Reshaping of mental health services to be ‘fit for purpose’
Mental health benefits and services in Bermuda are not on an equal footing as those dealing with physical health, the Ministry of Health has admitted.
It was responding after Tania Stafford, a former service user at the Mid-Atlantic Wellness Institute wrote an open letter to the Premier and the Government saying that mental health services on the island are in crisis.
In a statement, a ministry spokeswoman said: “Mental health parity has been a longstanding challenge globally, and unfortunately, Bermuda hasn't been exempt from those challenges.”
She added: “The Ministry of Health's vision is for an equitable and sustainable health system that promotes and protects individuals and the community's physical, mental and social wellbeing.
“Good mental health is a part of everything we do as a ministry.
“However, the Bermuda Hospitals Board and the private sector manage mental health in Bermuda from a service provider viewpoint. The ministry's direct involvement is to provide funding.“
In her letter, Ms Stafford, who was admitted to MWI in 2010 and now lives abroad, claimed that the facility was underfunded and called on the government to, “Invest in the facilities, training and overall welfare of the staff, and implement innovation in healthcare at MWI”.
Curtis Dickinson, the finance minister, announced in February’s National Budget that an almost $93 million capital projects programme would include “desperately needed” facility upgrades at the Devonshire plant, “consistent with this government’s approach to the importance of mental health”.
Last March, Kim Wilson, the Minister of Health, announced there would be an additional grant to BHB of $1.2 million to pay for the development of a team to support individuals with special needs who live in the community, but are not resident in BHB's group homes.
BHB this year received a government grant for all its services of $38.9m, an increase of $1.6m from $37.3m last year.
A spokeswoman for BHB said the capital funding would go towards upgrades including the maintenance and repair of plumbing and air conditioning systems.
She added: “Longer term, the facility either needs to be redeveloped or an alternative solution found.”
Asked whether the budget allocation for MWI went far enough, she responded: “For this year, we have enough funds to keep services running and to begin the development of more community-based services.
“The long-term financing of a mental health facility is different, as we are looking at options in a master estate plan. This could mean redevelopment or a new build. We do not have the final costings of the options yet, but any option is likely to be substantial.”
She said the hiring of a sixth consultant psychiatrist to expand community-based mental healthcare was under way adding: “This will help reduce the pressure on the psychiatric staff.
“We also need to find additional ways to support young adults with complex needs and children/adolescents, and this is something we are working with government to achieve.”
The ministry spokeswoman added that in 2019, a mental health analysis was conducted in partnership with Public Health England (PHE) and the Pan American Health Organisation to review mental health policy and plans, health services, community and information systems.
She said that through PHE, Bermuda is partnering with leading UK mental health charity Mind to address the stigma. She highlighted the partnership between the BHB and the Department of Health to integrate services from MWI more intensively into community and primary care.
Psychiatric services are now offered at the Urgent Care Centre at a local GP offices, within Magistrates’ Court and the Bermuda Police Service. A new mental health clinic is running from the Lamb Foggo Urgent Care Centre in St George’s once a week alongside a number of other hospital clinics aimed at supporting east-end residents, and west-end. Central services are being discussed.
The BHB spokeswoman said that while the MWI facility needs improvements, “our services are making a decisive shift towards providing more outpatient care outside the facility. This is how we are reshaping the services to be fit for purpose”.“
Integrated care is a key goal of a new strategy introduced by BHB this year, providing services that are closer to patients in the community while coordinating with other services.
“This helps people more effectively manage and treat their conditions to improve the stability and quality of their lives, and reduces the need for emergency or acute inpatient stays,” she added.
She said a recovery model at MWI is under way, which gives patients, residents and families a more active role in the treatment and management of conditions.
The spokeswoman said that MWI has a higher number of people with mental illnesses who do not have insurance and their care is covered by a government grant. There are also providers of outpatient services in the community for people with insurance or the ability to pay.
She said that there has been an increase in the intensity of support for outpatient mental health services and an increase in those requiring inpatient admission, and that demand is expected to intensify further due to the Covid-19 pandemic.
The Bermuda Hospitals Board’s annual statistics across all mental health including intellectual disability and substance abuse: Inpatient numbers for adults went from 219 in fiscal year 2016/17 to 255 in the fiscal year 2020/21. The figures in 2020/21 in other areas dropped.
Child and adolescent admissions went from 20 in 2016/17 to 32 in 2019/20, although they dropped to 10 in 2020/21.
New outpatient admissions went up from 326 in 2016/17 to 379 in 2019/20, then dropped in 2020/21 to 261, and unscheduled (walk-in) visits went down from 12,293 in 2016/17 to 9,357 in 2019/20, and dropped further in 2020/21 to 5,586.
A BHB spokeswoman said: “While inpatient admissions very clearly indicate an acute need, it is likely the outpatient numbers dropped in 2020/21 due to access issues related to the pandemic, with lockdowns and more remote consultations. Evidence overseas indicates there may well be an increase in demand as we continue to reopen … When we reviewed the admissions on Somers Annex at the Mid-Atlantic Wellness Institute for the period of April 1, 2020 to March 31, 2021 and compared them to the preceding 12 months (April 1, 2019 to March 31, 2020), we have seen admissions increase from 83 to 131. We have not seen an increase in outpatient services at this time but we are anticipating this may change over the course of this year.”