Exploring Community Perceptions of Mental Health and the State of Mental Health Services in Toledo, Belize

Background: Globally, mental health continues to be a crucial public health concern affecting populations across diverse settings. Provision and delivery of mental health services are particularly difficult in developing countries such as Belize due to persistent challenges related to culture, poor infrastructure, gaps in human capacity, and gaps in in-depth understanding of the issue. The Toledo district specifically has fewer resources and access to services when compared to the other districts in Belize. The proposed study aims to explore community perceptions of mental health and the current state of mental health services in Toledo, Belize. Given the dearth of literature on the state of mental health services in rural Belize, this study was completed to provide an environmental scan of mental health services access, utilization, and delivery in the community.

Methods: Using a community-based participatory research (CBPR) approach, we engaged the Toledo district community as active research participants in the study process. In close partnership with a local healthcare organization serving the community, staff members of the healthcare center (N=10) participated in 60-minute virtual interviews via the Zoom platform. The average age of the participants was 36.8 years. Majority of the participants (80%) were female and they worked as pharmacist, rehabilitation assistance, nurse, and intake specialist at the organization. A structured interview guide was used to elicit participant’s experiences serving patients with mental health concerns, their current perceptions of mental health among the Toledo community, and the impact of the COVID-19 pandemic on the mental health of the community. All interviews were video recorded and transcribed verbatim. Data was analyzed following the grounded theory principles and techniques: open coding, axial coding and selective coding with multiple rounds of coding and constant comparison.

Results: Five overarching themes were generated from data analysis: rising issue of mental health; cultural stigma; social issues and the impact on mental health; impact of COVI-19, and increased mental health supports. Results showed that health care providers in Toledo see mental health as an issue and feel uncertain of how to address it. They reported high levels of stigma and negative perceptions associated with mental health concerns. Participants identified depression, psychosis, alcohol and drug use, as well as domestic violence as rising concerns affecting mental health. Participants stated that the COVID-19 pandemic has been negatively impacting people’s mental health, most commonly due to job loss and financial strain. They identified an increase of awareness and understanding of what mental health is, as well as increased structural supports including increased providers, as solutions to increasing the well-being of community members.

Conclusion and Implications: Mental health continues to be an increasing issue in low- and middle-income countries, especially due to the impacts of COVID-19 on these communities. To our knowledge, this is the first investigation into the stakeholder views of mental health in Belize. This initial study shows the concerns healthcare workers have around the well-being of the community that warrant increased programming such as, awareness campaigns and an overall increase in mental health providers in the community.