Mental health care in Jamaica faces several systemic challenges, including stigma, the influence of substance abuse (e.g., smoking, alcohol), and limited access to specialized care. Despite increased global recognition of mental health’s importance, Jamaica’s public healthcare system is under-resourced, leaving significant gaps in care for the country’s most vulnerable. Expanding insurance or health subscription services, for the 80% of the population without insurance could play a vital role in improving access to mental health services particularly in the private sector. By making mental health care more accessible, we can help reduce stigma and promote healthier behaviors, leading to better overall health for Jamaicans.

Gaps in Mental Health Care

Mental health care in Jamaica is under-resourced and overburdened. Recent integration of mental health services into community-based primary care represents a positive stride in promoting awareness and improving care. However, only 1/3 of community primary care centers offer mental health services [1]. Challenges that remain include:

Limited availability of specialists: As of 2023, Jamaica has approximately 40 psychiatrists, serving a population of over 2.82 million people. That is, 1 psychiatrist for every 70,500 people, highlighting a severe shortage. This shortage leaves the public health system stretched thin, with long wait times and limited resources for those seeking mental health care. The World Health Organization (WHO) recommends a ratio of 1 psychiatrist per 10,000 people, underscoring Jamaica’s need for more mental health professionals.

Cost of mental health services: Even when mental health care is available in the private sector, it can be cost-prohibitive for most Jamaicans [2]. Private sessions with psychiatrists can cost between JMD$10,000 and $15,000 per visit, depending on the practitioner, which puts regular mental health care out of reach for the uninsured. For many, this leads to untreated conditions, which worsen over time.

Societal Stigma: Despite recent progress, mental health issues are still heavily stigmatized in Jamaica and represent a socio-cultural hurdle that must be addressed. Persons often forgo seeking care for fear of being viewed as weak or ostracized [3]. Stigma is compounded by high rates of substance abuse, particularly the use of alcohol, tobacco, and marijuana, which are prevalent coping mechanisms for stress or untreated mental health conditions [4]. The normalization of these behaviors makes it harder for individuals to recognize when they need help. Furthermore, substance use can exacerbate underlying mental health struggles.

It is well established that substance abuse is associated with a higher incidence of mental health disorders such as depression, anxiety, and psychosis. Studies show that the prevalence of substance use disorders in Jamaica is increasing, particularly among young adults. According to the National Council on Drug Abuse (NCDA), nearly 15% of Jamaicans over the age of 15 have used marijuana, and 65% have consumed alcohol [5]. In 2022, it was estimated that 14.3 of the adult population has depression [6-7]. Among persons with chronic diseases, to include sickle cell disease, depression was increased and was significantly associated with economic instability [8]. In recent studies, it was also shown that people with mental health disorders like schizophrenia had an increased incidence of chronic diseases such as diabetes [6]. These data highlight the intersectional relationship between chronic illness and mental health care, creating a vicious cycle. 

Benefits of Expanding Health Insurance and Health Subscriptions

One way to address these challenges is by expanding health insurance or subscription coverage to include mental health services. Currently, 80% of the population is uninsured, relying on the under-resourced public system or paying out of pocket for private care. By providing affordable microinsurance plans or health subscriptions, we can:

Increase access to private mental health services: Expanding coverage would allow more Jamaicans to access mental health care through private providers, reducing the burden on public facilities and decreasing wait times.

Promote regular, preventative care: Health subscriptions could cover routine mental health check-ups, counseling, and therapy sessions. Preventative care is essential for catching issues early and reducing the long-term costs associated with chronic mental health conditions.

Reduce stigma: By making mental health care more affordable and accessible, insurance expansion could normalize seeking help, combating the cultural stigma surrounding mental illness. If people are more comfortable accessing services, they are more likely to address their mental health needs before resorting to substance abuse as a coping mechanism.

Impact of Problem Management Plus (PM+)

Jamaica has made important strides in mental health care with programs like Problem Management Plus (PM+), a low-intensity psychological intervention developed by the WHO [9]. PM+ is designed to help individuals manage common mental health issues such as stress, anxiety, and depression. This program allows trained non-specialists to provide psychological support, making it a cost-effective way to reach more people, especially in rural and resource-limited communities. By expanding such programs through insurance or subscription models, Jamaica can extend mental health support beyond the limited number of psychiatrists available .

How BIG’s Expatriate Partnership Model and Mental Health Fund Can Help

The Barriffe Insurance Group (BIG) is committed to addressing these mental health gaps through an innovative expatriate partnership model and our dedicated Mental Health Fund. Jamaica has a vast diaspora, many of whom are health professionals or individuals eager to give back to their homeland. BIG’s expatriate partnership model seeks to:

• Develop a telemedicine platform where Jamaican patients can access mental health services from expatriate providers in other countries, ensuring timely and expert care, particularly for those in rural areas.
• Facilitate mental health training programs where Jamaican mental health providers can receive mentorship from expatriate psychiatrists, therapists, and counselors.
• Encourage philanthropic contributions from Jamaicans living abroad to fund community-based mental health programs and infrastructure improvements.

Mental Health Fund

BIG is also launching a Mental Health Fund, which will:

• Subsidize mental health services for low-income, uninsured Jamaicans.
• Support the development of mental health resources in underserved regions.
• Fund public education campaigns to reduce the stigma around mental health and promote substance abuse prevention.

Conclusion

Through increased access to mental health care and community-based solutions, we can help ensure that all Jamaicans have the opportunity to lead more fulfilling lives.

Jamaica’s mental health system faces significant challenges, from a shortage of specialists and limited access to care to the pervasive stigma surrounding mental illness. The influence of substance abuse, particularly smoking and drinking, further complicates the issue. However, by expanding health insurance and subscription services, Jamaica can improve access to private mental health care, reduce stigma, and promote healthier behaviors. The Barriffe Insurance Group’s expatriate partnership model and Mental Health Fund will play a pivotal role in building a more accessible and inclusive mental health system, one that better serves the Jamaican population.

Sources

[1] Working towards a paradigm shift in mental health – SpringerLink https://link.springer.com/article/10.1007/s44250-024-00093-7

[2] [PDF] Care for Mental Health Conditions in Jamaica – iris.paho.org. https://iris.paho.org/bitstream/handle/10665.2/51834/9789275121184_eng.pdf

[3] The Jamaican Government’s Efforts To Destigmatize Mental Health https://borgenproject.org/mental-health-in-jamaica/

[4] Address mental health challenges | Letters – Jamaica Gleaner https://jamaica-gleaner.com/article/letters/20230110/address-mental-health-challenges

[5] NCDA. (2022). Substance Use in Jamaica. https://ncda.org.jm/ 

[6] Whitehorne-Smith P, Martin R, Oshi D, Abel W, Milbourn B, Smith K, Burns S. A qualitative exploration of the health system responses to the screening and management of comorbid mental illness and chronic physical illness in Jamaica. PLoS One. 2023 Dec 14;18(12):e0290975. doi: 10.1371/journal.pone.0290975. PMID: 38096252; PMCID: PMC10721042.

[7] Ministry of Health and Wellness. Chronic Non-Communicable Diseases. Published 2018. [cited 2022 Apr12]. Available from: https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

[8] Asnani, M.R., Fraser, R., Lewis, N.A. et al. Depression and loneliness in Jamaicans with sickle cell disease. BMC Psychiatry 10, 40 (2010). https://doi.org/10.1186/1471-244X-10-40

[9] Dawson KS, Bryant RA, Harper M, Kuowei Tay A, Rahman A, Schafer A, van Ommeren M. Problem Management Plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry. 2015 Oct;14(3):354-7. doi: 10.1002/wps.20255.