Mental health in the Solomon Islands: developing reforms and partnerships.

OBJECTIVES: The Solomon Islands face significant shortages and geographical imbalances in the distribution of skilled health workers and resources, which severely impact the delivery of mental health services. The government's Integrated Mental Health Service has emphasised the importance of greater community ownership and involvement in community-based mental health care, and of moving from centralised services to increased local and accessible care. METHODS: From 2012 to 2014, the Solomon Islands Integrated Mental Health service worked with Asia-Australia Mental Health to build workforce capacity and deliver sustainable community mental health programs. RESULTS: Supported by the Australian Aid Program's Public Sector Linkages Program, this project shared resources and fostered links between public sector agencies in Australia, Fiji and the Solomon Islands. CONCLUSIONS: Key learning points from the collaboration included the critical need to establish partnerships with community stakeholders, the importance of sustaining a well-functioning mental health team, and optimising the strengths of the local resources in the Solomon Islands. Through this project, national policies, promotion and service delivery were strengthened, through the exchange of experiences and mobilisation of north-south (Australia-Solomon Islands) and south-south (Solomon Islands-other Pacific nations) technical expertise. This project demonstrates the potential for international partnerships to contribute to the development of culturally-appropriate and integrated mental health services.

Mental health services in the Solomon Islands.

The Solomon Islands comprise an archipelago of nearly 1,000 islands and coral atolls and have an estimated population of 549,574 people. Formal mental health services date back to 1950 when an asylum was established. Since then the process of mental health service development has been largely one of incremental change, with a major boost to community services in the last two decades. During the 1990s a mental health outpatient clinic was established in Honiara, together with attempts to recruit nursing staff as psychiatric coordinators in the provinces. In 1996, the Ministry commenced sending registered nurses for psychiatric training in Papua New Guinea. By 2010, there were 13 psychiatric nurses and one psychiatrist, with a second psychiatrist in training. A National Mental Health Policy was drafted in 2009 but is yet to be endorsed by Cabinet. A significant portion of the population still turns to traditional healers or church leaders for purposes of healing, seeking help from Western medicine only after all other alternatives in the community have been exhausted. There is still a long way to go before mental health services are available, affordable and accessible to the whole population, including people living in geographically remote areas. Realization of this vision requires increased resourcing for mental health services; improved communication and collaboration between the centrally-based, national mental health services and the provincial health services; and closer, ongoing relationships between all stakeholders and partners, both locally and internationally.

Psychiatry in paradise - the Solomon Islands.

The Solomon Islands is situated in the South Pacific Ocean and is a low-income country. It comprises nearly 1000 islands with a total land area of 304 000 km2 spread over a sea area of about 1 500 000 km2, making communications, travel and service delivery difficult and creating inequities in access. The population of the Solomon Islands was estimated to be just over 580 000 in 2008, and is young, with 42% aged under 15 years (Solomon Islands Ministry of Health, 2006). The majority of the people are Melanesian (93%) and 98% of the population belong to a Christian church. The population is, though, extremely diverse, with 91 indigenous languages and dialects being spoken, in addition to the Solomon Islands pijin (the most common language) and English (the official national language). Over 83% of the population live in rural areas, where subsistence agriculture, fishing and food gathering are the main sources of income. There is no substantial tourist industry. The gross domestic product (GDP) is US$1.5 billion and annual per capita income is approximately US$2800 (International Monetary Fund, 2009). Total expenditure on health represented 5.6% of GDP but only 1% of the total health budget is allocated to mental health (World Health Organization, 2005).