High-Level engagement sets clear roadmap for Mental Health Reform in Antigua and Barbuda

St. John's, Antigua and Barbuda, 27 February 2026 (PAHO) - The Pan American Health Organization (PAHO) met with the Prime Minister of Antigua and Barbuda, the Honourable Gaston Browne, and the Minister of Health, the Honourable Sir Molwyn Joseph, to review progress and agree on next steps for the transformation of the country's mental health system.

The discussion reflected strong political commitment at the highest level to modernize mental health services and reposition them within a broader national development agenda. Antigua and Barbuda has already made notable strides, and with the allocation of the necessary resources, the country is well placed to move to the forefront of mental health reform in the region.

The new Mental Health Bill is currently in the stakeholder consultation phase and is expected to be presented to Parliament by April, with gazetting anticipated by May. The updated legislation will provide a modern, rights-based foundation to guide service delivery, protect human rights, and support the transition from institutional care to a comprehensive, community-based model.

The Cabinet has approved the establishment of a centre for mental health, for which a building has already been purchased to be integrated within the Sir Lester Bird Medical Centre. The operationalization of this centre is one of the areas for which the Ministry has requested PAHO technical guidance. This integration signals a deliberate shift away from stand-alone psychiatric institutionalization toward a model embedded within the general health system, helping to reduce stigma and promote parity between mental and physical health.

The proposed model extends beyond acute clinical care. It includes psychosocial rehabilitation, a resource and training centre, day-care services, and designated spaces for arts, music, and community engagement. Workforce planning for the new centre will be critical to ensure that the appropriate mix of clinical and psychosocial professionals is available to deliver this expanded scope of services.

A key feature of the proposed reform is linking rehabilitation to economic participation. Plans are under consideration to acquire retail space within the public marketplace to display and sell arts, crafts, and other products created through rehabilitation programmes. This initiative is intended to foster dignity and self-reliance among participants, while strengthening connections with the tourism and creative sectors.

Such an approach positions mental health not only as a health issue, but as part of the country's broader social and economic development strategy.

Building a network of services

The Government is advancing the development of a defined package of mental health services delivered across a coordinated service network. This will include:

• Mental health services at the primary care level
• Specialist outpatient services
• Acute care within the general hospital
• Psychosocial rehabilitation and day programmes
• Assisted living and elderly care services

An assessment will determine the number of individuals currently at the Clarevue, the existing mental health facility, who may require assisted living, elderly care, or other forms of step-down support. The transition from institutional care will be implemented through a phased approach to ensure continuity of care and community readiness.

The Prime Minister underscored that mental health reform must extend beyond the health sector, with linkages to education, housing, employment, and agriculture. He reaffirmed his commitment to integrating a defined mental health package into the National Health Insurance (NHI) scheme. By the third quarter, mental health services are expected to be incorporated into NHI coverage, strengthening financial protection and expanding access.

2026: A transformational agenda

Framing 2026 as a year of national renaissance and transformation, Prime Minister Browne requested that, within 30 days, a clear framework be presented to guide the restructuring of mental health services. By the fourth quarter, the aim is to transition into a new integrated model of care that reduces stigma and emphasizes rehabilitation and community engagement. A proposed launch date of 1 November 2026, in celebration of Independence, was identified as a symbolic milestone.

He also emphasized the importance of including persons with lived experience in public education and awareness initiatives, recognizing their role in challenging stigma and shaping responsive services.

Moving to implementation

The Ministry of Health has established a core team to operationalize PAHO's recommendations for transitioning from institutional care to comprehensive, integrated, community-based solutions. Priorities include workforce planning, infrastructure development, service redesign, and intersectoral coordination.

PAHO will continue to provide technical cooperation to support Antigua and Barbuda in advancing this reform agenda. With sustained leadership and strategic investment, the country is positioned to deliver a modern, inclusive, and community-focused mental health system.