The Island Republic of Fiji in the Western Pacific with 850,000 people has had a mental hospital since 1884, a medical school since 1885 and a Nursing School since 1893 and its largest general hospital the Colonial war Memorial Hospital (CWMH) was opened in 1923. The country has 19 general hospitals now and hundreds of community based clinics for general health care, 40 years after its independence. However there have been no decentralization of its mental health services until 2005 when gradually about 10 infrequently run mental clinics (from 1 per week to 1 per 3 months) were started outside of the St. Giles Mental Hospital. The stigma of mental illnesses is emphasized by the location of the mental hospital next to a large prison, a graveyard and a rubbish dump.
The 1978 mental treatment law was replaced by a new Mental Health Decree in October 2010 that allows by 1 July 2011, for 3 Divisional level mental health units in Divisional hospitals in Labasa, Suva and Lautoka. With the Decree in place the Minster of Health Dr. Neil Sharma and the Dean of the Fiji School of Medicine Prof. Ian Rouse embarked on a partnership to reform mental health in Fiji in 2011. The programme of reform included hiring a consultant and help in the starting of the 3 Stress Management wards, a Stress Management Clinic, and 2 Stress Management Day Rehabilitation Centres in Suva and Lautoka cities. The term Stress Management Ward was chosen to de-stigmatize mental health and illnesses in the minds of patients, students and health care workers - as well as the public, in that order. Along with these developments a Fiji Alliance for Mental Health was launched by Fiji’s First lady on 10th March 2011. The FAMH has applied for membership of the Asian Federation of Psychiatric associations (AFPA) and the WPA. Major revamps in the teaching of psychiatry to nurses, and medical students have started with the coming move to the stress management wards and clinic and day Centres. Over 80 training sessions for doctors, psychiatrists, nurses, GPs and the public and FAMH members were conducted over 3 months from February to May 2011 throughout Fiji.
Coming on stream are another Stress management ward in Lautoka in June 2011 and research project on epidemiology and postgraduate diploma courses for nurses and doctors in 2012 at the Fiji School of Medicine. There are plans to get voluntary teachers in post graduate psychiatry from Taiwan, India, Malaysia and Australia. The Paradigm shift in Mental Health in Fiji in just 9 months may be a model other low income countries in other parts of the Pacific and the world.
Dr. M. Parameshvara Deva, FRANZCP, FRCPsych, FAMM
Visiting Professor of Psychiatry, Fiji School of Medicine, Fiji
Chairman WPA Section on Psychiatry in Developing Countries