The Identification of Mental Health Perceptions and Concerns in Toledo, Belize

Background and Purpose: Belize is a small country in Central America, where the knowledge about mental health and the practice of mental health care are both very limited. In 2004, Belize formalized the use of psychiatric nurse practitioners (PNPs) to begin providing care to the most severe mental health concerns. However, with limited resources and underfunded services, mental health care is not readily available to those who need it, particularly in rural areas of the country. In the small, low-resourced community of Toledo, in southern Belize, only two PNPs serve the population, which has resulted in large caseloads and limited time to work with clients. Nonetheless, no prior research exists involving mental health concerns or care in Punta Gorda; therefore, this research aims to explore the current mental wellbeing of the population, the resources available, and desired supports to address concerns.

Methods: This mixed-methods research was facilitated through a partnership with a School of Social Work from the United States and a physical health care clinic in Toledo. The clinic currently provides physical health care but is interested in implementing mental health care services. Ten interviews were facilitated with staff from the clinic, and 165 surveys were completed with the community to measure generalized anxiety disorder, depression, and access to resources. The interviews were transcribed, and thematic analysis was used to identify themes in the data. The survey data were cleaned, and linear regression was used to determine trends of mental health needs. The qualitative and quantitative data were then merged to identify findings.

Results: The participants in this study shared that mental health care is not only needed but desired by the community. Individuals in the community experience high rates of anxiety, depression, isolation, and substance use. Women experience higher rates of isolation and depression, with limited opportunities outside of their homes. High rates of substance use persist amongst men in the community as well as high levels of financial stress. The data also exhibits that mental health concerns worsened after the Covid-19 pandemic. Nonetheless, a high level of stigma persists about mental health care, which results in individuals sharing feelings of shame about receiving services, yet still desire formal resources to receive care.

Conclusions and Implications: The findings of this work confirm a need for greater mental health services in Toledo, Belize. However, it is critical that the services are provided in a confidential manner where individuals can receive care without fear of talk or rumors about the care. This demonstrates the appropriateness of a physical health care facility providing mental health care since many individuals in the community already request the clinic. These findings illuminate that education about mental health is necessary for the community and staff at the clinic, and the next steps of this work are to include community-based interventions to decrease the stigma of mental health care. Additionally, the researchers plan to continue this work with the health clinic to identify best practices for providing mental health care in low-resourced communities.