GIFF JOHNSON
Expansion of services is happening in a health program that has often been ignored or put on the back burner when the government budgets are allocated.
I’m talking about the Human Services/Mental Health program at the Ministry of Health and Human Services.
Over the past decade, the program has variously suffered from relatively little funding, under-staffing, a US shutoff of essential mental health-related money that had nothing to do with the hospital’s operation, and only one medical doctor trained in the field of psychiatry.
A lot of that has begun to change.
- For a period earlier this year, the mental health program had three medical doctors on staff who were trained in the field, allowing the program to begin expanding patient services and develop new policies to support their work.
- Increased synergy through partnerships with the Ministry of Education’s Public School System for referral of students with autism or other neurological issues for evaluation and follow up as needed.
- Partnership with the Marshall Islands Social Security Administration to evaluate everyone with possible physical or mental health disabilities who applies for the new social protection program that is to provide $100 per month to those with certified disabilities.
A new development for the Mental Health program was the presence of Dr. Colby Lea, a visiting psychiatrist from the United States, for a two month period at the beginning of this year. He joined the team of Dr. Holden Nena, who directs the program, and Dr. Adri Hicking.
Having three medical specialists with the program “allowed us time to sit down and work over issues,” said Dr. Holden.
The program is moving to gain approval for the use of medication for effective alcohol and drug intervention treatment, is in the final stages of rolling out a “psychiatric advance directive” policy giving patients control over treatment plans, developing a suicide prevention policy, upgrading the skills of nurses and counselors working in the Behavioral Health Clinic, and expanding community engagement with staff working at clinics in Laura and Woja one day per week as well as participating in training community health workers.
Dr. Colby, who was the first-ever psychiatric resident physical to work here, observed that the Majuro community “is lucky to have Dr. Holden” for this program. “Dr. Holden is extremely dedicated. He has no operating money but still manages to do outreach and community services.”
He praised both Dr. Holden and Dr. Adri for the quality of their work.
The way the Human Services program has worked since the 1980s is the RMI government funds staff salaries, while US federal grants have supported operations. A decision by the US Department of Health and Human Services cutting off a major mental health grant five years ago due to audits red flagging mismanagement and possible misuse of funds by an NGO associated with the Ministry of Finance’s Single State Agency has hampered Human Services by removing key sources of operations funding.
Despite meager resources, Human Services has been successful in adding additional nursing staff and counselors. Dr. Holden has concentrated on professional development for the staff to expand their ability to understand and diagnose different neurological conditions.
Dr. Adri said they see a lot of patients with autism or behaviors similar to autism. “Now the staff know how to evaluate conditions,” he said.
With new partnerships with PSS helping to connect families and students with professionals, Human Services is seeing a bigger flow of parents bringing children in for evaluation. An open autism screening day late last month saw 26 children receiving screenings.
In addition, the launch of the RMI government’s new social protection program of providing $100 per month to people with disabilities now involves Human Services’ Behavioral Health Clinic. All people applying for the disability payments must be evaluated at the clinic. Their doctors and nurses are also using it as an opportunity to screen people for mental health disorders.
As a result of this work, Dr. Holden said many more patients have been identified with autism, epilepsy, schizophrenia and other neurological issues.
Both Dr. Holden and Dr. Adri commented on the need to “de-stigmatize” mental health in the RMI. “It’s still a struggle to talk about mental health (in public),” said Dr. Adri. “But it’s important to stand in public and discuss it.”
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