Dr Benjamin Calls for Community-Based Mental Health Care to Replace Clarevue Model

Consultant psychiatrist Dr Griffin Benjamin has called for Antigua and Barbuda to move away from long-term institutional psychiatric care, arguing that replacing Clarevue Psychiatric Hospital must involve building comprehensive services that support people in their communities.

In a statement released on October 9 ahead of World Mental Health Day, Benjamin said reform must extend beyond closing an institution and include housing, family support, employment opportunities and accessible clinical care.

“Let us be clear, closing down Clarevue Psychiatric Hospital is not simply about closing a building or an institution,” he said. “It is about replacing it with something better.”

Benjamin, of Family Medical Clinic, argued that Antigua and Barbuda has fallen behind in developing community psychiatry while other Caribbean territories have integrated mental health treatment into their wider healthcare systems.

“While most of the world is transitioning from institution-based mental-health care to community-based models, we in Antigua are struggling, and we have not even started the process of community psychiatry,” he stated.

He cited Dominica and Montserrat as examples. According to Benjamin, Dominica had fully integrated mental health services into its primary healthcare and general hospital systems by 2011, while Montserrat constructed homes and community living centres for people with chronic mental illnesses in 2010.

His statement did not outline a timetable or funding plan for replacing Clarevue. Instead, it set out the services and principles he believes should guide a new national mental health system.

Central to his appeal was the involvement of people who have experienced mental illness, treatment, hospitalisation, stigma and recovery.

Reflecting on the theme cited in his message, “Lived Experiences Heard: Real Voices, Real Change,” Benjamin said listening must lead to changes in policy and service delivery.

“Behind every diagnosis there is a person, behind every person there is a story and behind every story there is a lived experience,” he said.

He described lived experience as a form of expertise that should complement medical knowledge, research and clinical practice.

Benjamin urged authorities to involve patients in designing services, assessing programmes and identifying what is working and what needs to change.

“Mental health services should not be designed simply for people. They should be designed with people,” he said.

The psychiatrist identified several areas requiring reform, including service design within the Ministry of Health, professional training at the Five Islands Campus, family involvement in hospital and clinic care, and responses to mental health emergencies at Sir Lester Bird Medical Centre.

He also called for stronger support through communities and health centres, arguing that mental health care must address the circumstances in which people live.

Benjamin pointed to poverty, homelessness, limited educational opportunities and unemployment as challenges affecting people with mental health conditions.

“Mental health does not exist in isolation from life,” he said. “It is lived in families, in schools, in workplaces and in our whole communities.”

He also urged healthcare professionals to avoid defining people solely by their diagnoses, stressing that patients have families, relationships, abilities and aspirations beyond their illness.

“As mental health professionals, we must never allow ourselves to become so familiar with illness that we forget the person,” he said. “We must never allow a diagnosis to become an identity.”

Benjamin concluded by calling for patients, families, professionals and policymakers to help shape the country’s future mental health services.

“I strongly recommend that we build our new national mental health care system together using our collective lived experiences,” he said.