ABSTRACT
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.
ABSTRACT
UNLABELLED: Social norms approaches (SNA) are based on the premise that we frequently overestimate risk behaviours among our peers. By conducting campaigns to reduce these misperceptions, SNAs aim to reduce risk behaviours. This study examines the extent to which 12 to 13year old pupils overestimate smoking among their peers and explores the appropriateness of using SNA in secondary schools to prevent smoking uptake. METHODS: The extent of overestimation of smoking among peers was assessed through an on-line SNA questionnaire in five schools (n=595). Based on questionnaire results, pupils developed SNA campaigns in each school. Qualitative methods of focus groups (7), interviews (7) and observation were used to explore in-depth, from the perspective of staff and pupils, the appropriateness and feasibility of the SNA to prevent smoking uptake in secondary schools. RESULTS: A quarter of pupils, 25.9% (95% CI 25.6% to 26.1%) believed that most of their peers smoked, however, only 3% (95% CI 2.8% to 3.3%) reported that they actually did; a difference of 22.9% (95% CI 19.1% to 26.6%). Self-reported smoking was not significantly different between schools (X(2)=8.7 p=0.064), however, perceptions of year group smoking was significantly different across schools (X(2)=63.9 p<0.001). Qualitative analysis identified full school engagement, minimal teacher time requirements, pupils' belief in questionnaire results and understanding wider context, as key in optimising implementation. CONCLUSION: This study shows significant misperception between self-reported and perceived smoking among peers in secondary schools, thus supporting a key premise of social norms theory. Implementing SNAs and studying effects is feasible within secondary schools.
