DEVELOPMENT OF PSYCHOLOGY AND

PSYCHIATRY IN
TRINIDAD AND TOBAGO

Siobhan Burroughs

Introduction emotional, biological, psychological, social, and

behavioural aspects ofhurnan functioning across

hi"ori~l
the life span in varying cultures and at all socio-

(7J ill, p"P<",=i,,, <he

development and relationship
economic levels" (American Psychological
Association 2008).

between psychology and psy- Psychiatry on the other hand refers to the
chiatry in Trinidad and Tobago as well the medical specialty concerned with the diagnosis
influence that psychology has had on both the and treatment of mental disorders (Stedman'S
private and public sectors. However, it begins Medical Dictionaty 2005). The national Mental
by first examining the general relationship HealthAct of 1975 defines a mental disorder as
between psychiatry and psychology then looks a mental illness; arrested or incomplete
more specifically at the case of Trinidad and development of mind. In specific terms, a mental
Tobago. illness means the condition of mind of a mentally
ill person, that is, a person who is suffering from
Psychology and Psychiatry such a disorder of mind that he or she requires
care, supervision, treatment and control, or any
Myers (2007) defines Psychj)logy as the of them for his or her own protection or the
scientific study of behaviour (anything an welfare of others (The Mental Health Act of
organism does) and mental processes (the 1975).
subjective experiences inferred from behaviour).
There are many sub-divisions of psychology The field of psychiatry is much older than
which include: clinical , counseling, the field of psychology. In Trinidad and Tobago,
developmental, social, occupational, school , clinical psychology has been significantly
forensic and neuropsychology. For the purpose influenced by psychiatry. A close relationship
of this paper, reference will be made to the therefore exists between them. TIlls relationship
field ofclinical psychology. "Clinical psychology between psychology and psychiatry will be
is the field ofpsychology that integrates science, examined by looking at the similarities and
theory, and practice to understand, predict and differences between them.
alleviate maladjustment, disability and
discomfort, as well as to promote human Initially, both psychology and psychiatry
adaptation, adjustment and personal were concerned with the problems of mental
development. It focuses on the intellectual, health. M ental health describes a level of

-
cognitive or emotional well being or the absence to the treatment of disorders. Psychiatry is based
of a mental disorder. Psychology and psychiatry on medicine and therefore the treatment of these
do not differ in terms of who or what they study. disorders tends to focus on the use of medication.
They generally investigate the same mental Psychiatry searches the brain and biological
illnesses, such as mood disorders, anxiety mechanisms for mental illnesses (American
disorders, schizophrenia, impulse control Journal of Psychiatry 1997) and explains the
disorders, adjustment disorders, and substance- symptoms of mental disorders, (for example,
related disorders. Therefore, their target hallucinations or delusions) in biological terms
population as well as the mental disorders and because the activities of the mind are believed
the symptoms that are displayed, are the same. to be reflected in these symptoms. Psychologists
In addition, both clinical psychologists and also acknowledge the biological etiology of some
psychiatrists are trained in clinical settings. In mental disorders but also recognize that other
fact, some clinical training occurs in psychiatric factors, such as psychological, emotional, social
inpatient settings under the supervision of and behavioural factors can also precipitate a
psychiatrists. Moreover, diagnoses of mental mental disorder.
disorders are based on the Diagnostic and
Statistical Manual (DSM), which is psychiatry's In treating these disorders they thus apply
classification system. This further contributes to "psychological principles to change habits,
psychiatry's influence on the field ofpsychology. behaviors, and lifestyles that increase the risk
Moreover, these professions have made for a number of illnesses" (Brentar & Mc
significant contributions to the diagnosis and Narnara 1991). Psychology is more research-
treatment of mental disorders as they have both oriented than psychiatry. Training in research
developed many new techniques and enables psychologists to assess the effectiveness
approaches, which have resulted in a wider of different kinds of treatment by analyzing
understanding of mental disorders as well as an information and drawing conclusions from
increase in areas of application and positive psychotherapy' sessions. Psychologists undergo
results (Menninger 1949). more intensive training in therapeutic approaches
than psychiatrists. This "training provides an
Despite their similarities, there are some introduction into investigative techniques as well
marked differences. Firstly, psychiatrists are as the experimental method, while the great
medical doctors whilst psychologists are not. majority of psychiatrists have had no such
The suffix "-iatry" means "medical treatment," opportunity" (Menninger 1949).
and '(-logy" means "science" or "theory,"
Therefore, psychiatry is the medical treatment Psychiatrists on the other hand, alter "the
of the psyche, and psychology is the science of psyche by prescribing medication but also
the psyche (Downs 2004). Psychology and modulates the psyche with psychotherapies that
psychiatry thus differ in terms of their approach address mind mechanisms, such as memory or

, Psychotherapy involves anwnber of treatment techniques, (such as individual and group

therapy) that help individuals with mental disorders understand the behaviours, emotions and ideas that
contribute to their illness; understand and identify life's problems; regain control over their lives; and

..
learn coping techniques and problem solving skills (WebMD Medical Reference 2008) .
consciousness." "This modulation works at the Research suggests that both psychology
neural level by producing changes in the brain" (psychotherapy) and psychiatry (pharmaco-
(American Journal of Psychiatry 1997). therapy) may be equally effective in the treat-
However, psychologists argue that medication ment of mental illnesses, for example acute
promotes a "disease model of mental illness" depression (Di Mascio et al. 1979; Weissman
(Brentar & Mc Namara 1991). They maintain et al. 1979). However, the combination of
that drugs do not deal with the underlying expertise can enable the client / patient to
psychological disorder but merely masks the receive holistic treatment. This is suppcrted by
presenting symptoms, which are then substituted researchers who found that psychotherapy in
for other symptoms because the cause of the combination with pharmacotherapy may
problem still exists. improve functioning and decrease relapse rates
in people suffering from depression (Di Mascio
Clinical psychology and psychiatry are et al. 1979; Frank & Kupfer 1987; Weissman
engaged in a mutually cooperative enterprise. et al. 1974) and schizophrenia (for example,
They both fonn part of a clinical tearn along with Falloon et al. 1982; Hogarty et al. 1986).
other mental health providers. They both share
their perspectives about specific cases, based Psychology in Trinidad and Tobago
on their training and experience, to help alleviate
the distress and disability caused by mental Trinidad and Tobago is a twin island
illness. Generally, when psychologists see a republic, which lies in the Caribbean Sea off the
patient that could benefit from medication, the north coast of Venezuela. The practice of
psychologist refers the patient to the psychiatrist. psychology in Trinidad and Tobago has been
The converse is also true, as a psychiatrist would (and still is) significantly influenced by the
refer a patient he or she deems to be in need of practice of psychiatry. Therefore , the
psychotherapy or psychological testing. development of psychology in Trinidad and
Tobago will be examined in part by investigating
Despite the strong influence psychiatry has the development of psychiatry in Trinidad and
had on the development of psychology, the Tobago.
contribution made by clinical psychology has
been critical to the "best practice of psychiatry" The practice ofpsychology and psychiatry
(Menninger 1949). Clinical psychology has in Trinidad and Tobago has been influenced by
made a major contribution to the practice of the country's rich history. "The influx of many
clinical psychiatry by the development and colonizing forces and cultures over the past 500
application of various personality tests years have resulted in interesting culturally based
(Menninger 1949). Menninger (1949,14-15) treatment modalities emerging from the collective
maintained that "the diagnostic function of the unconscious of its people" (Maharajh &
psychologist is now so well established in Parasram 1999).
psychiatry that the competent psychiatrist would
no more exclude the special techniques of the According to Maharajh & Parasram
psychologist in his diagnostic studies than would (1999), western psychiatry was introduced to
a capable internist routinely exclude the findings Trinidad and Tobago over 150 years ago, yet
of the roentgenologist." a clear distinction still cannot be found with
respect to psychiatry and traditional practices,

-
such as religion. Psychiatry and psychology by nationality also brought their religious practices
extension is thus characterized by a "unique to Trinidad and the freed slaves practiced their
blend of third world traditional practices and native customs.
scientific knowledge." Attempts that were made
to separate psychiatry in terms of science and The cultural influence that the colonizing
religion were opposed. Cox (1996) explained nations brought was also important to
that this may be due to the view that separation understand the history of these twin isles. Whilst
was a "peculiarly western phenomenon." Ful- Trinidad changed hands among the Spanish,
ford (1996) also purported that whilst psychiatry French and the British; Tobago changed hands
has a scientific basis, it remains an overtly value- more than 30 times among the English, French,
laden discipline, which may be closer to religion Dutch and even Corianders (Latvians). Tobago
than other branches of medicine. was won by Britain in 1814 and Trinidad and
Tobago were joined in 1889. They achieved
Trinidad and Tobago were joined in 1889 Independence from Britain in 1962 and became
and while they have a similar history, they do a Republic in 1976. The similarities in their
have differences. Before 1498, a period referred history helps one to understand the culture of
to as the Pre-Columbian period, the earliest the region but the differences in their cultural
known treatment for mental disorders was influences enable one to appreciate the sub-
documented. The Carib and the Arawak tribes cultural differences in the islands.
(the indigenous Amerindians) had devised their
own form of herbal medicine to treat mental These different religious practices and
disorders (Maharajh & Parasram 1999). These cultural influences created a Wlique environment
treatments also reflected their interaction with for the birth of Western psychiatry. "A system
the spirit world. According to Beaubrun et al. oftreatrnent was employed utilizing behaviour
(1976), they called the mentally ill "mind-riven" modification based on adherence to religious
and attended them with lavings and unguents and cultural norms. Out of this system, the
while singing and with salvent herbs, which they modem day village councils were born. Thus
also blended with food and left hanging on the priest, pundit, imam and obeah man remain
fruiting trees for those that wander. today the first contact for the majority of patients
suffering from mental illnesses" (Maharajh &
During the period of colonization (1498- Parasram 1999).
1797), the incidence of Negro slavery and the
influx of Catholics who settled in Trinidad, The Academic Development of Psychology
resulted in a religious melting pot of African
practices, Aboriginal (native) practices and Internationally, "Psychology is a well-
Christian practices. These different religious developed discipline with an incredible
influences fueled the growth of superstition, history" It is among those courses with the
sorcery and obeah practices in Trinidad. The highest demand for enrollment in universities.
period from 1797 to 1962 was characterized "Hence most Wliversities around the globe have
by the emancipation of slavery; large-scale incorporated faculties, schools and research
immigration from India, China and Madeira of institutions specifically dedicated to its study"
indentured labour and the establishment of (Ramdhanie 1999). However, "throughout the
westem psychiatry in Trinidad and Tobago. Each English-speaking Caribbean for most of the

..
1960s through the 1980s, psychology had been (M .Phil) and Doctoral (ph.D) levels. Therefore,
"grossly neglected" as an academic discipline no "pure" Psychology undergraduate or
and "largely unpracticed" as a profession graduate programme was available during this
(Ramdhanie 1999). period. Moreover, no provisions were made for
the conducting ofpsychological research, which
During an interview with Dr. Ramesh is especially impertant at the graduate level.
Deosaran, Professor of Criminology and Social
Psychology, he revealed that prior to 1999, Research in psychology is facilitated by
"society was relatively naive about psychology. a psychological laboratory. Courses in
They saw psychology in terms of horoscopes psychology typically have a laboratory
and reading palms, and felt that they could watch compenent, which enables students to familiarize
somebody's face and see what destiny they had, themselves with "well-established research on
if they are lucky or fortunate. Psychology was in human behaviour in a controlled setting"
the realm of superstitions and predictions. It was (Ramdhanie 1999). "Students, especially
popular psychology, faddish as beamed from graduate students, with access to such research
popular magazines" (Ramdhanie 1999). facilities would have also been able to under-
take innovative research, which may have led to
All three Campuses of the University of the important discoveries , developments,
West Indies (St. Augustine, Trinidad; Mona, confirmations, or refutations" (Ramdhanie
Jamaica and Cave Hill, Barbados) did not offer 1999). This would significantly have led to the
adequate graduate degree programmes in positive development of psychology in the
psychology (Ramdhanie 1999). Those interested Caribbean as well as international recognition
in pursuing a psychology programme at that time for the University of the West Indies. The
would have had to go to a foreign university. practice of psychology was therefore not
TIlls training however, put them at a disadvantage supported by local research because the
for adequately dealing with local issues because opportunities and facilities for local research
of the differences in theoretical frameworks, were absent. This resulted in a lack of
standards and formats received aboard psychological research or contribution to social
(Ramdhanie 1999). and even economic policies.

While psychology programmes were well Dr. Deosaran was instrumental in bringing
established throughout Departments of about changes that would create a fertile
Psychology at universities all around the world, environment for the further development of
only 2 undergraduate courses were being offered psychology. He belonged to the Foundation of
through the Department of Sociology in 1970. Psychological Research, which lobbied for the
These courses included General Psychology and creation of a Psychological Research Centre at
Social Psychology, which were both year-long the University. On 24 May 1989, the ANSA
courses. In particular, social psychology had a McAL Psychological Centre was built. Dr.
compulsory research component, which carried Deosaran stated that "the money was obtained
35% of the final mark. At graduate level, there by the Foundation for Psychological Research
was a Master of Science (MSc) in Sociology from the McEnearney Alstons Group (McAL)
with a specialization in Social Psychology. This and the Centre was passed on to University of
was also available at the Master in Philosophy the West Indies as a gift for promoting

-
psychological research" and for making it a place on a variety of themes to much success
of learning and proper research" (Rarndhanie (Ramdhanie 1999). Moreover, in 1994, "the
1999). According to Sir Isaac Hyatali , Chair- well recognized international journal of
man of the ANSA McAL Foundation, it was a criminology and social psychology was formed,"
contribution to the advancement ofeducation in which is in fulfillment of one of the centre's
psychology for the citizens of Trinidad and objectives. Another of the Centre's successes
Tobago and for them thereafter to spread their has been a significant amount of publications
learning and experiences to other students and in terms of books, working papers, and
the rest of the community." international journal articles to date. Further-
more, efforts are still being made forthe creation
TheANSAMcALPsychological Research of a psychology laboratory through the efforts
Centre vowed to uphold the University's mission of Dr. Derek Chadee, manager of the ANSA
statement in attempting to achieve its own McAL Psychological Research Centre and
mission of "promoting and developing the coordinator of the Psychology Programme.
discipline of psychology with particular focus on
research, teaching, professional and policy The ANSA McAL Psychological Research
development; as well as using psychological Centre served to fill gaps in the education system.
principles as an integral part of applied social Enrollment in the two psychology courses
science for personal, social and national offered by the university was very high and there
development" (Ramdhanie 1999). Some of its was a great demand for further psychology
objectives included "providing a research facility courses for personal or work-related reasons.
for psychology undergraduate and graduate Through the management of Dr. Deosaran, the
students and university staff; addressing Centre facilitated the introduction of additional
national problems through research projects, psychology programmes which served to
professional workshops and lectures/ expand its role within the University in terms of
conferences; ensuring that courses in psychology psychology.
have an accompanying laboratory component;
and the establishment of a professional journal Between the years 1991-1994, seven new
and library facility" (Ramdhanie 1999). undergraduate courses were added. These
included Introduction to Psychology, Personality
Although facing challenges of staffing and theories, Developmental Psychology, Abnormal
space, Dr. Deosaran expressed the view that Psychology, Selected Theories in Social
the Centre has grown from a "well-founded idea Psychology; Contemporary Issues in Social
to a national and regional icon of academic Psychology and a Supervised Research Project
research, teaching and policy development, par in Psychology. In the academic year 199411995,
excellence." To date, the Psychological research Introduction to Social Psychology, Statistics and
centre has conducted numerous research Research Design in Psychology, Physiological
projects, surveys, conferences and workshops, Psychology, Experimental and Applied
public lectures and publications. Additionally, Psychology and Community and Environmental
it has made policy proposals to government, Psychology were introduced. In the academic
(which have been accepted), hosted scholars/ year 199511996, a Bachelors of Science (BSc)
visitors, celebrated students' achievement and in Psychology was offered. In 1996/1997,
supported departmental teaching programmes Advanced Topics in Personality, Industrial and

..
Organizational Psychology, Psychology and the university to accept and value psychology
Ethnic Relations and Psychology of Politics were as a very cherished discipline, not only for
included. Furthennore, in 2007, a Specialization personal development, but for professional and
option in Psychology was introduced and national development as well" (Ramdhanie
included courses such as Introduction to 1999).
Cognitive Psychology, Sensation and
Perception, Motivation and Emotions, Learning Development of Psychology as a
and Memory and Advanced Topics in Personality Profession
(which are electives for the Major). Today, the
BSc. or the Special in Psychology is one of the Hamlin Duncan was the first psychologist
most sought after programmes at the University. in Trinidad and Tobago. Psychology started at
S1. Ann's Hospital in the 1960s. By 1968,
In temlS of graduate courses, the University the hospital had employed a counseling
offers an M. Phil and Ph.D. in Psychology with psychologist named Ms. Yvonne Rojas. Mrs.
specializations in either Developmental Judith Hinkson was one of the first Clinical
Psychology or Social Psychology. Dr. Steve Psychologists employed at S1. Ann's Hospital.
Rollocks, a Senior Lecturer at the University By the year 1997, there were approximately 30
and a Clinical Developmental Psychologist was psychologists in Trinidad, specializing in different
instrumental in the fonnation and maintenance areas of psychology. These individuals included
of the developmental specialization for the those who had Doctorate and Masters level
M.Phil in Psychology. Similarly, Dr. Derek degrees in Psychology as well as a few
Chadee, who is also a Senior Lecturer and counselors who had their Bachelors degrees and
Social Psychologist, is responsible for the Diplomas, who practiced as psychologists.
development and continuation of the Social
Psychological aspect of the M .Ph il in In the 1980s Mrs. Judith Hinkson and Dr.
Psychology. In addition, an MSc. in Clinical Ghany (Forensic Psychiatrist) saw the need for
Psychology was introduced in 2004 through the another psychologist at SI. Ann's Hospital. Dr.
Department of Psychiatry at the Faculty of Dianne Renaud was employed. Early
Medical Sciences. The programme is currently Psychologists at SI. Ann's Hospital also included
coordinated by Professor Gerard Hutchinson, Dr. Steve Rollocks, Mrs. Anissa Baksh-Ghany,
who is a Psychiatrist. Dr. Rollocks is also a Dr. Karen Moore, Mr. Steve Le Quoi, Ms.
Lecturer in this programme and plays a Sharice Stauble, Ms. Waveney Richards and
fundamental role in the training offuture Clinical Ms. Anna Maria Mora. Currently, Ms. Ruth
Psychologists. Clinical Psychology students thus Abrams and Ms . Sian Allum are employed at
benefit from the rwo perspectives, that is, clinical St. Ann's Hospital as clinical psychologists. Ms.
psychology and psychiatry. Allum is the first regional health authority
psychologist that has come out of the Masters
On reflection, Dr. Deosaran stated that the in Clinical Psychology programme started in
Foundation of Psychological Research has 2004.
"succeeded in both qualitative and quantitative
tenns in getting both the community inside the Prior to 1992, Psychologists were mostly
university as well as the community outside of trained to work in health and education.

-
According to Ramdhanie (1999), up to the early standards of conduct and proficiency of the
1990s, psychologists were inclined to focus on profession of psychology; (5) representing the
educational, clinical and drug rehabilitation! interests of psychologists ofTrinidad and Tobago
counseling areas through working with in local and international bodies; (6) promoting
psychotic, retarded, abusive, addictive, good relations within the profession, between
emotionally disturbed, criminal and learning the profession and other professional bodies and
disabled people. However, since 1992, the public generally; (7) promoting good relations
psychologists have delved into "new" fields such between the profession and professional bodies
as public relations, sports, law and family, in in other countries and to participate in the
addition to the traditional areas. activities of any international body or association
of psychologists and to become a member
There was also a change in the workforce thereof; (8) promoting continuing education and
of Trinidad and Tobago that caused the role of research in the field of psychology; (9) engaging
psychologists to be expanded in "commtmities, in publications, seminars, workshops and other
and in prevention! intervention settings, such as activities for the purpose of disseminating
commtmity, physical ! mental health clinics and information and knowledge of psychology; and
hospitals." In addition, within the educational (l0) doing all such other lawful things as are
environment, they were being called upon to incidental or conducive to the achievement of
contribute to the "formation of attitudes, ideas, the foregoing aims and objectives" (Trinidad and
beliefs and morals" (Ramdhanie 1999). Tobago Gazette 2000).

Another landmark for the development of TTAP has been given the authority by the
psychology in Trinidad and Tobago was the government of Trinidad and Tobago to carry
passing of the Trinidad and Tobago Association out such disciplinary measures amongst its
for Psychologists ' (TTAP) constitution on 25 members as it deems necessary for the
August 1996. It provided the rules anq maintenance and carrying out ofits objectives.
regulations guiding the behaviour of its members However, this authority only extends to its
as well as gave a description of the duties of members and not those who have opted not to
different members of the executive. Dr. Krishna join the association for whatever reasons. The
Maharaj, the current Senior Clinical Psychologist association will thus be only able to meet its aims
at St. Ann's Hospital, is considered the "founding of "maintaining and improving the standards of
father ofTTAP" and is one ofits early presidents. conduct and proficiency of the profession of
psychology" to an extent. In addition, "there is
TTAP was incorporated as a legal entity yet no official licensing certification apparatus and
on 20 October 2000. TTAP represents all therefore anyone with a degree in psychology
psychologists in Trinidad and Tobago. Their goals can set up a private practice" (Ramdhanie
include: (l) "promoting the concept of total 1999). The association can thus do little about
wellness as it pertains to the psychological well this as legislation does not exist to protect the
being of all persons; (2) promoting and public in this way from unqualified persons.
maintaining the honour and interests of the
profession of psychology; (3) promoting and The Association has also been gi ven the
protecting the interests and welfare of power to 'from time to time' make rules for the
psychologists; (4) maintaining and improving the proper conduct of its proceedings and discharge

..
of its duties, powers and ti.mctions and such rules Psychiatrists from St. Ann's Hospital went
may be amended from time to time. Similarly, to San Fernando General Hospital to treat
the making and enforcing of rules extends only patients because they did not have a clinical team
to its members. or a treatment programme. Dr. Helene Marceau-
Crooks was the first Psychiatrist to be employed
Influence of Psychology on Private and at the San Fernando General Hospital. Dr.
Public Sectors in Trinidad and Tobago Roma Joseph-Thomsonjoined her as Registrar
in 1977. Dr. Celia Ramcharan was employed in
Public Sector 1979 and succeeded Dr. Marceau-Crooks as
Specialist Medical Officer and Head of
The field ofPsychology has influenced both Department in 1992. Dr. Karen Ghany joined
the public and private sectors of Trinidad and the staff as Specialist Medical Officer in 1999
Tobago. Psychology was developed within the and is the current Head of Department (South-
psychiatric setting. In 1849 under British rule, West Regional Health Authority 2008). In 1979,
the first ordinance was passed to detain insane Dr. Krishna Maharaj was also employed at the
persons who were charged with offences at the San Fernando General Hospital as a Clinical
Royal Goal. In 1858, the Belmont Lunatic Psychologist. Ms. Diane Renaud was also
Asylum was opened with 47 inmates (South- employed as a Clinical Psychologist at the San
West Regional HealthAuthority 2008). By 1863, Fernando General Hospital during this period.
there were 101 patients at the asylum. The St.
Ann's Asylum was constructed in 1900 to In 1975, the first Child Guidance Clinic in
address the poor conditions at the Belmont Trinidad and Tobago was established (James
Lunatic Asy lum. It accommodated more than 1984). Prior to this, children, adolescents and
500 inmates. The name of the institution was then adults were seen in adult clinics by psychiatrists.
changed from St. Ann's Asylum to St. Ann's The Child Guidance Clinic is a specialized clinic,
Mental hospital in 1935 and to St. Ann's Hospital which provides psychiatric and psychological
in 1961 (Beaubrun et al. 1976) in an attempt to services for children and adolescents up to the
de-stigmatize patients. age of 18 years (South- West Regional Health
Authority 2008). There are 2 child guidance
Dr. LFE Lewis was one of the first units, one at Mt. Hope Hospital and one at
psychiatrists at the St. Ann's Hospital in 1943. Pleasantville Health Centre. Neither of them has
He was instrumental in creating changes in St. in-patient or day-care facilities. Each unit
Ann's during his 45 years of service, one of comprises of at least a psychiatrist, a clinical
which was the establishment of outpatient clinics psychologist and two psychiatric social workers.
in 1950. In 1959, as Chairman of the Ministry Dr. A. Thompson is the Clinical Psychologist at
of Health, he produced a comprehensive mental the Mt Hope Child Guidance Clinic. She is also
health plan for the territory which was pivotal to one ofthe few Neuropsychologists in the country.
the creation ofa psychiatric unit at Port of Spain The Community Mental Health Programme was
General Hospital in 1965 and San Fernando formalized in 1975 with the Sectorization Plan
General Hospital in 1966 (Maharajh & and the Mental Health Act (1975 ). Professor
Parasram 1997). Michael Beaubrun, a renowned Caribbean

-
psychiatrist, who was Principal Medical Officer Regional Health Authority (NWRHA), Eastern
at the time, was largely responsible for the Regional Health Authority (ERHA), South-
implementation ofthe plan. He is also referred Westem Regional Health Authority (SWRHA),
to as the "Father of Caribbean Psychiatry." and the Tobago Regional Health Authority
(TRHA). The goals and objectives of the Menta!
In terms of the sectorization plan, Trinidad Health Plan (2000) included encouraging "the
and Tobago was divided into 5 sectors or development and maintenance of the highest
catchment areas (namely, sector I A, I B, 2, 3A, level of menta! health in the population ofTrinidad
3B, 4 and 5) of approximately 200,000 persons and Tobago and to provide an adequate level of
each. Each sector consisted of a team of indi vidualized care for those who have a menta!
psychiatrists, social workers, mental health disorder or are at risk of suffering from a mental
officers (community nurses) and mental disorder," primarily through education and
health attendants (paramedical auxiliaries). adequate primary, secondary and tertiary care
Psychologists and occupational therapists were (South-West Regional Health Authority 2008).
few in number and so were not assigned to just
one area (James 1984). The multidisciplinary The NWRHA, SWRHA and TRHA have
teams were responsible for the care of patients psychologists and a programme for treatment.
within their respective sectors from inpatient care The ERHA does not yet have a programme and
to community care. The goals were to provide is still served by the other RHAs in terms of its
psychiatric care as near as possible to the mental health staff. The RHAs are autonomous
patients own home; to upgrade the facilities at statutory bodies ensuring health care service
St. Ann's Hospital; to introduce sub-specialist delivery to all residents in their respective
services in psychiatry; to develop a system of regions. Every hospital, health centre, or
consultation with the community and to integrate outpatient clinic falls under one of these RHAs
mental care with genera! and public health care and treatment is provided by the multi-
as much as possible (Ministry of Health 1975). disciplinary team. Treatment over the years has
The development of these clinical teams evolved from custodial care (except in chronic
encouraged the different helping professions to and locked wards) to pharmacotherapy and
work together to promote wellness in mentally psychotherapy.
ill persons. Through case conferencing, each
professional gave his perspective and a holistic These developments within the public sector
treatment plan was formed for each patient. have marked the development of psychology
within the public sector. To be specific,
In 1975, the Mental Health Act (No. 30 of Psychologists have been employed at St. Ann's
1975), which had undergone several drafts since Hospital as early as 1968 and have contributed
1960 became law (Mental Health Act, 1975). to the well ness of the population ofTrinidad and
A new category of mental health officers was Tobago since then. They formed part of the tearn
created by this Act. In 2000, the Mental Health that was sent to the South-West Regional
programme was reformed and became the Authority to help treat the mentally ill in that
responsibility of the Regional Health Authorities catchment area., until then this RHA employed
(RHA) as against the Ministry of Health. It its own clinical psychologists to make up its
divided Trinidad and Tobago into 4 instead of5 multidisciplinary team. This pattem was seen in
RHAs. These included the North-Western all hospitals where the mentally ill were being

..
treated. Therefore as psychiatrists made their professions to operate within the boundaries of
services more available to the public through their respective professions. For example, some
transformations within the health sector so did psychiatrists make requests for particular tests
psychologists. to be carried out. However, "these requests often
do not correspond with the problems that are
Psychologists had been clamouring for being presented." While this may be frowned
some ofthe aforementioned changes in the health upon, legally, no constraint exists to prohibit a
sector. For example, Ms. Yvonne Rojas, one of psychiatrist (or any physician) from performing
the first psychologists employed at St. Ann's the recognized functions ofa clinical psychologist
Hospital, lobbied for the improvement of (Iscoe 1957). This issue still exists as is evidenced
psychological services; more effective utilization by the fact that referral letters have to be sent
of available resources and sufficient training for back to get the required infom1ation included or
clinical staff. These concerns have been inconsistent infommtion (such as the request for
addressed to an extent with the reformation of specific tests) removed.
the health sector.
Furthermore, she lobbied for career
She also made requests forthe development mobility for psychologists. She believed that the
of child guidance clinics and recommended that clinical setting (psychiatric units) should also
these clinics should house a child psychiatrist, have a Senior Psychologist, Junior Psychologist
psychiatric social worker, psychologist and and a Psychometrist. Dr. Krishna Mal1araj also
speech therapist. While these clinics exist today, shared this view as he added that individuals who
speech therapists for example, are not had their Bachelors in Psychology should have
necessarily part of the multidisciplinary team the opportunity to be research assistants so that
and have to be out-sourced. Shortages in terms they can obtain the invaluable experience of
of staff exist even today but Dr. Krishna Maharaj working in a clinical setting. These together with
indicated that one 0 f the ways in which this has other concerns have been echoed by other
been addressed is by the proper screening of psychologists. Some psychiatry units have
patients. employed at least a senior psychologist as well
as ajuniorpsychologist.
However, some concerns raised by
psychologists have not been sufficiently However, as one reflects upon the
addressed. For example, Ms. Rojas also lobbied development of psychology in Trinidad or more
for a different system of referrals and testing. specifically the public sector, one can see that
She wanted to encourage other helping psychology tends to playa secondary role to
professions to provide adequate explanation for other professions (for example, psychiatry) in
the referrals of their patients as well as to provide the clinical setting and other fields in the academic
sufficient information on their patients, such as setting, such as sociology. This is also reflected
age which is important for the scoring of tests. in the Mental Health Act No 14 of1999, which
These made the psychologist's role in addressing makes no direct mention of Psychologists and
mental health more challenging. the role that they play in providing treatment for
the mentally ill. This may be an indicator of the
Ms. Rojas as well as other psychologists value that is placed on the service that
also wanted to encourage other hel ping psychologists provide to the country or the level

-
of respect for the profession as a whole. The The Ministry of Education 's EAP provides
value placed on psychology in Trinidad and its employees with "quality psychological services
Tobago is also reflected in the poor pay in an ethical and responsible manner to facilitate
incentives and working conditions of their personal and professional growth and
psychologists in the past as well as in the present development." Psychologists form part of their
compared to other professions in Trinidad and in-house EAP and are also contracted. They
Tobago or other psychologists abroad. provide confidential personal assistance (such
However, a new Mental Health Act was to be as anger management; financial crisis; stress
released at the end of 2008 or the beginning of management; mental health issues and time
next year 2009 and there is hope that it may management) and organizational services (such
clearly identifY psychologists and their role in as job coaching, mentoring, team building and
promoting weJlness as well as address some of retirement policy). When acting in a consultancy
the concerns that have been raised by capacity, psychologists provide lectures, training
psychologists. sessions and workshops. This is done in order
to enhance employee and workplace
Private Sector effectiveness through prevention, identification,
and resolution of personal and productivity
Psychology has also influenced the private issues" (Ministry of Education 2003).
sector for psychologists are also engaged in
private practice. Individually or as a medical Neal and Massy Holdings Limited is
health team, psychologists offer the same kind another company with an EAP programme. They
of care as the St. Ann's Hospital or any other contract EAP providers, namely "psychologists,
psychiatric unit. However, the waiting time is therapists and counselors to offer psycho-
significantly less and there is more privacy for emotional and psychosocial therapeutic
receiving medical health care. Whilst the public services to employees" (Neal and Massy
hospitals tend to cater for the lower class and Holdings 2008). These and other services,
the lower middle class, private practice tends to which include management and supervisory
cater for the upper middle class and the upper training; mediation in dispute resolution and
class. critical incident interventions are fully paid by
the company.
Psychologists are also hired by private
companies to provide Employee Assistance Elders Associates Ltd. is an example of a
Programmes (EAP) for their employees. The group of psychologists who "provide assistance
EAP is a confidential service that is offered to to employees who are experiencing personal
employees, and their immediate families to help problems that may be negatively affecting their
them "cope with personal and work-related job performance" (Elder Associates 2008) on
problems," such as "employee/executive behalf of companies. They acknowledge that
burnout, personal trauma, family crises, personal problems affect productivity, and
relationship problems, substance abuse or encourage companies to help their employees
hostile confrontations." The EAP programme work through those issues (especially the ones
aims to "enhance the health, well-being and that affect job performance) as against firing
productivity of employees" (Neal and Massy them for there is no guarantee that the workers
Holdings 2008) . who are hired would not have the same

..
problems. Elder Associates Ltd. aim to reduce objectives. Some of these psychologists include
financial costs to firms by providing assessment, Dr. Steve Rollocks, Dr. Camp bel Phillips, Dr.
counseling and follow-up. They forecast that Dorrell Phillip and Ms. AJlyson Hamel-Smith.
investing in employees emotional and
psychological wellbeing will reduce insurance Dr. Steve Rollocks is a clinical child
claims, sick leave, accidents and injuries, psychologist who also specializes in
turnover, poor decision making and grievances. developmental psychology. In addition, Ms.
This will also improve staff working conditions AJlyson Hamel-Smith is a clinical psychologist
and public image. who specializes in learning difficulties and
behaviour problems in children and adolescents.
Psychologists also serve the public through Other Clinical Psychologists who have influenced
non-governmental organizations (NOOs) like the private sector include Dr. Karen Moore (who
Families inAction (FIA). Established in 1988, specializes in child and adolescent Psychology);
FIA was developed in an effort to "address the Dr. Judith Hinkson (who specializes in
growing problem of drug addiction" in Trinidad adolescents and adults with mental health or
and Tobago (Families inAction 2008). They aim neurological issues as well as career or personal
to "promote healthy family life, balancing assessment); Dr. Jillian Ballentyne (who
emotional, physical, spiritual, social and specializes in individuals, couples/marital and
psychological needs" in an attempt to "regenerate group counseling as well as treatment for
both the family unit and/or any individual of that depression, eating disorders and stress) and Ms.
unit who is experiencing pain, isolation, addiction Waveney Richards, (who specializes in trauma
or dysfunction" (Families inAction 2008). Their counseling for older adolescents and adults as
services include child development, confident well as women's issues). These and other
parenting, youth education and employee psychologists influence the private sector of
assistance through a 24 hour hotline, group and Trinidad and Tobago by providing confidential
workplace support, counseling, community services that promote mental health to individuals
outreach, assessment and referrals. of different age groups, ethnicity, sex and socio-
economic status.
Other NOOs address different issues that
can affect the quality oflife of the people of The field of psychology has steadily
Trinidad and Tobago. Some of them include the developed both in the private and public sectors
Trinidad and Tobago Coalition against Domestic of Trinidad and Tobago. It is also a product of
Violence (T&TCADV), Childline; Lifeline, the history of the region and its religious and
Rebirth House Drug Rehabilitation Centre; Rape cultural influences. Despite being "supported"
Crisis Centre; Organization of Disaster throughout its development by psychiatry,
Preparedness and Management (NEMA); psychology has established itself as a discipline
Serenity Place;Autistic Society and the National and a profession in its own right (and continues
Alcohol and Drug Prevention Programme to do so). This unique blend of psychology has
(NADAPP). Psychologists have worked for contributed to the improvement or maintenance
some of these NGOs to help them achieve their of mental health and wellbeing to the
population.

-
 References

American Journal of Psychiatry. 1997. What is Psychiatry? 154, no. 5: 591-593. (Accessed October
1,2008).

American Psychology Association. 2008. About Clinical Psychology. http://www.apa.org/divisionsl

divl2/aboutcp.htrnl (accessed October 9, 2008).

Beaubrun, M.H., P. Bannister, L.F.E. Lewis, G. Mahy, K.C. Royes, P. Smith, and Z. Wizinger. 1976.
"The West Indies." In World History ofPsychiatry, edited by J. Howells (Chapter 21). New
York: Brunner Maze!.

Brentar,1. & 1. R. Mc Namara. 1991. The right to prescribe medication: Considerations for Pro-
fessional Psychology. Professional Psychology: Research and Practice, 22, no. 3: 179-187.

Cox, 1. L. 1996. "Psychiatry and religion: a general psychiatrist's perspective." In Psychiatry and
religion, context, consensus and controversies, edited by D. Bhurga. London: Routledge.

Charles, 1. A. 2003. Policy Document for the Employee Assistance Programme, Ministry of Education.
http://www.moe.gov.ttlunits_eap.html (accessed October 1,2008).

Di Mascio, A., M. M. Weissman, B. A. Prusoff, C. Neu, M. Zwilling, and G. L. Klerman.1979.

Differential symptom reduction by drugs and psychotherapy in acute depression. Archives of
General Psychiatry, 36: 1450-1456.

Downs, M. F. 2004. Psychology vs. Psychiatry: Which is better? http://www.webmd.comlmental-

healthlfeatures/psychology-vs-psychiatry-which-is-better? (accessed October 9, 2008).

Elder Associates Ltd. 2008. http://www.trinidad.netfeal(accessedOctober 1,2008).

Falloon, I. R. H., J. L. Boyd , C. W. McGill, J. Razani , H. B. Moss and A. M. Gilderman. 1982.

Family management in the prevention and exacerbation of schizophrenia: A controlled study. The
New England Journal ofMedicine, 306: 1437-1440.

Families InAction. 2008. http://www.farniliesinaction.netJindex.htm(accessed October 9, 2008).

Frank, E., and D. J. Kupfer. 1987. Efficacy of combined imipramine and interpersonal psychotherapy.
Psychopharmacology Bulletin, 23: 4-7.

Fulford, K. W. M. 1996. Religion and psychiatry, extending the limits of tolerance. In: Psychiatry and
religion, context, consensus and controversies, edited by D. Bhurga. London: Routledge .

..
Hogarty, G. E., C. M.Anderson, D. 1. Reiss, S. 1. Komblith, D. P. Greenwald, C. D. Jaunaand M. 1.
Madonia. 1986. Environmental/personal indicators in the course of schizophrenia research groups:
Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare
treatment of schizophrenia: J. One-year effects of a controlled study on relapse and expressed
emotion. Archives oJGeneral Psychiatry, 43 : 633-642.

Iscoe, I. 1957. Relationship between Psychology and Psychiatry. The American Psychologist, 12,
no. 5: 279-280 (accessed October 5, 2008).

James, V. 1984. A review of psychiatry in Trinidad and Tobago over the decade 1970-1980
(unpublished report). Trinidad: St. Ann's Hospital.

Menninger. W. C. 1949. The relationship of Clinical Psychology and Psychiatry. The American
Psychologist. Menninger Foundation.

Ministry of Education. 2003. "Policy Document for the Employee Assistance Programme." http://
www.moe.gov.ttlunits_eap.html (accessed October 1,2008).

Ministry of Health. 1975. Sectorization plan for Trinidad and Tobago. Trinidad and Tobago: Ministry
of Health.

Ministry of Legal Affairs. 2008. Mental Health Act, Chapter 28:02. http://rgd.legalaffairs.gov.ttllaws/
Chs.%2028-31128.02128.02%20aos.htm (accessed October 5, 2008).

Myers, D. 2007. Psychology. New York: Worth Publishers.

Neal and Massy Holdings Ltd. 2008. http://www.neal-and-massy.coml(accessed October 5, 2008)

Ramdhanie, I. K. 1999. The ANSAMcALPsychological Research Centre: The Miracle ofSt. Augustine
1989-1999. Curepe: The ANSA McAL Psychological Research Centre.

South West Regional Health Authori ty. 2008. http://www.swrha.co.ttlward_l.htm#psychiatry (accessed

October 9, 2008).

Stedman. 2005. Stedman:S Medical Dictionary. (5"' ed.) United States of America: Lippincott,
Williams and Wilkins.

Trinidad and Tobago Gazette. 1999. Mental Health Act No. 14 of 1999 38 (237): 126-129.

Trinidad and Tobago Gazette. 2000. Act for the incorporation of the Trinidad and Tobago Association
of Psychologists and related matters 39(208): 1-5.

-
WebMD Medical Reference. 2008. http://www.webmd.comlanxiety-panic/guide/mental-health-
psychotherapy (accessed October 1,2008).

Weissman, M. M., G. L. Klerman, E. S. Paykel, B. Prusoff and B. Hanson, 1974. Treatment effects
on the social adjustment of depressed patients. Archives a/General Psychiatry, 30: 771-778.

Weissman, M. M., B. Prusoff,A. Di Mascio, C. Neu, M. Goklaney and G. L. Klerman. 1979. The
efficacy of drugs and psychotherapy in the treatment of acute depressive episodes. American
Journal 0/ Psychiatry, 136: 555-558 .

..