Mental health illnesses is a global burden that every country is attempting to challenge. The problem with mental health is its impact on the population's ability to be productive and contribute to stabilizing the country's economy. The aim is to understand the burden of mental health in Jamaica and how the country is attempting to face the problem. The objective is to assess the treatment situation and conduct a study at Bellevue Hospital (BVH) to understand how the country's treatment approaches are helping to reduce the burden of the country's mental health. The aim is to make suggestions on a suitable package or intervention measures that can help the Jamaican healthcare system deal with the burden of mental health.
Focus for Study
In this study, the focus is on mental health conditions and treatment approaches in Jamaica. Mental health disorders are severe mental health conditions that alter a person's way of thinking and mood. According to Pottinger & Carroll (2020) , many people experience different types of psychological concerns. However, mental concerns become severe mental issues when the patient or the victims exhibit symptoms that are continuous and cause a specific stress level. Mental health illnesses present different symptoms such as depression, lack of attention, inadequate focus on daily activities, and also aggression. Therefore, mental health conditions are serious issues that change people's lives and their businesses. Mental disorders range from simple stress to severe bipolar diseases, which can restrict an individual in a mental health facility for quite long.
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Treatment of mental conditions is an area that gives people a lot of hope regarding the burden of mental health issues in the world. Due to its high prevalence in different parts of the world, the focus has changed from the understanding of how mental health conditions come about to understand the best ways to relieve mental stress and avoid it if necessary. Through their ministry of health, most governments are planning on a comprehensive approach to mental health with the focus on understanding its root causes and finding the best ways to reduce it among people. Currently, most mental conditions treatments depend on not only pharmaceutical drugs, but also therapies. There are wide ranges of therapies that have become useful, such as cognitive behavior therapies and narrative therapies. Besides, there are also community-based interventions, which different governments encourage as a way to reduce the number of inpatients in various hospitals. Also, there is a deinstitutionalization which focuses on decongesting the mental facilities. The deinstitutionalization encourages the need to cater to most of the mental health patients at home or in a local institution where they can get the care and go back home (Pottinger & Carroll, 2020) .
Mental health is currently a burden in Jamaica. In a research study aiming to understand the responsibility of the psychic depression in Jamaica. The authors realize that about 3.2% of the Jamaican population is depressed. The data coincide with the World Health Organization data on mental health, which places depression in Jamaica at 3%. Therefore, Jamaicans should understand the government's intervention, through its ministry of health, to reduce the increasing rate of the mental health condition. Current analysis of Jamaican healthcare mostly on mental health reveals that one of the most deinstitutionalization to allow for the community-based care and treatment of the mental health in the country. Further, a focus on the Jamaican mental health reveals that there is a forgoing treatment intervention launched by the World Health Organization called the Mental Health Gap Action Programme (mhGAP), which is currently under implementation. The success of these interventions is to bring a debate, and so are the treatments approaches that the Jamaican healthcare system prefers for its mental health department.
Therefore, the study's focus is understanding the mental health in Jamaica regarding its burden and intervention that the Government is taking to reduce the burden. Thus, the following will be the objective of this stud:
To understand the situation of mental health illnesses in Jamaica by assessing its prevalence and burden.
To establish government interventions regarding Mental health illnesses in the country.
To discover the treatment strategies that are prevalent to combat the rise of the mental illnesses and their impact in Jamaica.
Establish the best preventive and treatment measure that can be suitable to reduce the burden of mental ill-health in Jamaica.
The study outcome will define the state or the prevalence of the burden of this disease in the country. Therefore, the study will reveal some of the interventions that the Jamaican government is using as a way to reduce the burden of the disease. The aim is to assess the impact of these treatment approaches and the intervention that can be in place to make them better for the Jamaican populations.
Description of the Issue
Jamaica is a Caribbean island nation. The country is the third-largest island in the Caribbean Sea. Jamaica is about 146 miles (235 km) long and ranges from 22 to 51 miles (35 to 82 km) wide. Currently, Jamaica has about 2.9 million people as its population (Pottinger& Carroll, 2020) . The country has an average economy but has since shown a good reputation on its economic progress. A significant challenge facing the country’s health care system is mental health conditions. In Jamaica, the burden of mental illness is considerable. The projection is that between 2015 and 2030, the mental health issues should cause an economic loss amounting to US$ 2.76 billion ( Pottinger & Carroll, 2020) . The implication is that Jamaica is one of the countries where mental health issues are affecting many people. The worrisome statistic reveals that most of the psychiatric diseases in this country begin at childhood, progressing to adolescents until the late stages of life. The implication is that the Government must have intervention measures to reduce the illness to have a productive youth ( Pottinger & Carroll, 2020) . Therefore, studying mental health problems and its treatment is a worthy venture because the burden in the country is alarming, and the trend shows that the state may continue experiencing mental problems ( Pottinger & Carroll, 2020) .
Mental health is a problem of every person Jamaica. The current statistic reveals that about 21.1 % of the country's people have experienced a severe mental health problem in their lives. In most cases, females are the most vulnerable in the state. Children also experience psychological issues in equal measures. In the country, about 3% of the population is depressed ( Pottinger& Carroll, 2020) . Female gender leads the way with 3.7% of them having the signs and symptoms of depression. Furthermore, there are about 10% of the population who are at risk of developing depressive symptoms. Most people in the country also suffers from anxiety ( Pottinger & Carroll, 2020) . According to data generated by Maloney, Abel, and McLeod (2020), about 4% of Jamaicans suffer from anxiety. The anxiety rate denotes spare any age. However, most of these cases are present mostly among those within the age group of 20-34 and 35-59 age groups ( Pottinger & Carroll, 2020) . Anxiety is also common among the Jamaican working group, with where it hits about 6.4%. In this case, those affected are mostly those within the age group of e 35-39 age group who suffer from anxiety.
Also, there is a high rate of psychosis that manifests itself in the form of hallucinations. In the country, psychosis results in more than 100,000 visits to mental health institutions in Jamaica. In statistics by the World Health organization collected in the year 2016, the data revealed that psychosis was the cause of more than 80% of the mental health visits in the country. According to Pottingerand Carroll (2020) , “Psychotic disorders place a major burden on the social and physiological aspects of individuals’ lives” (p. 23). In comparison with bipolar and schizophrenic patients, schizophrenic patients were less likely to have marketable job skills than bipolar patients and schizophrenia was associated with lower educational attainment. The implication, therefore, is that the disease affects many people in the country. Therefore, finding the solution to reduce its spread and prevalence should be a relief to many people and the Government.
Mental health in Jamaica is thus a worthy topic because on the rate at which it affects people, and the trend that indicate that without proper invention, the disease is likely to continue. The data concerning mental health in Jamaica is, and the trend has continued over time ( Pottinger & Carroll, 2020) . For instance, there were approximately 90,000 visits to public health facilities for mental health treatment annually between 2013 and 2014. Also, these visits are never constant in the country ( Hickling, 2020). Every year, this figure rises by about 20%. For instance, the number rose from 90,000 to about 108,000 visits in 2015( Pottinger& Carroll, 2020) . There was another rise from the 108,000 to the about and 132,000 in 2016. The implication is that trend is Continuous, and there despite the effects that are in place to flatten the curve, the trend is increasing ( Pottinger & Carroll, 2020) .
Other than that, the issues need more discussion and research because the Government has done a lot in coming up with different measures, but the trend is still rising ( Pottinger & Carroll, 2020) . For instance, the Government, under the ministry of health in Jamaica, has collaborated with community health bodies to reduce the prevalence of the mental conditions in the country ( Pottinger & Carroll, 2020) . They have also increase facilities and have decentralized the functions of different mental health bodies. Currently, the governments are championing for activities such as involving the community in mental health treatments ( Pottinger& Carroll, 2020) . Despite these strategies, the figure is still high. Therefore, there is a need to understand whether these strategies make the situation better or the Government should change its approaches. Therefore, the purpose of this study is to attempt to understand the burden of mental health issues in the country. Mainly, the study aims to assess the treatment intervention and whether they impact reducing the country's mental health issues ( Hickling, 2020). The aim is to develop proper recommendations that can help deal with the country's psychological situation.
Relevant Literature and Methods
Literature Review
Mental health in Jamaica is a topic that different scholars have discussed and have done a lot of research regarding its prevalence, causative factors, and treatment approaches. First, the causative factors of the mental health issues in Jamaica is a topic that many scholars focus on while discussing the topic. According to Hutchinson et al. (2019), the authors pinpoint the stressful work environment as the key areas that result in pressure and, thus, mental health issues in the country. From the authors' perspective, most Jamaicans work long office hours. They do not get enough time with their families, which could contribute to stressors that develop to and build up to mental health issues such as depression ( Hickling, 2020) agrees that the long working hours could be a problem for the employees in the country. The authors indicated that most of these individuals work between eight to twelve hours with limited shifts. Therefore, they lack time to relax their mind. The long working hours build pressure, and this could be a problem for their mental health.
In a similar opinion, Nelson et al. (2020) cited poor planning for mental health in the country as a contributing factor to the rising state of mental ill-health. According to the authors, only 4% of the expenditure on health sectors goes to mental health. The authors further compere this financial allocation to other countries and realize that the distribution is less in Jamaica. For instance, the authors recognize that 7% of finance in the health sector in Canada goes to the mental health department. In the United Kingdom, about 8% of healthcare finance is allocated to the health sector that goes to the mental health department ( Nelson et al., 2020). Therefore, the authors recommended that the ministry of health in this country should allocate more finance to this sector to hire doctors and also avail resources to fight the mental health challenge.
The treatments and intervention approach the Government is taking to combat the rise of the mental problems in Jamaica is an area of concern. First, the focus is on the treatment facilities for mental health in the country. Hickling (2020) researched the topic and came up the different findings regarding the situation of the treatment facilities for mental ill-health in the country. The authors realize that most of the mental ill-health are handled by the psychiatric facilities at the national level. The mental hospital at the national level handles about 46% of mental health cases in the country. Also, there are 24% of the mental health cases that the residential facilities at the community level handle in the country.
Besides, in Jamaica, forensic units control about 19% of the mental health cases. At the community health facilities, they are 5% of these cases. The rest, which is about 4%, goes to the inpatient units in the country. Therefore, Hickling (2020) c laim that the best way to fight the mental issue in the country is to devolve mental health centers' functions so that the community hospitals address mots mental health cases. They claim that such a move would mean that most people get treatment in areas they can access easily.
In Jamaica, the overreliance on the medication for treating mental illnesses. Statistics by Nelson et al. (2020) concerning the treatments of the mental health issues in the country revealed that about 67% of the intervention are pharmaceutical. The authors further state that for a non-pharmaceutical response, cognitive therapy was the most prescribed by the doctors. However, the rate was still low, with only 26,000 patients out of 100,000 who were referred to psychotherapists in the year 2014 ( Nelson et al., 2020). Other non-pharmaceutical interventions that most of the doctors adopt in the country include narrative therapy. Therefore, these authors claim that with the rising prevalence of this condition, pharmaceutical intervention may not work well. They claim that for mental issues such as depression and bipolar diseases, it would be essential to encourage comprehensive care. Comprehensive care would allow the citizen to use both the pharmaceutical and non-pharmaceutical intervention as an excellent way to eliminate the disease
Finally, inadequate primary care due to the free healthcare system in Jamaica is another area most of the authors discuss. The key to fighting this disease is financial stability that allows people to seek primary care and also be able to seek for non-pharmaceutical interventions. However, the situation is different in Jamaica. First, healthcare is free in Jamaica ( Logie et al., 2019). All citizens, as long as they are legal citizens, get free medication and services in Jamaica. The problem with free healthcare in the country is that doctors do not allow for free consultations, which means that people will have to pay for mental health consultations. Without proper insurance cover, this could be expansive for other struggling families. Therefore, Lacey et al. (2019) claim that this could be a big loophole in contributing to the spread of mental health issues.
From the literature review, it is evident that the mental health issue in Jamaica is a topic of interest for many scholars. The mental health problem is a sensitive topic in the country because the figures are not showing any indication of a dropdown. It is a significant threat to the country's healthcare system. Therefore, the study contributes to the knowledge about the situation of mental health in this country. The study will add to the literature on the effectiveness of the treatment intervention and the government's preventative measure on mental health.
Sampling, Data collection, and analysis
The study setting is Bellevue Hospital (BVH), the main hospital in the country catering to mental health issues. The hospital has a bed capacity of about 960 in Jamaica. Currently, the hospital has nearly 5500 staff, which are the target of the study. Therefore, the target population is approximately 5500. The online sample size calculator was useful for this case. First, the confidential level was 99%. With a confidential interval of 50% and the sample population size of 5500, the total sample population was seven people. The table below shows the demographic of the participants in the study.
| Profession | Age group | Number |
| Psychiatrists | 35-60 | 2 |
| Doctors | 25-60 | 2 |
| Nurses | 30-70 | 2 |
| Nurse educationist | 23-65 | 1 |
| Mean/total | Mean age; 37 years | 7 |
Data collection was through interviews because of critical reasons. The first was a distance between the participants and the study populations. Also, there was the matter of the COVID-19 restrictions. Therefore, the only possible way to collect data was an interview through Skype. A consent was emailed to each participant to request and tell them about the study's objective and the role they will be taking during the research study. It was essential for them the researcher to use consent as a way to alert the participant about the study. The Skype interview was scheduled for twenty minutes for each participant as a way to give them time to explain some critical issues concerning the mental health status in the country.
Data analysis took a content review approach. In a qualitative study, content analysis entails analyzing the content of the study findings. Therefore, the process involves reading through each response and comparing them regarding their contents. The thematic comparison was critical in this case ( Hu et al., 2020). Also, understanding and regrouping keywords were essential in identifying answers that were similar and those that were different. Through content analysis, the researcher was able to locate central themes and deduce results from the interview results.
Recommendations for Action Research Project
The project aims to find the best solution to help the Government reduce the high rate of mental ill-health in Jamaica. From the study results, the following were the findings. First, most participants claimed that there is a high rate of mental health in the country. Lack of sensitization among these populations is a leading cause of ignorance for those who had shown slight disease symptoms. Also, there was a concern among the participants about the lack of proper support. Lack of appropriate financially to access some of the best mental health hospitals within the communities in the areas was an issue. Also, there was a concern as most of the participants claimed that most people rely on pharmaceutical medication for treating psychotic disorders. In their opinion, most people are not exploiting non-pharmaceutical disorders, and this could be due to the expenses they have to pay for such services. From the findings, the project, therefore, makes the following recommendations regarding treatment and mental issues in Jamaica.
The first recommendation is that the Jamaican Government should deinstitutionalization mental health treatments. There is an overemphasis on the use of the Bellevue Hospital (BVH) as the primary treatment center ( Lacey et al., 2019). Therefore, the best way is to increase the use of other hospitals at the community level so that most of the patients get easy access to these facilities. Most people are unable to access National mental health centers. Therefore, they have to wait until their condition worsens, leading to a high rate of hospitalizations. The best way is to decongest most of these facilities to allow more people to get treatment at the community level.
Also, the Jamaican Government needs to support the WHO’s Mental Health Gap Action Programme (mhGAP) as a first project to help reduce the country's mental issues. The mhGAP has a critical treatment package that can be critical to this country regarding mental health issues. Some of the proposals that mhGAP put forward and can be vital for this national include the depression package, psychotic package, and anxiety package. These are treatment package proposals that WHO puts forward for the country to imitate to reduce the rate of anxiety, depression, and psychotic illnesses. For most of them, sensitization becomes the most critical point of the treatments. They also encourage the use of non-pharmaceutical interventions such as cognitive therapies, which are essential for patients suffering from mental diseases. These also include Intensive psychosocial treatment and antidepressant medication for recurrent moderate-severe cases on a maintenance basis.
Also, the Government needs to support its population regarding mental health care issues in the country. First, there should be more allocation of funding to this sector. Their current percentage of finance targeting the mental health sector should have some adjustments to cater to the cost. Another right way is to create a package for mental health patients. Currently, healthcare is free in Jamaica. However, consultation is not part of this freedom. Therefore, coming up with better healthcare coverage package to cater to mental health consultations and non-pharmaceutical treatments can beat a good idea.
Summary
From the discussion, mental health and its treatment is a topic that is sensitive in Jamaica. In the country, numerous people suffer from this problem, making it one of the most critical areas to address in the healthcare sector. The government has put the right initiatives to reduce the spread of this illness; some unique approaches should be in place. A method such as increasing support and funding is necessary. Also, encountering non-pharmaceutical intervention and supporting a high rate of deinstitutionalization to decongest its main mental hospital, can help localize the treatments and achieve better results.
References
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Pottinger, A. M., & Carroll, K. (2020). Reproductive needs of PLHIV in Jamaica: The relationship between fertility desire, motives and depression. Journal of Reproductive and Infant Psychology , 38 (1), 38-48.
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