Mental Health Services in the Dominican Republic from the Perspective of Health Care Providers

Background: Psychiatric disorders create a significant burden of disease in middle and low income countries.  Unfortunately, 80% of patients with severe mental illness do not receive necessary care.  The most comprehensive report on the state of mental health services in the Dominican Republic  is the WHO/PAHO report that pertains to data dating back to 2005. 

Objectives: The purpose of this research is 1) examine existing mental health care services in the Dominican Republic 2) Identify barriers to treatment and mental health services delivery; and 3) explore potential strategies to improve health services in the primary care health care setting and at a national policy level.

Procedures: Through referrals and word-of-mouth, a total of 36 health care workers were part of five initial interdisciplinary focus groups and subsequent follow-up interviews conducted six months later.  Participants included nurses, physicians in primary and specialty care, occupational therapists, psychologists, hospital and regional health administrators, government and non-governmental foundation officials. 

Results: Participants agreed that there was a lack of financial resources dedicated to mental health services, evidenced by the absence of day programs and supportive care to people with mental illness.  To date, there existed only one day treatment facility for the entire country.  Essential medications were not reliably distributed throughout the country to be adequate for long-term treatment.  Patient barriers to obtaining treatment included stigma and lack of resources.  Domestic violence was a huge public health problem that contributed to persistent mental illness. Health care professionals’ stigmatizing attitudes contributed greatly to poor quality care. 

Recommendations: From a policy perspective, mental health care should be integrated into primary care and coupled with interdisciplinary provider education to reduce stigma towards people with mental illness.  The government needs to recognize the health care burden of mental illness and domestic violence and allocate equitable and sufficient funding.