Global Health Blogs with Professor Swahn

I am a first generation American. My parents were born in the rural hills of Jamaica. Growing up their livelihood came from farming. They cultivated the land and sold their harvest at the local markets. It is no doubt that they have had to overcome tremendous challenges to succeed in that lifestyle to immigrate to another country and to thrive here. Growing up, we never spoke about mental health. In our household we championed strength and any sign of weakness was frowned upon. As an adolescent, I dealt with many issues including anxiety and depression. I had no skills or tools to deal with it and felt like a complete failure because I associated my issues with weakness. When I would try to go to my parents about it, they would say “hush”, or “pray about it.” I was left feeling weak, helpless and still anxious. 

As I’ve grown, mental health has become very important to me. I have experienced sound counseling and therapy and have unlearned the stigma that I was taught in my Jamaican household. Mental Illness is real, and resources to reduce stigma and increase care is urgently needed– especially in countries like Jamaica. In this blog, i’ll discuss the stigma that exists around mental health in Jamaica from being immersed in the culture as well as looking at the current literature. 

Jamaica is a small country in the Greater Antilles, known globally for their contributions like reggae music and phenomenal foods like jerk and oxtails. Jamaica is home to some of the most beautiful beaches and has the greatest hospitality in the world in my opinion. But how does Jamaica faire when it comes to prioritizing mental health and mental illness as a country? What is the current stigma towards mental health among the communities there? 

In Jamaica there is significant mental health stigma. According to some articles, Jamaican’s view mental illness typically as having to do with some sort of dark possession. An article entitled, “Mad, Sick, Head Nuh Good”, evaluates a community’s reaction to mental illness and many participants stated an acknowledged fear of people with mental illness. They cite religion and family members as places to receive guidance on mental issues and reported little knowledge of the limited mental health resources offered in Jamaica. Many Jamaicans noted that when facing “hard times”,  people may resort to alcohol and drug abuse. Marijuana use was also noted as a possible trigger for mental health episodes as well as a tool to help people cope. In 2016, there was a study done looking and the relationship between social and economic factors and mental health in Jamaica and Guyana. The results showed that the rate of depression was reportedly high for Jamaicans. The article called for an in depth analysis of social and economic factors that may influence mental health in these countries. As I combed through the literature this was true. It is very limited and from the looks of the outdated Jamaican mental health system, so are their policies. A systemic overhaul is necessary to help reduce stigma and to increase the accessibility and quality of mental health care in the country. 

In comparison, here in the United States, where I grew up we use  The Diagnostic and Statistical Manual for Mental Disorders (DSM). It is the guide used by healthcare professionals predominantly in the US, and in some other countries, to diagnose mental disorders. It includes the criteria for diagnosing over 150 mental disorders. America currently has a very complex mental health infrastructure and many other developing countries look to it for guidance as they expand their mental health services. Jamaica currently does not use the DSM-5 to diagnose mental health. They have one large mental health institution and a 1 in 100,000 psychiatrist. This country is clearly lacking in resources and has an urgent need for development to serve the needs  of its people. 

Is there a generational gap? 

One promising study was done comparing Jamaican adolescent views on help-seeking behaviors for mental health with African-American adolescents. They’re hypothesis was not supported as those Jamaican youth had similar and more positive attitudes towards seeking professional mental health. It was not as negative as they previously thought.  This is promising and asserts that formal mental health visibility could be integrated into schooling and could help in reducing stigma starting with younger generations. It could also help to have more positive outcomes in mental health help-seeking behaviors amongst the next generation of Jamaicans. 

As a Black, Jamaican- American woman who works in Public Health and as a future Global Health Educator, I am particularly interested in the development of this system in Jamaica. I have seen first hand how drug and alcohol abuse can ravage a community because of a lack of resources. I have seen how socio-economic factors lead to poor outcomes in education and health in Jamaica. I call on the governments of Jamaica both nationally and locally to invest into their communities’ mental health. With that they will certainly see more positive outcomes in mental health care and services.