Shawn Addison, age 46, who lives in Barbados, noticed his mental health problems initially in his teenage years. He struggled with staying focused, withdrew after socialising, and did not feel like he was in full control of how his brain worked.
“In my early 30s, things started to really get to a point where I wasn't managing the daily functions of my life. A friend of mine, who is a doctor, recommended that I go to my closest polyclinic, speak to the sister in charge there, and she recommend me to the mental health programme. From there, I saw the doctor and did an assessment,” said Shawn.
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Shawn Addison, mental health patient in Barbados © PAHO/WHO Barbados
Shawn was diagnosed with bipolar disease. He was initially reluctant to take medication, but with encouragement he started on a low dose with positive effects and began therapy. Twelve years later, Shawn regularly visits doctors and nurses at his local polyclinic and gets his medication there.
“I have to give big, big commendation to the mental health clinic, and the structure of how the mental health care programme works in Barbados. From my usage of it and my observation of the professionals who work in it, the system is tremendous. Anyone that is experiencing difficulty can go to their neighbourhood polyclinic,” said Shawn.
Shawn’s experience demonstrates the power of embedding mental health services in community settings and ensuring they are accessible, easy-to-use, and effective over the long-term. Across the nation, thanks to the Government’s robust efforts to strengthen mental health care, the whole population of Barbados is now able to access mental health services in all polyclinics.
Integrating mental health into primary care
The population of Barbados is facing increasing mental health challenges with depression, anxiety, and substance use disorders among the leading causes of disability. Exacerbated by the impact of the COVID-19 pandemic, the Ministry of Health and Wellness has reported increased suicide rates in 2022/2023 and a surge in mental health cases.
Recognising the urgency, the Government of Barbados, with support from PAHO/WHO, embarked on a comprehensive reform to further integrate mental health into primary health care (PHC), engage with communities, and strengthen community-level support systems. This underscores Barbados’s commitment to achieving universal health coverage (UHC), or universal health as it is known in the Americas Region.
PAHO/WHO, through the UHC Partnership, has supported the reform’s strategic activities including policy development and legislative updates, capacity building for PHC staff, community engagement activities, and expanding resources for new mental health staff positions.
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Mechelle Marshall, Public Health Nurse, Barbados © PAHO/WHO Barbados
The activities have led to measurable improvements and transformative outcomes for mental health in Barbados. Today 100% of polyclinics nationwide offers a wide range of mental health services, along with psychiatric medicines and more people are accessing services and benefitting from community engagement activities than ever before.
“To achieve universal health, there must be coverage, and we must involve the provision of mental health services. In Barbados, we are seeking to reform the whole process of mental health care provision to move away from the old tradition [of psychiatric hospitals] and we are moving services into our communities. We now have community mental health services in all our clinics. We are providing psychiatrists dedicated to those clinics, community mental health nurses, community health social workers, and community mental health psychologists,” said Senator Dr The Most Honourable Jerome Walcott, Minister of Health and Wellness.
Transforming mental health care to achieve universal health coverage
Across the world, evidence shows that people with mental illness have better health outcomes when their care is community based. Assessing and treating people in their community settings allows health professionals to see patients in their own environment and understand the strengths and weaknesses that they have in relation to their home and community contexts. Importantly, the integration of mental health into PHC reduces the need for admission at psychiatric hospitals which contribute to stigma reduction.
A multi-disciplinary team of health and social care workers are now engaged throughout the provision of mental health services across Barbados.
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Mechelle Marshall, Public Health Nurse with a colleague and patients in a polyclinic, Barbados © PAHO/WHO Barbados
“PAHO/WHO remains committed to supporting Barbados in its ongoing mental health transformation, which is a critical component of achieving universal health coverage. The country is advancing a model of care that prioritizes accessibility, upholds human rights, and addresses stigma in a world where mental health needs continue to grow.
“The resolution on mental health adopted by PAHO Member States last year provides a clear framework for such action, and Barbados exemplifies accelerated national efforts to translate this commitment into tangible progress,” said Dr Amalia Del Riego Abreu, PAHO/WHO Representative for Barbados and the Eastern Caribbean, the United Kingdom overseas territories.
The UHC Partnership operates in over 125 countries, representing over 3 billion people. It is supported and funded by Belgium, Canada, the European Union, France, Germany, Ireland, Luxembourg, Japan, the United Kingdom of Great Britain and Northern Ireland, and WHO.