Falling Through the Cracks | Less than 10% of children with severe mental health disorders receiving help

There are estimates that up to 46,000 Jamaican children are afflicted with a severe form of mental health disorder that requires immediate intervention.

However, only 4,006 were seen at the child guidance clinics during 2018 according to Ministry of Health and Wellness.

“The number of individual patients, i.e., the caseload, is 4,006 patients seen for mental disorders in the child guidance clinics for 2018,” said Dr Judith Leiba, director, child & adolescent mental health in the ministry. She was responding to questions posed by The Gleaner.

It must be noted that there is a significant difference in the number quoted by Leiba (4,006) and the 13,356 that is contained in the 2018 edition of the Economic and Social Survey Jamaica (ESSJ) which Leiba also referenced.

“The key difference is contained in Dr Leiba’s response,” said a child behavioural specialist who has spent more than 20 years working with mentally challenged children.

Struggling and understaffed

“What she quoted is the actual number seen by the struggling and understaffed child guidance clinics. The reality is that some of these children had several sessions, especially those with severe cases like those affected by post-traumatic stress disorder or those with suicidal thoughts or extremely aggressive behaviour,” the specialist explained.

Leiba was asked how many child guidance clinics exist and whether they were fully staffed to deal with the issues they are presented with. However, the picture presented is worrying.

“There are 20 clinic sites throughout the island but the frequency of clinics vary from parish to parish.

“Only three clinics are open five days for the week, some once per month (some) once per week,” Leiba revealed.

She was quick to add that “Worldwide, there is a shortage of mental health professionals who are qualified, competent and willing to work with children.

“The issue is no different in Jamaica.”

According to the director, working with children with mental health disorders is much more challenging than working with adults.

“The professional has to work with child, family, and sometimes there has to be school and community interventions,” she pointed out.

... Health Ministry coordinates wide range of mental health services across island, says official

 

Between three and four per cent of the Ministry of Health’s budget is dedicated to mental health. Of the nearly $73 billion allocated to the ministry for the fiscal year 2019-2020 some $69 billion has been set aside for recurrent expenditure and $3.7 billion for capital spending.

Leiba said the amount is hard to quantify as the services are administered through the various health regions.

Child and adolescent mental health services are administered through the child guidance clinics throughout the government health centres island wide and at the Teen Hub in the Half-Way Tree Transport centre where mental health screening, counselling and referrals are available from a psychologist once weekly.

Leiba explained that child guidance clinics are part of the community mental health services islandwide. Clients can be referred from a number of agencies within various ministries, departments and agencies that deal with children for psychiatric screening, assessment and therapy.

Therapeutic options are wide ranging and may include psychotherapy, behaviour therapy and medication therapy. Counselling and other forms of therapy for example play therapy and referrals to other agencies are also available.

“Many behavioural problems are related to learning problems and hence referrals for psychoeducational assessments are frequently done,” Leiba explained.

She told The Gleaner that the mental health unit within the Ministry of Health and Wellness works closely with the Ministry of Education, Youth and Information, and the Child Protection and Family Services Agency to coordinate programmes and to develop innovative solutions.

There is also collaboration with the Ministry of Justice’s National Task Force Against Trafficking in Persons and the Child Diversion Policy as well as with the Juvenile Correctional Services of the Ministry of National Security.

When asked, Leiba pointed to the internationally accepted but conservative estimate that 10 per cent of children in any population who are under 18 years old are affected at some point by a mental health disorder.

“There is no corresponding Jamaican study but there is no reason to believe that our reality is any different, particularly with a number of our children being exposed to high levels of crime and violence,” she said.

 

However, leading experts in the field have put Jamaica’s estimate at closer to 15 per cent. That would mean roughly 140,000 of an estimated 930,000 children will at some time have an issue. A leading expert said about 10 per cent or 93,000 will need a diagnosis while five per cent or more than 46,000 will need some form of intervention.

Meanwhile, the ESSJ noted that 57 per cent of children seen at the clinics were males. It also noted that there was an overall 15 per cent increase in the number of those utilising the facilities at the clinics in 2018 when compared to 2017.

The ESSJ said this was despite the downturn in reporting from the Cornwall Regional Hospital (CRH) during 2017-2018 when the CRH was the site of a major occupational hazard and most of the hospital services had to be relocated.

“This resulted in much lost data and missed appointments with challenges in retrieving dockets and an unsatisfactory clinic area,” the ESSJ said.