WILLEMSTAD – Curaçao’s government is being pressed to explain who is ultimately responsible for psychiatric patients when several healthcare and public agencies are involved, amid concerns that vulnerable people could fall between different parts of the mental healthcare system.
PAR Member of Parliament Shaheen Elhage has submitted extensive questions to Health Minister Tyron Boekhoudt about continuity of psychiatric care, crisis intervention and coordination between mental health providers, general practitioners, social services, public health authorities and police.
The questions follow a psychiatric case that became public on September 14 and, according to Elhage, raised broader concerns about possible fragmentation of care. He is deliberately seeking answers about the healthcare system rather than confidential details concerning the individual patient.
One of the central questions is which institution is formally responsible for coordinating and maintaining treatment when a psychiatric patient receives services from more than one organization.
Elhage wants the government to explain who had responsibility for managing the care in the case that triggered the questions and, if several institutions were involved, who was in charge and how authorities verified that the agreed treatment was actually provided.
The PAR parliamentarian is also seeking clarity about standards for psychiatric patients receiving outpatient treatment, including those who periodically receive medication or depot injections.
He wants to know whether existing protocols require healthcare providers to assess not only a patient's psychiatric condition but also self-care, nutrition, housing conditions, safety and social functioning.
Another issue is what happens when healthcare workers encounter serious self-neglect.
Elhage asks whether providers who find that a psychiatric patient is living in severely unhygienic or unsafe conditions, or presents a possible risk to the surrounding neighborhood, are legally or professionally required to document and report the situation. He also wants to know which institution should receive such a report, how quickly it must respond and what follow-up action is mandatory.
The questions extend beyond the healthcare sector.
Elhage wants to establish whether Curaçao has a mandatory multidisciplinary protocol connecting mental health services, general practitioners, public health services, social services, police and other agencies when psychiatric problems coincide with serious social problems or public-health risks.
If no such protocol exists, he wants Boekhoudt to explain why and say when one will be introduced.
The MP is also questioning whether the Health Inspectorate has systematically examined during the past decade how effectively the different parts of Curaçao’s mental healthcare system connect with each other, including outpatient psychiatric care, crisis services, emergency psychiatry and clinical admission.
If such supervision has taken place, Elhage wants the conclusions and resulting improvements disclosed. If it has not, he questions how the Inspectorate can determine whether patients are being prevented from falling through gaps between institutions.
Elhage is asking the minister to consider commissioning an independent investigation into possible fragmentation of mental healthcare, the functioning of Curaçao’s psychiatric crisis safety net and the Health Inspectorate’s supervision of the mental healthcare chain.
He wants the findings presented to Parliament within six months, together with an improvement plan containing deadlines, responsible institutions and measurable quality indicators.
The PAR parliamentarian is also challenging the government to demonstrate whether public spending on mental healthcare produces measurable improvements in early detection, prevention, continuity of treatment, crisis care and the prevention of severe self-neglect.
His questions ultimately link healthcare financing with accountability: Elhage asks whether the minister agrees that financial management cannot be separated from the quality and safety of care and, if so, how that principle is reflected in government budgeting, contracting, supervision and accountability to Parliament.