< PreviousCall or email us to set up your appointment: Monday to Friday, 9:00am – 6:00pm Main: 345-745-6463 Fax: 345-745-6466 Email: info@oncourse.ky Web: www.oncourse.ky CONTACT US Suite 130 Windward 1, Regatta Office Park, West Bay, Grand Cayman, KY1-1208 SERVICES RENDERED: • Individual and Group Psychotherapy: CBT, DBT, ACT, Solution-Focused, Parent Management Training • Therapeutic Interventions for: Anxiety, Depression, Bipolar Disorder, PTSD, Substance Abuse, ADHD, Personality Disorders, Career Counselling, and more • Psychological, Psycho-Educational, and Psycho-Legal Assessments • Corporate Training and Workshops: Communication, Team Building, Mindfulness, Crisis Support, Mental Health in the Workplace, and more • Equine-Assisted Psychotherapy: Therapeutic activities with horsesMENTAL HEALTH caymanhealth.com39With the pressures of the COVID-19 crisis on mental well-being, Cayman Health shines the spotlight on the issues being faced by men. Two experts on men’s mental health are psychiatrist Dr. Marc Lockhart, chairman of the Cayman Islands Mental Health Commission, and Dr. Stenette Davis, psychiatrist at the Health Services Authority. Here, they talk about the risks, symptoms and treatment of this often overlooked issue. DR. LOCKHART What are the some of the pressures that men in the Cayman Islands and across the wider region are facing? The socialisation of boys and men to ‘be strong’, with the expectation that being strong means suppressing emotions, feelings and asking for help, has contributed significantly to the manifestation, onset, and complexity of men’s mental health challenges. In societies where a hyper- masculinised approach to maleness is held as a norm, mental health challenges can be more insidious, with complex presentations. What are the symptoms that family members/friends should look out for? Challenges with financial stability, especially during an economic downturn, like the COVID-19 pandemic, along with cultural expectations of the male being the ‘breadwinner’ and ‘head of household’, complicates how men cope with self-doubt, MEN’S MENTAL HEALTH Cayman Health 2021 MENTAL HEALTH 4 0appraise self-esteem and seek comfort and guidance. Symptoms consistent with reduced ability to perform tasks needed to cope with the normal stresses of life should be a cue that something is amiss. This includes a change in mood, with men experiencing not just periods of sadness and depression, but irritability, anger and short-tempered episodes. Reduced enjoyment in activities, disturbances with sleep, appetite, including decreases or increases with both, changes with thinking, unusual beliefs, preoccupations or activities with any increased use of alcohol or other substances, are some of the symptoms that family and friends should look out for. At what point should men themselves seek help? A man should seek help when he fi nds diffi culty coping with the normal stressors of daily life and that he is not living up to his full potential. A discussion with a primary care physician is a good starting point if any of the aforementioned symptoms are noticed by the person or a loved one. Taking the discussion seriously and persisting with recommended interventions is extremely important, as earlier intervention can forestall a more complicated onset of illness. How important is the new mental health facility in East End going to be for men’s mental health (along with other mental health patients, in general)? While the facilities at the HSA provide a wide range of services, an area of continued need is for those with serious and chronic illness requiring longer term treatment. Efforts are underway by the Cayman Islands Government to complete the construction of a therapeutic community facility in East End by the end of 2021. This facility will play a vital role in the continuum of care and provide a missing component that is required for reducing the burden of disease. This facility will be instrumental in providing the compassionate, evidenced-based rehabilitative, occupational and social skills rebuilding vital for those with serious and persistent disorders. This includes a large segment of men with chronic and serious disorders. What is the greatest piece of advice you give to anyone facing mental health challenges? The best advice that I would give, based on more than 20 years of practice, is to seek guidance or help early. Do not feed denial, if you or a family member is having changes in mood or behaviours that are affecting functioning, social interaction, work or school pursuits, then talk with a professional. Dr. Lockhart (right) looks at plans for the mental health facility in East End. caymanhealth.com41Cont. from p41 This can include your family doctor, school counsellor, therapist, psychiatrist, or a spiritual or religious advisor. Care and consultation provide confi dentiality without stigma. Interventions to re-stabilise mental health challenges come in many different forms: talk therapy, occupational therapy, intensive psychotherapy, medication assistance, cognitive assessments and other emerging and novel treatments. DR. DAVIS There are risk factors for mental illness that are ubiquitous and sets up Caribbean men for mental illness, just like other nationalities. A growing trend in Caribbean men is an education defi cit and, as such, a growing number of men are unemployed or have low- income jobs. Financial distress is an invariable stressor. Loneliness is an under-reported problem as Caribbean men are not traditionally taught to talk about their feelings. This means men socialise to displace their feelings but do not address it; this creates a disconnect of being alone in a crowd. Stigma is also an overwhelming force where men feel that their manhood is challenged if they were to admit to having symptoms of mental illness. Outside of mental health personnel, other medical practitioners are less likely to screen males for mental illness. Women are also more likely to be supported if they become mentally ill. Males are disproportionally homeless if they develop serious mental illness like schizophrenia. All of the above creates barriers for men to access treatment until their symptoms become overt or seriously impact their lives. What kind of stigma is attached to mental health issues in Caribbean culture, how diffi cult is it to overcome and what is being done to do so? A large portion of Caribbean folks still attribute mental health issues to spiritual cause or witchcraft. There is still a belief that mental illness is a result of mental inferiority or weakness. There is also unreasonable fear of being harmed, or wondering if the person will ‘fl ip out’. Oftentimes, employers do not want mentally ill persons in the workplace, automatically assuming they are not fi t for work. Are you seeing that the COVID pandemic is adding challenges to men’s mental health? COVID has increased the amount of clients being seen for anxiety, depression and, of concern, suicidal thoughts. There has also been an uptick in persons starting to use drugs excessively, or persons who were recovering addicts relapsing. Can you give some self-help tips and practices for men if they are feeling under pressure, to help ease mental health strain? • Firstly, admit there is a problem. • Learn to identify the emotion you are feeling and the thought going with emotion. • Next step: ask is this true or just the way I feel? • What is a more useful thought that helps me move forward? • Exercise 30 to 45 mins at least three times per week, especially with friends. • Practise deep breathing. Dr Stenette Davis Cayman Health 2021 MENTAL HEALTH 42• Do not smoke or use other drugs to manage emotion. • Seek a mental health professional. Alex Panton Foundation e: info@alexapantonfoundation.ky w: alexpantonfoundation.ky Alcoholics Anonymous Cayman Islands t: AA hotline 926-9044 w: caymanaa.org Alzheimer’s and Dementia Association of the Cayman Islands t: 924-4170 e: info@adacayman.com Bethseda Counselling Centre t: 923-6488 w: caymanetherapy.com Caribbean Haven Residential Centre t: 947-9992 w: dcs.gov.ky/chrc Cayman Island Crisis Centre t: 949-0366 t: 24-hour crisis line 1-800-534-2422 e: info@ciccc.ky w: cicc.ky Cayman NA (Narcotics Anonymous) t: Helpline 349-929-NANA (6262) The Counselling Centre t: 949-8789 e: counselling.services@gov.ky Day Hospital Programme (Occupational Therapy) Health Services Authority t: 949-8600 e info@hsa.ky Emergency Services t: 9-1-1 Employee Assistance Programme of the Cayman Islands t: 949-9559 w: eapcayman.com/#contact Family Resource Centre t: 949-0006 e: frc@gov.ky Grand Cayman Al-Anon t: (345) 928-8843 w: caymanalanon.com Health Services Authority t: 949-8600 t: 948-2243 (Cayman Brac) e: info@hsa.ky Infinite Mindcare t: 926-0882 w: infinitemindcare.com Loud Silent Voices t: 922-3847 Mental Health Helpline (free and confidential support) t: 1-800 534 6463 OnCourse Cayman t: 745-6463 w: oncoursecayman.com WHERE TO SEEK HELP caymanhealth.com43Animal-assisted therapy is a growing field that can help with a range of physical, emotional and mental health challenges. In Cayman, two programmes tap into the therapeutic benefits of animals: Healing Paws and Equine- Assisted Psychotherapy (EAP). HEALING PAWS Healing Paws is a volunteer organisation that uses therapy dogs to provide comfort and support in a variety of settings, such as schools, hospitals and nursing homes. Therapy dogs are trained to help people cope with a range of emotional issues, or can simply brighten someone’s day during visits. “Animals have wonderful healing skills,” says Dr. Denise Osterloh, medical director of Healing Paws. “We have seen through this programme that positive human-animal interactions have improved the physical, emotional and psychological lives of those we have served.” Healing Paws therapy dogs and their handlers work with such groups as the Special Needs Foundation, Lighthouse School and The Pines Retirement Home. “We have seen our therapy teams give unconditional love, boost self-esteem and relieve loneliness and boredom,” says Dr. Osterloh. “Therapy animals involved with children result in helping them learn empathy and nurturing skills.” Therapy dogs can also improve a patient’s mindset and reduce the perception of pain. “Often, the presence of a therapy animal improves a patient’s outlook with respect to their illness – they provide an escape from the pain they may be in by providing comfort,” added Dr. Osterloh. Launched on a small scale in 2011, she joined Healing Paws more than four years ago, working with Tracy Stone, Fiona Graham, and dog trainer Heidi Suarez to build the programme. THERAPY ANIMALS BOOST WELL-BEING Cayman Health 2021 MENTAL HEALTH 44“We decided to make Healing Paws more of a programme in which we could start training other people with their dogs to be able to use pet therapy as an instrument of rehabilitation and therapeutic modality in the Cayman Islands,” she says. EQUINE-ASSISTED PSYCHOTHERAPY (EAP) Equine-assisted psychotherapy incorporates horses into the therapeutic process. “The therapeutic benefits of interacting with animals is well- documented but (EAP) takes the work with the animals to a deeper level,” says Dr. Alexandra Bodden, whose clinic OnCourse Cayman offers EAP co-facilitated by Shanna Pandohie, equine specialist and owner of Cowboy Town Stables. OnCourse Cayman offers EAP through the Equine Assisted Growth and Learning Association (EAGALA) model, where a mental health professional and an equine specialist work with the client in the arena. “Whatever happens in people’s lives tends to also play out in the arena,” says Dr. Bodden. The model involves only ground-level work, no riding, so that the horses can freely respond. Horses are keen observers, and often mirror a client’s behaviour or emotions. “This is what makes them great for therapy as they will respond to persons as they feel and perceive them, providing genuine, in-the- moment feedback,” says Dr. Bodden. This form of therapy can be helpful for emotional or relationship difficulties, as well as those coping with trauma or addiction. “When persons (or teams) are open to the work with the horses, they often learn a lot about themselves,” says Dr. Bodden. “It is such a novel experience that people often continue to develop insights even days or weeks after the session.” caymanhealth.com45HEALTH ADMINISTRATION AND POLICY Cayman Health 2021 46Health insurance is required by law for all residents in the Cayman Islands. It can be purchased on an individual or family basis or through an employer’s group plan. Health insurance plans are based around the Health Insurance laws and regulations. The Health Insurance Commission and Cayman Islands Monetary Authority license and regulate the health insurance companies. Health insurance must be obtained through an approved health insurance company. The Health Insurance Law (2013 Revision) mandates that every person needs to be covered by no less than the basic plan of coverage, which is called the Standard Health Insurance Contract (SHIC). Employers are obligated, at minimum, to provide a basic insurance plan for all their employees – regardless of the type or length of their work permits. The employer is required to pay 50% of the premium for the SHIC plan, and the employee pays the other 50%. The law also states that the employer is responsible for providing health insurance coverage for the employee’s dependents. However, the employer is not required to pay the premium for them, and usually deduct those amounts through the employee’s pay cheque or as arranged with the employee. A self-employed person is required to provide insurance cover for themselves and their dependents in the same way they would be required to provide cover for their employees. If employment is ended, the employer is required to continue to provide the ex- employee access to cover (but not contribute to the premium) for three months after the end of their employment. An employer who fails to do this is in breach of the law. HEALTH INSURANCE IN THE CAYMAN ISLANDS caymanhealth.com47Next >