GENERAL INFORMATION Saint Kitts and Nevis Saint Kitts and Nevis is a country with an approximate area of 0.26 thousand square kilometers (O, 2008) and a population of 52,368 (O, 2009). The proportion of the population under the age of 18 years is 19% (O, 2009). The healthy life expectancy at birth is 62 years for males and 67 years for females (PD, 2010). The country is in the upper middle income group (based on 2010 World Bank criteria). The total expenditure on health as a percentage of gross domestic product is 6.02% and the per capita government expenditure on health (PPP int. $) is $471.0 (WHO, 2006). In Saint Kitts and Nevis, neuropsychiatric disorders are estimated to contribute to 20.4% of the global burden of disease (WHO, 2008). GOVERNCE An officially approved mental health policy does not exist and mental health is not specifically mentioned in the general health policy. A mental health plan does not exist. Dedicated mental health legislation exists and was initiated, or most recently revised, in 1956. Legal provisions concerning mental health are not covered in other laws (e.g., welfare, disability, general health legislation etc.). Note: A draft of the mental health policy was created and reviewed in 2010. A Mental Health and Substance Abuse Strategic Plan (2008-2012) was drafted in 2007 and will be implemented from 2010 to 2014. A revised version of the Mental Health Legislation was drafted in 2007, and a Mental Health Act was prepared in 2002, and a second one in 2007, but these documents still require approval. FINCING Mental health expenditures by the government health department/ministry are 1.09% of the total health budget. Mental hospital expenditures are not available. Note: The figure above is based on data from the year 2007. The overall expenditures on mental health services represent approximately 1% of the Saint Kitts and Nevis annual health budget. An analysis by island showed that Saint Kitts appropriated approximately 4% of its annual health expenditures to mental health services, while Nevis appropriated about 2% of its health budget to mental health. MENTAL HEALTH CARE DELIVERY Primary Care Prescription regulations authorize primary health care doctors to prescribe and/or to continue prescription of psychotherapeutic medicines. In contrast, the department of health does not authorize primary health care nurses to prescribe and/or to continue prescription of psychotherapeutic medicines. Similarly, official policy does not permit primary health care nurses to independently diagnose and treat mental disorders within the primary care system.
The majority of primary health care doctors and nurses have not received official in-service training on mental health within the last five years. Officially approved manuals on the management and treatment of mental disorders are not available in the majority of primary health care clinics. Official referral procedures for referring persons from primary care to secondary/tertiary care do not exist. Referral procedures from tertiary/secondary to primary care also do not exist. Mental Health Services Availability of mental health Total number of /beds population Number of /beds reserved for children and adolescents only Mental health outpatient 7 13.37 0 0.00 Day treatment 0 0.00 Psychiatric beds in general 12 22.91 0 0.00 hospitals Community residential 0 0.00 Beds/places in community 0 0.00 residential Mental hospitals 0 0.00 Beds in mental hospitals 0 0.00 Access to care Rates per 100,000 population) Females (%) Persons treated in mental health outpatient 1172.47 41% 2% Persons treated in mental health day treatment Admissions to psychiatric beds in general hospitals Persons staying in community residential at the end of the year Admissions to mental hospitals Long term care in mental hospitals (% of persons staying): Rate per 100,000 population Under age 18 (%) Less than 1 year More than 1 and less than 5 years More than 5 years
HUMAN RESOURCES Workforce and training Health professionals working in the mental health sector Psychiatrists 1.91 0.0 Medical doctors, not specialized in psychiatry 0.00 Nurses 13.37 Psychologists 5.73 Social workers 0.00 Occupational 0.00 therapists Other health workers 19.1 Informal human resources (Family and User Associations) Training of health professions in educational institutions User Present in the country? Yes No Number of members 3 Participation in the never or rarely formulation/implementation of policy/plan/legislation? Family Note: The community-based approach is the main strategy for mental health care in Saint Kitts and Nevis. In Saint Kitts, mental health services are delivered through: 1. weekly-scheduled clinics in 3 of the 11 primary health care centers; 2. bi-monthly clinics at Her Majesty s Prison; 3. the counseling centre; 4. the counseling clinic at outpatient department at the Joseph N. France hospital. Some mental health patients are also provided inpatient care at specific nursing homes (CARDIN house in Saint Kitts and the Flamboyant Nursing Home in Nevis). Mental Health Officers sometimes make home visits and are occasionally accompanied by psychiatrists. MEDICINES Expenditures for medicines for mental and behavioral disorders at country level Type of Medicines Expenditures at country level per year and per 100,000 population (in USD) All the psychotherapeutic medicines 1 1 N03AG01, N05A, N05B, N05C, N06A
Medicines used for bipolar disorders 2 Medicines for psychotic disorders 3 Medicines used for general anxiety 4 Medicines used for mood disorders 5 Note: There is a major shortage of medication for mental health and neurological illness in the country and those that are available (e.g. from private companies) are extremely costly. INFORMATION SYSTEMS Data on number of people/ activities are collected and Data on age and gender are collected and Persons with mental disorders treated in primary Yes Yes No health care Interventions (psychopharmacological and Yes Yes Yes psychosocial) delivered in primary health care for people with mental disorders Persons treated in mental health outpatient Yes Yes Yes Contacts in mental health outpatient Yes Yes Yes Persons treated in mental health day treatment Admissions in general hospitals with psychiatric Yes Yes Yes beds Admissions in mental hospitals Days spent in mental hospitals Admissions in community residential Data on patient's diagnosis are collected and Note: Information regarding mental health is collected from comprehensive, annual reports from five different service providers including the: (1) Community mental health team in Saint Kitts; (2) Counseling service at the Joseph N. France General Hospital; (3) Counsel Centre at Greenlands; (4) Psychiatric in-patient ward at the hospital; (5) Mental health team in Nevis. Note: Mental health data (either on the public system, private system, or both) have been compiled for general health statistics in the last three years, but not in a specific mental health report. 2 N03AG01, N05A, N05B, N05C, N06A 3 N05A (excluding N05AN) 4 N05B & N05C 5 N06A
OTHER INFORMATION There is currently (as of 2010) no mental health authority or director of mental health programs in the Federation of Saint Kitts and Nevis. The sole psychiatrist in the country, the community mental health team, and the Mental Health Associations, with support from the Ministry of Health (Permanent Secretary, Chief Medical Officer and Administrative Officer), drive the mental health initiatives in the Federation.