Bermuda comprises a group of small islands in the Atlantic Ocean, situated approximately 1000 km east of the USA. It is a self-governing crown dependency of the UK. It is the third richest country in the world, with average wages per head of US$41 495 in 2000. Its economy is based on a flourishing offshore insurance industry and tourism.

Psychiatric services

Bermuda's healthcare comprises both private and public initiatives. Employees are required to obtain health insurance for themselves and their dependants. For those who are not insured, the government provides through the public system.

The island has two hospitals, King Edward VII Memorial Hospital, a general medical hospital, and a separate psychiatric unit, St Brendan's Hospital. The latter provides mental healthcare for the majority of the islanders and receives a budget of over US$28 million per year.

Human resources

St Brendan's Hospital employs three adult and one child and adolescent psychiatrist. Each adult psychiatrist takes on the responsibility for providing one specialist area of service. The majority of staff in the hospital are Bermudian, although, given the global shortage of suitably qualified mental health staff, Bermuda recruits actively for doctors, nurses and allied staff in jurisdictions such as the UK, Canada, Australia and the USA. The cultural diversity of the staff produces an interesting mix of perspectives and ideas about healthcare policy.

Overview of services

Since the early 1980s, mental health policy within Bermuda has focused on making services more accessible, more community oriented and less stigmatised.

The closure of two long-stay wards in the 1980s provided the momentum for the development of community mental health teams. Teams are multidisciplinary; individual members case manage up to 50 patients. Bermuda's small size facilitates assertive outreach.

There is a housing shortage for people with severe mental illness. The high cost of real estate due to the expansion of the business sector makes accommodation costs prohibitive for those on a low income and finding cheaper accommodation, such as at the island's Salvation Hostel, can be difficult. Many individuals with severe mental health problems live with their families, despite the high level of burden this frequently places on carers.