In March 2007, Director of the Douglas-based Montreal WHO Collaborating Centre Dr. Gaston P. Harnois, and Douglas Director of Nursing and Director of Quality Hélène Racine, Nurse, MSc, MAP, were invited by the government of the Caribbean island of Dominica to reassess the state of its mental health services. This would be a follow-up visit, since Dr. Harnois had made initial recommendations in 1995. Thanks to financial support from the Douglas Foundation, they were able to accept the invitation. Upon their arrival, they saw that the situation had changed for the better in recent years. Mental health was now an important, well-recognized component in all of Dominica’s nine health clinics—which are the backbone of the country's health system. In addition, the clinics were staffed with local people, familiar with the customs and needs of their patients.

Unfortunately, little had changed in the psychiatric units of Dominica’s general hospital since the first visit, despite the fact that two senior nurses from Dominica had spent six weeks at the Douglas in 1995, learning the latest mental health techniques. It was obvious that many of the hospital’s staff members still feared their mentally ill patients, and lacked information on mental illness. Psychiatric units remained locked, with patients receiving little treatment or rehabilitation. However, on the whole, Dr. Harnois and Hélène Racine were optimistic. “It’s clear that Dominica is determined to improve its mental health situation. Dominica’s families are close-knit, so people tend to support each other when mental illness strikes a loved one. This provides fertile ground for change. But much still needs to be done,” explains Dr. Harnois.

A Promising Future

As for the future, improvements are just around the corner. Modern open and closed psychiatric units are planned for Dominica’s main hospital in the coming year. Hélène Racine has confirmed that Douglas staff will be providing nursing training, taking into account Dominica’s needs and culture, and Douglas resources.

On the policy front, Dominica's health ministry is preparing a revision of its Mental Health Plan, with input from Dr. Harnois and colleagues. Also, at the request of PAHO (the regional WHO office), Dr. Harnois will be advising on the creation of an Eastern Caribbean Mental Health Network that would include Dominica, Guadeloupe, Saint Lucia, Martinique and conceivably others. Although they are close geographically, there are few contacts between these islands. The idea is to exchange knowledge, expertise, best policies, and training programs between the members.

By sharing their knowledge, the Montreal WHO Collaborating Centre and the Douglas community—with its mandate to promote best practices in mental health—are helping Dominica forge a mental health system that will respect their culture and strengthen their society, socially and economically.