Working towards a paradigm shift in mental health: stakeholder perspectives on improving healthcare access for people with serious mental illnesses and chronic physical illnesses in Jamaica

The Jamaican public health system has incorporated mental health services into community-based primary care to improve healthcare access for people with serious mental illnesses (PWSMI), especially given global concerns about the high rate of comorbidity of chronic physical illnesses (CPI) among this population. Although it has been over twenty years since this strategy was implemented, there is a dearth of research into the views and experiences of stakeholders relating to this health system response. The current study sought to explore stakeholders’ perspectives and recommendations for improving the Jamaican public health system's response to healthcare access for PWSMI & CPI. A constructivist grounded theory approach was used to collect and analyse data from fifty-seven participants across six participant groups: health policymakers, primary care physicians, psychiatrists, mental health nurses, PWSMI & CPI and, their caregivers. The findings of the study identified one overarching category, “a paradigm shift in mental health” supported by six subthemes: (1) prioritise mental health, (2) reduce stigma and discrimination, (3) fill gaps in policies and practice, (4) address workforce issues, (5) improve health infrastructure and operations, and (6) respond to social needs. Findings highlighted a need for strategies that address social determinants of health inequalities such as stigma and discrimination as well as poverty to improve healthcare access. The paradigm shift in mental health will require greater financial and human resource investment in responding to these comorbid conditions and increased involvement of PWSMI and other stakeholders in strategies aimed at improving healthcare access and outcomes.