O-36 Strengthening primary mental health care in Small Island Developing States: Lessons from the GGZ-Carib Participatory Action Research Project in Curaçao and Bonaire
Author(s):
E Hellings, M Griffith-Lendering, T Alberts, I Gerstenbluth
Year of Presentation:
2026
Objective: To evaluate the structure, accessibility, and utilisation of primary and specialist mental health services in
Curaçao and Bonaire, and to identify practical strategies for strengthening primary mental health care (PMHC) in Small
Island Developing States (SIDS).
Methods: A participatory action research (PAR) approach grounded in Appreciative Inquiry was applied. Quantitative data include: (1) Mental Health Insurance administrative claims data for outpatient mental health care in Curaçao (2018–2022), (2) General Practitioner (GP)/ Mental Health Practitioner Assistant pilot data from two Curaçao GP practices, (3) Mental Health Caribbean (MHC) service-use data on Bonaire, and (4) routine Mental Health Practice Assistant data from two Bonaire GP practices. Qualitative data consist of 44 semi-structured interviews with 48 participants and six stakeholder design and validation sessions. Quantitative data were analysed descriptively, and qualitative data were analysed thematically.
Results: In Curaçao, administrative claims data recorded 75,292 to 84,874 reimbursed outpatient mental health service contacts annually across four provider groups serving 7–8% of SVB-insured population. Independent psychologists saw the most clients (4,296–5,089 yearly), with youth making up 29-36% of their caseload. On Bonaire, MHC data showed a 192% increase in clients, from 350 in 2018 to 1,021 in 2023, about 4% of the population. GP Mental Health Practitioner Assistants (GPMHPA) services aided early intervention: in Curaçao (n=86), 74% of clients were discharged without specialist referral, and 54% improved; Bonaire’s GPMHPAs handled 329–336 new referrals annually. Both islands’ GPMHPAs provided accessible, culturally sensitive support, resolving many mild-to-moderate cases in primary care. Barriers included access issues, waiting times, fragmentation (Curaçao), workforce limits (Bonaire), stigma, language, and limited youth services.
Conclusion: Strengthening primary mental health care, especially by boosting GP Mental Health Practitioner Assistant capacity, enhancing triage and system navigation, and improving interorganizational collaboration, offers practical, scalable opportunities to improve mental health system performance in SIDS.