Prominent Saint Lucian psychiatrist Dr. Julius Gilliard warns that the island’s mental health support system has been in a prolonged state of crisis, severely limited by a critical shortage of medical personnel and regional funding. Speaking on a recent episode of the 1461 Podcast, Dr. Gilliard shared harsh realities about the local landscape, revealing that Saint Lucia relies on just three to four practicing psychiatrists.
“I’m very disappointed first of all that a lot of the doctors who come out of medical school run away from psychiatry. I am baffled as to why because this is one of the most rewarding fields of medicine that I know of.” Dr. Gilliard said.
Compounding the issue, Dr. Gilliard announced during the interview that he is preparing to exit his own practice in Saint Lucia.
While Dr. Gilliard acknowledged that Saint Lucia has made marginal steps toward community-based mental health care since he began practicing locally in 2017, he stressed that the structural foundation remains incredibly weak.
“When I just got into medicine, mental health was in shambles, but I think we are making progress.”
He noted that Saint Lucia has placed great emphasis on community care when it comes to mental health through “community mental health nurses.” However, he said that this approach often “put the cart before the horse,” as individuals were sent into communities lacking the necessary support and infrastructure needed. He added that historically, the local mental health budget has hovered at a meagre 1% of the total national health budget.
As for the personnel and institutions meant to handle the mentally ill, Dr. Gilliard expressed concern.
“I don’t know what their trainings [the police] is like at training school and I do not know that law enforcement has been formally trained in dealing with mental health issues. I know that the police do the best they can, and they have made a lot of progress in the last few years, to avoid what used to happen before of mentally ill persons being abused by police.”
He added that The Bordelais Correctional Facility currently operates without a designated psychologist or counsellor revealing that he has been asking for nine years for this to be rectified. As for primary and secondary schools, he said they lack sufficient dedicated counsellors, leaving untrained teachers to navigate complex special needs and behavioural disruptions that can arise in the classroom.
Public perception of mental illness in Saint Lucia remains a substantial barrier to care. Dr. Gilliard explained that most citizens equate mental health crises exclusively with visible psychosis, such as individuals exhibiting highly erratic or unclad behaviours in public. However, psychosis accounts for only about 1% of the population. Most of those struggling are dealing with less visible, highly prevalent “iceberg” conditions like anxiety and severe depression, according to Dr. Gilliard.
On the bright side, Dr. Gilliard believes that the rise of internet access has triggered a recent surge in patients seeking private care as online resources allow individuals to demystify their symptoms and realize they are not alone.
“I do have persons that tell me, ‘Doc I was watching this or I was watching that or I was reading up on that and it looks like it is what I am experiencing.’”
Dr. Gilliard strongly cautioned against societal naming conventions, calypso music, and local parlance that reduces mental illness to “weakness” or an “aberration” that should simply be locked away.
He added that a particularly vulnerable segment of the population is young men. He explained that certain severe conditions like schizophrenia and ADHD naturally present earlier in males due to biological and hormonal variations. He added also that there is a lot more pressure on women to adapt.
Dr. Gilliard noted that Saint Lucian men are heavily conditioned by peers and society to mask their internal battles to appear strong. When men attempt to express vulnerability or depression, he noted that they are frequently dismissed by friends or told to “go take a drink” or party it away rather than face the underlying trauma. He added that a severe lack of healthy coping mechanisms and positive male mentorship contributes heavily to the visible high rates of substance abuse, homelessness, and aggression seen across local markets and communities.
Despite the heavy toll of clinical burnout, which Dr. Gilliard managed by undergoing his own intensive personal therapy, he remains hopeful that earlier medical intervention can fundamentally alter patient outcomes. He adamantly advises families to seek professional clinical assistance the moment early signs of behavioural shifts or distress appear, as early treatment is the strongest indicator of a positive long-term prognosis than viewing mental health struggles as a permanent tragedy.
“Without us having difficulties, we cannot grow,” Dr. Gilliard concluded.
“Life is an adventure. You go up a hill or down a slope, you stub your toe, you fall, you get up, you brush yourself off, and you continue.”
