Mental health in the Dutch Caribbean gets a baseline: what 8,400 patient records reveal

GREAT BAY--The first regional mental health profile for the Dutch Caribbean gives policymakers something they have not had before: a shared set of numbers that compares who is being treated, for what conditions, and where the gaps lie. The report, published in October 2025 by the Federation Dutch Caribbean Mental Health, compiles records from providers in Aruba, Curaçao, St. Maarten, Bonaire, St. Eustatius, and Saba. It counts approximately 8,400 people who received care in 2024, a figure that undercounts total demand because several services could not contribute data this cycle. Women account for a majority at 56 percent, about three in ten clients are younger than 25, and a similar share is older than 55.

Schizophrenia spectrum and other psychotic disorders top the list in absolute numbers. Depression, neurodevelopmental conditions such as ADHD and autism spectrum disorders, and trauma and stressor-related disorders follow. Youth are more likely to show conduct problems, neurodevelopmental issues, trauma and stressor-related disorders, and broad psychosocial challenges. Older adults are more represented in neurocognitive disorders, and they also show a relatively higher share of bipolar disorder. These patterns match what front-line clinicians have long reported anecdotally, but the region now has a baseline to measure change over time.

The gender differences point to planning needs. Men are more present in addictions, conduct and disruptive behavior disorders, and psychotic disorders. Women appear more often in depression, trauma and stressor-related categories, anxiety, personality disorders, and psychosocial complaints. Services that want to reduce waiting lists and improve outcomes will need to calibrate capacity by age and sex, and to link mental health to social services, child and family programs, and elder care.

The institutions that supplied data cover much of the formal system. Respaldo in Aruba, GGz Curaçao and partners including Brasami and PSI Skuchami on Curaçao, Mental Health Caribbean on the BES islands, and St. Maarten’s Mental Health Foundation are listed as federation members. Staffing ranges from 26 FTE at Brasami to more than 300 FTE at GGz Curaçao, with ambulatory and specialist teams, day programming, residential and crisis services, and in some cases youth-specific units. The report notes that MHF, while a member, could not deliver 2024 data because of ICT issues. That gap matters, because it reduces the precision of island-level comparisons and masks part of the burden in St. Maarten.

The monitor does not include some providers on Aruba and St. Maarten, it does not cover independent psychologists across several islands, and it excludes forensic youth services, prisons, and organizations that only provide psychosocial care. The authors describe the dataset as an underreporting of true demand. Even so, the aggregated approach was necessary to start. It protects privacy, but it also means that future analyses require coordination with source systems. That, in turn, argues for an information architecture that the islands share and trust.

For health leaders, three operational questions follow from the numbers:

First, how to balance island-based care and referral networks. The report shows most clients are treated at home, which is efficient and humane, yet some diagnostic clusters benefit from supra-island expertise. Schizophrenia spectrum disorders drive large volumes and need continuity in medication, psychosocial rehabilitation, and supported housing, with crisis response that does not rely on police first. Depression and trauma require stepped care that starts in primary care, integrates school and workplace programs, and escalates to specialist treatment quickly when risk increases. Neurodevelopmental disorders need earlier screening in schools and family support that includes speech and occupational therapy. A region-wide skills plan would help match teams to need.

Second, where to add capacity. The age split, with roughly 30 percent under 25 and 30 percent over 55, points to pressure at both ends of the life course. Youth capacity is not only about therapy hours. It is also about coordination with education ministries, referral pathways from schools, and community-based programs that stabilize families. Among older adults, the higher weight of neurocognitive conditions means home-based support, caregiver training, and memory clinics should be developed with social services and primary care. Gender patterns suggest targeted approaches for men in addictions and psychosis, and for women in depression, anxiety, trauma, and personality disorders.

Third, how to strengthen data quality. Several institutions had missing or incomplete diagnostic coding, which underreports addictions and some other categories. The monitor describes corrective steps underway. Standardized diagnostic capture, common minimum datasets, and routine validation would allow a sharper view of comorbidities and outcomes. The authors recommend continuing the monitor and expanding it in breadth and depth. That includes bringing non-member services and independent practitioners into the fold, and adding forensic and prison mental health in a later phase.

For St. Maarten, the island needs to finish the ICT fixes that blocked 2024 data submission, then publish a clear local profile that aligns with the regional monitor. That profile should list waiting times by service line, workforce vacancies, referral rules for youth and adults, and progress on supported housing and community teams. Because the regional report shows psychotic disorders, depression, neurodevelopmental conditions, and trauma as the largest groups, St. Maarten’s plan should explicitly state how many clinicians will be hired or trained in each domain, what the school system will do on screening and referral, and which social services will co-fund supported living and day programs.

The report’s quiet achievement is that it turns island realities into comparable metrics. That is the basis for better budgets and better care. If the next edition can close the data gaps, the islands will be able to track whether expanded school-based services reduce crisis calls, whether new addiction programs cut hospitalizations, and whether caregiver support lowers institutionalization for dementia. Good policy follows good numbers, and the region now has a start.

‍