ABSTRACT
This paper reviews the development of mental health services in the Cayman Islands throughout a twelve-year period (1989 to 2001). I was appointed the resident consultant psychiatrist to the islands in 1989, after which time a consultative process between the Ministry of Health, Senior Management of the George Town Hospital and myself allowed the development and establishment of a comprehensive community-based mental health service delivery system (MHSDS), specifically designed to suit the needs of the Cayman Islands. The components of the MHSDS and their evolution in the absence of adequate facilities are reported. The framework for the service is outlined, and the concerns and objectives of the MHSDS are discussed, along with short-term and long-term goals.