Seychelles is a country with an approximate area of 0.45 thousand sq. km. (UNO, 2001). The country is an archipelago consisting of more than 100 islands. Its population is 0.081 million, and the sex ratio (men per hundred women) is 97 (UNO, 2004). The proportion of population under the age of 15 years is 28% (UNO, 2004), and the proportion of population above the age of 60 years is 9% (WHO, 2004). The literacy rate is 91.4% for men and 92.3% for women (UNESCO/MoH, 2004).
The country is a higher middle income group country (based
on World Bank 2004 criteria). The proportion of health budget to GDP is 6%. The
per capita total expenditure on health is 770 international $, and the per
capita government expenditure on health is 525 international $ (WHO, 2004).
The main language(s) used in the country is (are) English, French and Seselwa. The largest ethnic group(s) is (are) Seychellois. The largest religious group(s) is (are) Roman Catholic (five-sixths). The life expectancy at birth is 67 years for males and 77.2 years for females (WHO, 2004). The healthy life expectancy at birth is 57 years for males and 65 years for females (WHO, 2004).
There is a paucity of epidemiological data on mental illnesses in Seychelles in internationally accessible literature. Myers and Davidson (1998) conducted a large controlled longitudinal study on the neurotoxicity of methylmercury in a population consuming seafood. No adverse associations were found in the Seychelles, where exposure is mainly from fish consumption. The study did not support the hypothesis that consumption of such fish during pregnancy places the fetus at increased neuro-developmental risk.
Mental Health Policy A mental health policy is present. The policy was initially formulated in 1992. The components of the policy are advocacy, promotion, prevention, treatment and rehabilitation. The policy was revised in 1995.
Substance Abuse Policy A substance abuse policy is absent. A National Alcohol Policy was formulated in 2003.
National Mental Health Programme A national mental health programme is present. The programme was formulated in 1989. The national mental health programme for the period 2000-2004 has been drafted for approval.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 2001. The essential drug list is being drafted. The essential drugs are compiled in the National Drug Formulary (NDF). The present NDF (Third Edition, 2000) is being reviewed and updated.
Mental Health Legislation The existing law on mental health, the Mental Treatment Act, has been reviewed and submitted for enactment in 2001. The latest legislation was enacted in 1906.
Mental Health Financing There are budget allocations for mental health. The country spends 2.8% of the total health budget on mental health.
The primary sources of mental health financing in descending order are tax based and private insurances. The health services are free of charge to every citizen. The country has disability benefits for persons with mental disorders. There are provisions for invalidity benefit by the social security funding.
Mental Health Facilities Mental health is a part of primary health care system. Actual treatment of severe mental disorders is not available at the primary level. Follow-up maintenance treatment is available with the support of the community psychiatry nurse along with other specialists and primary health workers. Since the return of the Seychellois psychiatrist in October 2003, the patients in the community are also being reviewed every 3 months by the psychiatrist.
Regular training of primary care professionals is carried out in the field of mental health. Training is provided to health workers as an ongoing continuous programme. Primary care doctors also attend seminars on mental health twice a year.
There are community care facilities for patients with mental disorders. Community care is provided by the community psychiatry nurse with help from the primary health care workers and other specialists.
Psychiatric Beds and Professionals
Total psychiatric beds per 10 000 population
Psychiatric beds in mental hospitals per 10 000 population
Psychiatric beds in general hospitals per 10 000 population
Psychiatric beds in other settings per 10 000 population
Number of psychiatrists per 100 000 population
Number of neurosurgeons per 100 000 population
Number of psychiatric nurses per 100 000 population
Number of neurologists per 100 000 population
Number of psychologists per 100 000 population
Number of social workers per 100 000 population
There are only 3 occupational therapists working in psychiatry though there is an established network of them. The social workers are employed by different ministries. One social worker is working in mental health. There is no medical school or university, so most of the doctors are expatriates. Since February 2004, an 18-month diploma course in mental health nursing was started. Twelve nurses are enrolled in the programme.
Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in advocacy, promotion and rehabilitation.
Information Gathering System There is mental health reporting system in the country. The country has data collection system or epidemiological study on mental health. Mental disorders are included in epidemiological morbidity data.
Programmes for Special Population The country has specific programmes for mental health for elderly and children. Support for the special population is available only when asked for and is not an outreach programme. There are also programmes for the mentally retarded.
Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: carbamazepine, ethosuximide, phenobarbital, phenytoin sodium, sodium valproate, amitriptyline, chlorpromazine, diazepam, haloperidol, lithium, carbidopa, levodopa.
Some drugs which are not there in the primary health care can be dispensed if prescribed by consultants.