Bermuda’s mental healthcare system is said to be about 40 years behind the developed world as patients are still being “hidden behind the walls”.It is this “stuck in the past” mentality that Dr Michael Radford has worked hard to change during his two years as chief of psychiatry at Mid-Atlantic Wellness Institute.Dr Radford, who has lost his job because of budget cuts, says the Island will continue to fall behind until all services are “community based and recovery orientated”.But he said “changing the shift in mental health philosophy” remains a slow process as many still believed patients “should be in the asylum rather than the community”.Dr Radford said: “The problem is Bermuda is still playing catch up. This country is 40 years behind the developed world in terms of mental health orientation.“The staff here are absolutely amazing and I’m not talking about services, but it’s very hard to move things forward when things are still done with the old way of thinking.“The new philosophy is that we should be enabling clients rather than using the looking after philosophy.“These people are citizens who with assistance can be fully functional in society. They don’t have to be hidden behind the walls”.Dr Radford said it was “a very different story” in the UK and US where most mental health services were already community based.He said it was very important for Bermuda to make similar changes “before we fall further backwards”.The Mental Health Plan, which Dr Radford helped to write, recommends home treatment, establishing outreach teams and relocating community rehabilitation services from MWI to Hamilton.It is hoped that more patients can live among our communities in group homes and with the support of caregivers as they “embrace and thrive when living in more ordinary dwellings”.Dr Radford said: “Looking after people just accumulates handicaps, but enabling them eradicates the handicaps.”He hopes more introduced community-based living will also “open people’s eyes” and help to remove the stigma of mental health, which is “still very much alive and well”.Dr Radford said: “Mental health is still highly stigmatised in Bermuda. It’s just not talked about, it’s a taboo topic.“You’ll hear more talk at Chewstick than at church or among politicians in the House. These people who have been away to college and come back are the ones to bring change.“There is an older generation of people who have remained chained to the rock. Mental health clients are still ‘St Brendan’s cases’ as far as they are concerned.”MWI’s outpatient programmes are currently benefiting about 600 people; 400 people use the acute services and 200 people use the community rehabilitation services.Depression remains the most common form of mental illness, but it also includes anxiety disorders, psychotic disorders, personality disorders and addiction.Dr Radford said Bermuda’s worsening gun crime was having an affect on patient numbers as they had treated several relatives of murder victims.He said the history of slavery, internalised racism, physical and sexual abuse and the economic downturn also added to MWI’s workload.Dr Radford said: “There are a lot more people coming into contact with us and it has the potential to keep on growing. We know there are lots more out there who are not seeking help.“With the budget cuts, they are reducing our capabilities at a time of greater demand”.Dr Radford has spent a lot of time working with GPs to help them recognise the signs of mental health and to ensure they know which medications to prescribe. He said “more work needs to be done” as there were still “huge gaps between GPs and MWI”.Dr Radford said in other countries GPs automatically get six months of mental health training and are deemed to be specialists in the field.But Dr Radford said some of those people who were referred to MWI by GPs “refuse to step foot in the place because of the stigma”. These people either pay more to go overseas for treatment or go without.Dr Radford said there was only currently one private psychiatrist in Bermuda and Residential Treatment Services, the Child Development Programme and Court Services were without psychologists because of budget cuts.To encourage more people suffering from mental health issues to seek help, Dr Radford wants health insurance companies to add treatment to the ‘standard health benefit.’ This is currently proposed under the National Health Plan.Dr Radford said MWI was “ticking along” after it was forced to make savings of $1 million because of the three percent decrease in Government funding this year. The MWI subsidy for this fiscal year is $38.578 million.The Budget cuts mean Dr. Radford and a junior doctor are not having their contracts renewed.MWI’s current compliment of ten psychiatric support staff will be reduced to eight; four psychiatrists and four resident doctors. The three positions of art therapist, occupational therapist and physiotherapist are also being frozen.Dr Radford said: “Budget cuts have really affected us, we have had to cut expatriate staff and senior clinical leadership.“It’s very hard as I am one of the victims of the budget cuts but I am only grateful it is not a lot worse.“But it’s going to affect client care. It means the staff left behind will have less time to spend with clients and less time to develop programmes. Everything will be tighter”.Dr Radford, who recently celebrated his 70th birthday, initially worked at what was St. Brendan’s Hospital from September 1974 to July 1985. He worked as a consultant psychiatrist before being made medical director.Between 2007 and 2009 he returned to Bermuda for stints as a locum at MWI. Then in August 2009 he returned as chief of psychiatry.One of Dr Radford’s highlights is working on the “huge task” of “taking Bermuda forward” with the Mental Health Plan, which was passed by the House in December 2009.Its aim is to improve partnerships with other agencies and to replace the ‘revolving door’ of patients.It also saw MWI partnering with a medium secure unit in Birmingham, England, so that those with the most severe mental health issues can be transferred. This facility has not yet been used by any Bermudians with Dr Radford estimating that patients requiring that level of care are only seen about “once every ten years”.Under the Mental Health Plan it has also been part of Dr Radford’s job to train Bermudians and he’s pleased those in the industry are on the rise. There are currently five Bermudians in the field one is qualified, two are in training and two are at university.Dr Radford said he was “very sad” to be leaving as he felt Bermuda was “just beginning to feel the changes”. He will leave on August 31 and return to Birmingham, England.However, Dr Radford said he would continue to keep in touch with staff and hoped the Mental Health Plan would continue to be implemented.He said: “I’m confident changes will come, it’s just a matter of time”.