The development of a community-based comprehensive mental health service delivery system for the Cayman Islands (1989-2001)

This paper reviews the development of mental health services in the Cayman Islands throughout a twelve-year period (1989 to 2001). I was appointed the resident consultant psychiatrist to the islands in 1989, after which time a consultative process between the Ministry of Health, Senior Management of the George Town Hospital and myself allowed the development and establishment of a comprehensive community-based mental health service delivery system (MHSDS), specifically designed to suit the needs of the Cayman Islands. The framework for the service is outlined, and the concerns and objectives of the MHSDS are discussed, along with short-term and long-term goals. (AU)

Psychiatric referrals in the University Hospital of the West Indies

The creation in 1965 of a Department of Psychiatry at the University of the West Indies and the introduction of an inpatient psychiatric service at the University Hospital, marked an important step in the development of community psychiatry services in Jamaica. This study examines two important areas of the Psychiatric Unit's activities which have not been reported on to date: referrals to psychiatry from the Hospital's Casualty Department and referrals from general hospital wards. The very fact of providing a twenty-four hour emergency referral service for Casualty attenders is an important factor in encouraging the use of Casualty as a first point of medical contact for psychiatric disorders, even though it serves in practice as a walk-in facility rather than a true emergency service. The judgement of the casualty officers both in diagnosis and disposal is shown to be good. Day Hospital is probably under-used by the duty psychiatrist as a disposal option for persons seen in Casualty. There is a high incidence of cannabis use among males aged 20-29 and the findings agree with earlier reports of the association between cannabis and schizophrenic disturbance. Inpatient referrals to the consultation service show a low rate compared to that reported for other hospitals. With more than a quarter of these referrals originating from complications of medical condition and medical treatment, the consultation-liaison service is well justified. The fact that less than one in ten of these patients needed transfer to the psychiatric unit for management of their disorder should encourage a community-based approach to mental health in the minds of all practitioners. The author's view is that a consultation-liaison service assists the teaching of psychiatry by encouraging an awareness of the relationship between physical and psychological medicine (AU)