World Health Organization Centre for Mental Health Research, Policy & Service Development Situational analysis of mental health needs and resources in Pacific Island countries University of New Zealand WHO HQ, Geneva WHO Regional Office for the Western Pacific Dr Frances Hughes Dr Michelle Funk Dr Xiangdong Wang Dr Mary Finlayson Ms Natalie Drew Dr Katherine Fritsch M. Patrick Firkin Dr Thomas Barrett January 2005 Contents 1. EXECUTIVE SUMMARY ........................................................................................... 1 1.1 INTRODUCTION ..................................................................................................... 1 1.2 PROGRAMME OUTLINE......................................................................................... 1 1.3 PROCESS .............................................................................................................. 2 1.5 PROGRAMME PILOT.............................................................................................. 2 1.4 OVERVIEW ............................................................................................................ 3 2. INTRODUCTION ......................................................................................................... 8 2.1 BACKGROUND....................................................................................................... 8 2.2 REPORT OUTLINE................................................................................................. 9 2.3 PROGRAMME OVERVIEW ..................................................................................... 9 2.3.1 Organisation................................................................................................... 9 2.3.2 Goals ............................................................................................................... 9 2.3.3 Objectives....................................................................................................... 9 2.3.4 Benefits ......................................................................................................... 10 2.3.5 Western Pacific Region ............................................................................. 10 3. PROCESS .................................................................................................................. 13 3.1 INTRODUCTION ................................................................................................... 13 3.2 CONTACTS DEVELOPMENT ................................................................................ 13 3.3 INFORMATION GATHERING AND ANALYSIS........................................................ 13 3.3.1 Overview....................................................................................................... 13 3.3.1.1 South Pacific Nursing Forum (SPNF) ................................................ 14 3.3.2 Documents ................................................................................................... 14 3.3.3 Interviews and Surveys.............................................................................. 15 3.3.4 South Pacific Nursing Forum Mental Health Workshop ...................... 15 3.4 ANALYSIS ............................................................................................................ 16 3.5 LIMITATIONS........................................................................................................ 16 3.6 CONCLUSION ...................................................................................................... 17 4. COUNTRY-BASED MENTAL HEALTH OVERVIEW........................................ 18 4.1 INTRODUCTION ................................................................................................... 18 4.2 MENTAL HEALTH ISSUES ................................................................................... 18 4.3 SITUATIONAL OVERVIEW.................................................................................... 19 4.3.1 Health Services Delivery and Organisation ........................................... 19 4.3.2 Governance.................................................................................................. 21 4.3.3 Financing ...................................................................................................... 21 4.3.4 Legislation .................................................................................................... 22 4.3.5 Policies, Plans and Programmes............................................................. 23 4.3.6 Workforce ..................................................................................................... 25 4.3.7 Services and Facilities ............................................................................... 30 4.3.8 NGO Involvement ....................................................................................... 37 4.4 SUMMARY ........................................................................................................... 39 5. COUNTRY-BASED HEALTH EDUCATION OVERVIEW................................. 44 5.1 INTRODUCTION ................................................................................................... 44 5.2 OVERVIEW .......................................................................................................... 44 5.2.1 Introduction .................................................................................................. 44 5.2.2 Commentary ................................................................................................ 47 5.2.3 Mental Health Related Training of the Primary Health Workforce..... 54 5.3 SUMMARY ........................................................................................................... 55 6. REGIONAL EDUCATION & COMMUNICATION OVERVIEW........................ 57 6.1 INTRODUCTION ................................................................................................... 57 6.2 TELEHEALTH ....................................................................................................... 57 Report to WHO on a Technical Support Programme for Mental Health Services Organisation in the Western Pacific 6.3 REGIONAL EDUCATION AND TRAINING.............................................................. 58 6.3.1 Introduction .................................................................................................. 58 6.3.2 Commentary ................................................................................................ 60 6.3.2.1 Secretariat of the Pacific Community (SPC)..................................... 60 6.3.2.2 Pacific Open Learning Health Network (POLHN) ............................ 61 6.3.2.3 University of the South Pacific (USP)................................................. 62 6.3.2.4 Fiji School of Medicine (FSM).............................................................. 63 6.3.2.5 National University of Samoa (NUS) .................................................. 64 6.3.2.6 University of Guam (UoG) .................................................................... 66 6.3.2.7 Pacific Resources for Education and Learning (PREL).................. 66 6.3.2.8 University of Papua New Guinea ........................................................ 66 6.4 WORKSHOP, INTERVIEW AND SURVEY OVERVIEW........................................... 66 6.4.1 Workshop Feedback on Education and Training.................................. 66 6.4.2 Programme Design, Modes of Learning and Support ......................... 66 6.5 SUMMARY................................................................................................................... 70 7. CONCLUSION ........................................................................................................... 72 7.1 INTRODUCTION ................................................................................................... 72 7.2 PILOTING THE PROGRAMME .............................................................................. 72 7.2.1 Piloting Overview ........................................................................................ 72 7.2.2 Criteria........................................................................................................... 73 7.2.3 Shortlist ......................................................................................................... 74 7.3 REPORT SUMMARY ............................................................................................ 74 APPENDIX A ....................................................................................................................... 79 INTERVIEW / SURVEY QUESTIONS ............................................................................ 79 APPENDIX B ....................................................................................................................... 80 COUNTRY PROFILES....................................................................................................... 80 COOK ISLANDS............................................................................................................. 81 FIJI .................................................................................................................................... 83 GUAM............................................................................................................................... 87 KIRIBATI .......................................................................................................................... 89 Tarawa Technical Institute......................................................................................