Mental health systems in six Caribbean small island developing states: a comparative situational analysis

Ian F. Walker*, Laura Asher, Anees Pari, Jennifer Attride-Stirling, Ayoola O. Oyinloye, Chantelle Simmons, Irad Potter, Virginia Rubaine, June M. Samuel, Aisha Andrewin, Janett Flynn, Arline L. McGill, Sharra Greenaway-Duberry, Alicia B. Malcom, Gemma Mann, Ahmed Razavi, Roger C. Gibson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
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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.

Original languageEnglish
Article number39
JournalInternational Journal of Mental Health Systems
Issue number1
Publication statusPublished - 12 Aug 2022

Bibliographical note

Funding Information: The PHE programme of public health technical assistance to the UKOTs is funded by the Foreign, Commonwealth and Development Office of the UK Government under the Conflict, Stability and Security Fund. The funder had no role in the design of the study, collection, analysis, and interpretation of data and in writing the paper. The views expressed do not necessarily correspond to those of the funder. This programme is now delivered by the UK Health Security Agency (as PHE was dissolved in 2021).

Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Publisher Copyright: © The Author(s) 2022.

Citation: Walker, I.F., Asher, L., Pari, A. et al. Mental health systems in six Caribbean small island developing states: a comparative situational analysis. Int J Ment Health Syst 16, 39 (2022).



  • Caribbean region
  • Mental health services
  • Mental health systems
  • Small island developing states


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