Therapy via the internet proposed as a solution for mental health care on St. Maarten
PHILIPSBURG — “Bringing mental health problems up for discussion is the best way to break the taboo surrounding mental illness,” says Fredericka Ford, CEO of Ethegrity Healthcare Consulting. Yesterday morning the consultant gave a presentation to Members of Parliament in a subcommittee on health matters chaired by MP Grisha Heyliger-Marten. Ethegrity wants to offer organizational advice for the Mental Health Foundation as well as telepsychiatry for the population of St. Maarten.
Two of the MPs took the opportunity to share their own struggles with depression and mood swings with the public. Chairman of Parliament MP Rolando Brison (UP) explained that while he was a student in the Netherlands, he was diagnosed with Borderline Personality Disorder, a mental health disorder that impacts the way you think and feel about yourself and others, causing problems functioning in everyday life. MP Ludmila Duncan (NA) said that she struggled with depression after the death of her baby, and can therefore well imagine that people who are less mentally strong than herself are slipping further. “I commend the committee members for personalizing the issue and sharing their stories,” said mental health consultant Ford. “This is how we move forward in addressing the stigmas surrounding mental health. Thanks to people who lead by example.”
The subcommittee meeting on public health matters, with a quorum of eight MPs present, was chaired by MP Grisha Heyliger-Marten (UP). She had requested the meeting herself. Before giving her presentation, Ms Ford expressed her condolences to the family of Caulette Julien, a 43-year old psychiatric patient who died in the isolation cell of the Mental Health Foundation in Cay Hill on August 25th. “I would like to extend my heartfelt sentiments to the family,” said Ford.
The American consultant started her presentation explaining that she has worked in Antigua as an advisor in the field of mental health. Her consultancy company has been operating since 2012. The name Ethegrity is a combination of Ethics and Integrity, “two of our core values”. One of the things she personally values is that “every individual deserves a second chance”. In identifying the prejudices that exist with regard to mental illness, she came to the conclusion that “often there are individuals who are suffering in silence.” They often don’t have an opportunity to reclaim their voice or be pillars, contributors in the community, she says. “We have really held with our mission and the culture of our organization, combining quality and ethics in the delivery of services in an equitable manner, as well as the integrity in the delivery of those services.”
During her assessment of mental health care in St. Maarten in 2019, Ford explains, she identified imperfections and challenges in the communication between the Inpatient facility of the Mental Health Foundation in Cay Hill and the outpatient services provided. “We have a group of senior healthcare operations and management experts. We have over one hundred years of health care professionals, combined, both clinical, medical as well as operational and financial consultants.” Among her team are specialty psychiatrists, says Ford. “During our assessment in 2019, one of the challenges that we identified was the access to providers. Just because St. Maarten is an island that doesn’t have all the specialists, that doesn’t mean that we can’t make their expertise available to individuals in St. Maarten that deserve the care.”
Ford proposes telepsychiatry, a subset of telemedicine, the process of providing health care from a distance through technology, often using videoconferencing. Psychiatrists would not come to St. Maarten to see patients but deliver services online. Through Ethegrity Ford aims to provide a range of services including psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management.
Ethegrity is a US based company. MP Claudius Buncamper wants to know what the cost of doing business will be. Ms. Ford was not able to provide Buncamper with an answer. “An assessment will need to be made,” she said, elaborating that she is merely a consultant. With that said, Ford answered Buncamper’s question on liability in case of medical failure, negligence or medical wrongdoing. In case of an overdose of medication, as is suspected to be the cause of death of an elderly patient of MHF last week in the ICU of the St Maarten Medical Center, Ethegrity Healthcare Consulting will not be held accountable.
The majority of the Members of Parliament present questioned whether Ethegrity can deliver services that match the culture of St. Maarten. Ms Ford referred to her work experience in Antigua and the temptations lurking in the Caribbean islands, especially during the Carnival period. She mentioned alcohol and drugs, and pointed out that partying is not the same for everyone. Stimulants can have an undesirable effect on some.
Is there a link between physical health and mental health, MP Omar Ottley (UP) wanted to know? Ms Ford points out that a holistic approach to mental illness is essential. “We not only look at a patient’s mental state, but also at his physical and medical condition. Diabetes, heart problems, diet and exercise can affect the psychological outcome. ” According to the consultant, the population of beautiful St. Maarten should enjoy the natural splendor of the island to the fullest by opting for exercise and locally grown food. “Healthy people make for a better economy.”
Based on the fact that ms Ford approached the government before, MP Brison asked: “What have you seen from the initial assessments you have done, what are the things that St. Maarten can do and should do better?” Ms Ford says she has concluded that the quality of care leaves something to be desired. In response to MP Angelique Roumou’s question, she does not want to go as far as to state that the staff of the Mental Health Foundation is insufficiently qualified for their task. But she noticed irregularities on her visit to the facility in Cay Hill last year, the consultant said. She is convinced that the medical experts she has at her disposal are of such a high level that they exceed the quality standards of the BIG Act and can make a big difference to mental health care on St Maarten.
MP Sarah Wescot-Williams wanted to know from Ms Ford what exactly is the role of Ethegrity? “We certainly have to do a comprehensive assessment,” Ford answered. At this point, she says, “it is a little bit challenging to say whether or not we would come in solely as a consultant, or we would come to provide all the operational support as well. But I did want to illustrate that we have the capability of both. ” She is aware of the budgetary constraints. “We are very mindful of that.”
Is Ms. Ford aware that there was a Mental Health Plan for 2014-2018, MP Wescot asks. Ford replies in the affirmative. She indicates that in 2019 she visited the site for the Mental Health Foundation’s new building. “The interim director (Eileen Healy, ed.) was making preparations to present her budget and there was some information that led us to believe that there was a need for additional services. Or a better way to evaluate the financial costs of providing those services. I know that there was some conversation of looking for a new site plan to construct a new building, so we understood that certainly was without having a full understanding of, operationally, how to arrange for it efficiently and effectively, those numbers may not accurately depict both the construction as well as the operation.”
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The Landsverordening regelende het toezicht op krankzinnigen Dutch and non-compliance by MHF, the Inspector General, the Minister of VSA and the Public Prosecution Service was not discussed during the meeting. Chairman of Parliament MP Rolando Brison indicated that he has shared related news articles within the parliament group chat. “Really terrible things, people losing their lives while being treated at the Mental Health Foundation,” he said. The news prompted MP Wescot-Williams to request a parliamentary meeting with the Minister of VSA and the management of the Mental Health Foundation. MP Grisha Heyliger-Marten confirmed that the email message had been received, and that the requested meeting will take place soon.
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