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Mental health systems in six Caribbean small island developing states: a comparative situational analysis

Walker, Ian F.; Asher, Laura; Pari, Anees; Attride-Stirling, Jennifer; Oyinloye, Ayoola O.; Simmons, Chantelle; Potter, Irad; Rubaine, Virginia; Samuel, June M.; Andrewin, Aisha; Flynn, Janett; McGill, Arline L.; Greenaway-Duberry, Sharra; Malcom, Alicia B.; Mann, Gemma; Razavi, Ahmed; Gibson, Roger C.

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Ian F. Walker

Clinical Associate Professor

Anees Pari

Jennifer Attride-Stirling

Ayoola O. Oyinloye

Chantelle Simmons

Irad Potter

Virginia Rubaine

June M. Samuel

Aisha Andrewin

Janett Flynn

Arline L. McGill

Sharra Greenaway-Duberry

Alicia B. Malcom

Gemma Mann

Ahmed Razavi

Roger C. Gibson


Background: Small island developing states (SIDS) have particular mental health system needs due to their remoteness and narrow resource base. We conducted situational analyses to support mental health system strengthening in six SIDS: Anguilla, Bermuda, British Virgin Islands, Cayman Islands, Montserrat and Turks and Caicos Islands. Methods: The situational analyses covered five domains: 1. Socio-economic context and burden of mental disorders, 2. Leadership and governance for mental health 3. Mental health and social care services 4. Strategies for promotion and prevention in mental health and 5. Information systems, evidence and research for mental health. First, a desk-based exercise was conducted, in which data was drawn from the public domain. Second, a field visit was conducted at each site, comprising visits to facilities and consultation meetings with key stakeholders. Results: Our key findings were 1. Despite most of these SIDS being high-income economies, social inequalities within states exist. There was no population-level data on mental health burden. 2. All SIDS have a mental health policy or plan, but implementation is typically limited due to lack of funds or staff shortages. There was minimal evidence of service user involvement in policy or service development. 3. All SIDS have a specialist, multi-disciplinary mental health workforce, however Montserrat and Anguilla rely on visiting psychiatrists. Child and adolescent and dedicated crisis intervention services were found in only two and one SIDS respectively. A recovery-oriented ethos was not identified in any SIDS. 4. Mental illness stigma was prevalent in all SIDS. Promotion and prevention were objectives of mental health strategies for all SIDS, however activities tended to be sporadic. No mental health non-Governmental organisations were identified in three SIDS. 5. Health information systems are generally underdeveloped, with paper-based systems in three SIDS. There has been no rigorous local mental health research. Conclusion: Cross-cutting recommendations include: to develop mental health action plans that include clear implementation indicators; to facilitate community surveys to ascertain the prevalence of mental disorders; to explore task-sharing approaches to increase access to primary mental health care; and to develop programmes of mental health promotion and prevention.


Walker, I. F., Asher, L., Pari, A., Attride-Stirling, J., Oyinloye, A. O., Simmons, C., …Gibson, R. C. (2022). Mental health systems in six Caribbean small island developing states: a comparative situational analysis. International Journal of Mental Health Systems, 16, Article 39.

Journal Article Type Article
Acceptance Date Aug 2, 2022
Online Publication Date Aug 12, 2022
Publication Date Aug 12, 2022
Deposit Date Oct 13, 2022
Publicly Available Date Oct 14, 2022
Journal International Journal of Mental Health Systems
Electronic ISSN 1752-4458
Publisher Springer Science and Business Media LLC
Peer Reviewed Peer Reviewed
Volume 16
Article Number 39
Keywords Psychiatry and Mental health; Public Health, Environmental and Occupational Health; Health Policy; Pshychiatric Mental Health
Public URL
Publisher URL


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