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Local mental health services challenged on all levels

— policy and operational

In his presentation on behavior health care, pertaining to mental health in American Samoa, Department of Health psychiatrist Dr. Peni Biukoto shared with participants in last week’s 7th Bilateral Health Summit of the two Samoas some of the challenges faced by the territory when it comes to mental health services.

Biukoto, who works at the Tafuna Community Health Center, said, “The reality is that Pacific island countries, like us, cannot reach the level of resources that other developing countries have.”  

Noting the summit’s theme, “Saving Time, Saving money, Saving Lives, ”he said, “So we have to think smarter and act smarter in terms of... intervention and programs that we implement in our different countries.”

The DoH psychiatrist explained the history of health services in the territory starting from the 1900s up to now with a new 10-bed Behavior Health Center in Fagaalu dedicated a few months ago. He also spoke of the territory’s health planning program and other relevant information over the years.

“In the absence of a health planning program in the territory,” he said, “money, time and manpower can be wasted in the provision of ineffective or inefficient services and programs.”

Biukoto went on to point out that the territorial health plan from 1982 to1986 had four goals related to mental illness and mental disability which “have been a concern of our leaders back several decades ago. And they have been trying over the decades to [resolve] this problem.” Among the goals: increasing the number of mentalally ill persons to be restored to productive living; and acute psychiatric inpatient and outpatient services to be provided at the LBJ Medical Center appropriate to the needs and resources of the territory.

He also discussed the “factors that influence service delivery in the territory” saying that “we rely mostly on federal funding to support the delivery of services” but federal regulations outline specific guidelines for the grantee to follow on the types of services that can be provided.

For example, when the psychiatric unit was located within LBJ hospital, it was within the US Center for Medicaid and Medicare Service guidelines, which “were very strict on what services can be provided for the psychiatric unit within an acute general hospital,” Biukoto said adding that “federal regulations govern the scope of funded services that can be provided within the community health centers.”

On the area of shortage of “human resources”, the psychiatrist said, “looking back over the history of health care services in the territory, this has always been a concern, it’s not a new concern, it has been there from the 60s and 70s and our leaders have tried several times to address this problem.”

Another issue on behavior health services, is the information that is available in order to make decisions at the policy level and at operational level, he said.

“So this is a challenge that we are striving to overcome,” Biukoto said. Collection of relevant data, collaboration of information, the sharing of information, and the analysis of the data, so that it can be used by our leaders to make decisions that will have good health outcomes for those who suffer from mental illness and mental disability.”

Two participants from Samoa later told Samoa News that the “human recourses” issue is something that many health care service providers in the Pacific are faced with.

“There is always a shortage of human resources and we make do with what we have,” said one participant. However, American Samoa is faced “with an additional” challenge because most of the funding for health service comes from the US government.

In his presentation, Biukoto told participants that the DoH community health centers now have “depression screening, we have alcohol and tobacco screening for each individual presented to the primary care clinic.” DoH works collaboratively with Department of Human and Social Service on alcohol and tobacco issues under a special program, which has been in place for the last four years.

Additionally, community health centers have started conducting depression screening, which is part of the screening measures. He says DoH is in the early process of screening, and with plans that by this time next year, “we have in place trained nurses assistants” to carry out “screening for depression among pre natal mothers.”

“In the future we want to establish and strengthen training of primary care staff... in evidence based behavior intervention,” he said. “We want to strengthen collaboration with other agencies and the community on health care practices. And we have to advocate to the leaders... the need to strengthen primary care.”