00:00 Professor Rohan Maharaj, who made history by being the first ever professor of family medicine
00:05 at the University of the West Indies, says mental health in primary care appears differently,
00:10 in that it is more subtle than when it is seen at a level of psychiatry.
00:15 He says a common symptom like fatigue can at times be a sign of a mental health problem.
00:21 Based on a screening test conducted, Professor Maharaj states that
00:26 one third of patients reported fatigue, which researchers found to be coupled with
00:31 symptoms of depression.
00:32 And when you took these patients and you questioned them a little bit more,
00:36 this is what you found. Domestic violence, family stress, life stresses, divorce, work stress.
00:45 And one person had an existential problem. Why am I here? What's the purpose of life?
00:50 So you start off seeing a patient with fatigue and when you go a little further,
00:54 all of these very interesting sort of phenomenons are opening up to you.
00:58 He says depression was also linked to a lack of education,
01:02 medical problems, including pain, among other issues.
01:05 And interestingly, there was no ethnic link. So whether you're Afro-Trinidadian,
01:10 Indo-Trinidadian or mixed, the rates were the same in all three groups.
01:14 But once you put in things like education, that's where it really matters.
01:18 So some key points. This is important because if you're diabetic
01:22 and you have no energy or you're feeling depressed, you're not going to look after
01:26 yourself. You're not going to look after your diet.
01:28 And so, according to Professor Maharaj, treating the mental health problem first
01:33 can redound to being able to better treat with the other medical problems a patient has.
01:39 We looked at the presence of other types of psychiatric disorders within the
01:44 walk-in clinics and we found a range of them. People with hypochondriasis, somatoform disorder,
01:51 other depressive disorders and small rates with post-traumatic stress disorder.
01:56 He says that in those settings where patient flow can be heavy,
02:00 it can stymie doing the relevant investigations to identify the mental health problem,
02:05 leading to dissatisfaction by patients.
02:08 In terms of PTSD, the study found cases being linked to the death of loved ones
02:14 or people feeling that their safety and security were being threatened.
02:18 For the past two years, this country has experienced the highest murder rates recorded
02:23 in its history.
02:24 At that time, 2011, when this was published, we were seeing a lot of criminal issues in the
02:30 country and so this was having an impact on our patients.
02:33 Based on these studies, Professor Maharaj cites plans for the way forward that would
02:38 help medical practitioners better treat with mental health at the primary health care level.
02:44 We've developed some guidelines for the management of depression in the primary care for the region.
02:49 In the family medicine program, we have a six-week diploma course on recognizing and
02:54 managing common problems. We have that collection of readings that we've sort of put together as a
03:00 resource and within the masters of family medicine, which is in the postgraduate, the final
03:04 years of the postgraduate family medicine, the DM year, we don't have the MSc anymore.
03:09 We offer semester-long course on giving counseling to patients.
03:13 Alicia Boucher, TV6 News.
03:16 [BLANK_AUDIO]
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