illnesses generally experience hallucinations (auditory, visual, olfactory, gustatory, tactile, general somatic), delusions, confused thinking and speech, and a warped perception of reality. The more common types are schizophrenia, bipolar disorders, and psychotic depression.

Every year in the UK, there are 25-32 new cases of psychosis per 100,000. In SVG, with the liberal use of marijuana, these numbers are likely to be significantly higher.

Most new-onset psychosis begin between the late teens and late twenties. It is rare for such to begin before age 12 or after 60.

Approximately 3% of people will develop a psychotic disorder.

Several studies conducted over the last six decades have shown that individuals with psychotic disorders without access to appropriate treatment are up to ten times more likely to commit violent crimes, including murder, compared to others in the general population. In countries with robust psychiatric services, psychotic individuals commit approximately 10% of all murders.

I must emphasize that the vast majority of persons with psychosis, including schizophrenics, will not commit violent acts.

Those with psychosis who are more likely to perpetrate violent acts have:

• No or inadequate access to psychiatric care
• Prolonged untreated psychosis.
• Cncurrent heavy alcohol or drug use
• Absconded from follow-up
• Suboptimal medication compliance
• Previous history of violence
• Onset of psychosis in early adolescence
• Schizophrenia

A psychiatrist’s role in managing psychotic patients:

• Assess the patient and arrive at an accurate diagnosis
• Investigate for contributing morbidities
• Determine the management
• Prescribe medications
• Conduct psychotherapy and other forms of therapy (e.g. electroconvulsive therapy, transcranial magnetic stimulation)
• Review the patient periodically to determine if treatment adjustments and or additional treatments are necessary.

The aim of the psychiatrist:

• Improve the life of the patient both qualitatively and quantitatively.
• Reduce socially unacceptable behaviors.
• Facilitate the reintegration of the patient into their family, home, school, workplace, society, etc.
• Achieve maximum patient functionality.
• De-institutionalize patients.

At-risk (pre-psychotic) mental state:

If family members, teachers, and others identify certain abnormal behaviour patterns on time, such individuals can be assessed using specific diagnostic tools (CAARMS/ SIPS). If necessary, relevant interventions can be made, thereby mitigating the onset and or severity of future psychosis.

Pre-psychotic behaviour may include:

• Excessive worrying or fear.
• Changes in eating habits.
• Low self-esteem.
• Mood swings.
• Withdrawal from others.
• Disturbed sleeping patterns.
• Difficulty concentrating.
• Substance abuse.
• Self-harming behavior.
• Suicidal thinking.

A psychiatrist is an integral part of the team for managing such at-risk individuals.

Failure to treat the first psychotic episode expeditiously and appropriately can result in:

• Reduced chance of satisfactory recovery.
• Vagrancy/ homelessness.
• Poor general health.
• Reduced chance of economic independence.
• Poor social functioning and educational outcomes.
• Unemployment/ Underemployment.
• Increase in relapses.
• Increased chances of institutionalization.
• Increased interaction with the criminal justice system.
• Murder
• Suicide
• Early death.

Regrettably our passion for delivering basic mental health care to Vincentians has ignominiously and perniciously fallen short of our effervescent fervour for delivering a great Vincy T/20 WC experience to the world. With a modicum of forethought there is no good reason why these two have to be mutually exclusive.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)

Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.