A four-bed inpatient ward for adolescents that the Government said would be established at the Anthony S. Eden Hospital by the end of 2026 has not yet been built, and the Ministry of Health, Environment and Sustainability says construction is now expected to finish in the first quarter of next year.

Asked by The Caymanian Journal (TCJ) whether the ward was built, funded, staffed and commissioned, the Ministry said: "The contractor RFP is currently out for tender and will close on 4th November, after which submissions will be evaluated and a contract awarded. Construction is expected to be completed by the end of Q1 2027, and staffing will be ready once construction is complete." The infrastructure is funded by the Health Services Authority within the 2026 budget period, and staffing through a Ministry output.

The ward was one of four commitments announced alongside the National Health Policy and Strategic Plan on 21 November 2025. Until it opens, the territory's entire adolescent mental health inpatient capacity is three beds. The Authority publishes its unit at the Anthony S. Eden Hospital as an "11-bed inpatient facility" in which "8 beds accommodate adults and 3 beds for adolescents", serving a resident population the Economics and Statistics Office put at 90,577 as at December 2025.

A 54-bed centre, 24 residents

The Poinciana Rehabilitation Centre at East End has capacity for 54 residents across nine cottages. Its published criteria state that a service user "must be between 18-65 years of age", and that the centre cannot provide an appropriate service where a service user "has not attained the age of 18 years old", is "in an acute phase of mental ill health", or poses "a risk of harm to self or others". It adds that "no emergency admissions will be accepted by the facility".

The Ministry told TCJ the centre currently holds 24 residents, with a further six to ten admissions expected before the end of the year. It gave the final capital cost as $21.32 million against a figure of $16.24 million originally approved in 2016, and put the annual budget cost for 2026 at $11.48 million. Contracts were announced on 7 October 2019 with an expected opening in the second quarter of 2021, and the centre took its first residents in January 2025.

Alden McLaughlin, then Premier, said at the 2019 signing that "one of the driving forces behind the establishment of this new centre is to bring patients home who are overseas in institutions". Dwayne Seymour, then Minister of Health, called it "a state of the art facility of its type in the region".

Where under-18s go

Asked what provision exists for under-18s requiring residential care, the Ministry said overseas referrals are used for services not available on island. "The approach for young persons differs from adults," it said. "At present, the Ministry's approach for minors focuses on prevention, early intervention, and family-centred care." It said the Government is exploring options to strengthen intensive treatment pathways for high-need youth, that "the number of cases requiring residential treatment remains relatively low", and that "we do recognise the gap in more intensive treatment options, and where required, access is facilitated through overseas placements".

For adults, the Ministry said those in acute crisis "continue to receive assessment, stabilisation, and inpatient treatment" at the Anthony S. Eden Hospital, and that once clinically stabilised they may be considered for Poinciana. It referred questions on the number and cost of overseas mental health placements to CINICO.

The gap is not therapists

A clinical psychologist in private practice in the Cayman Islands, who until recently chaired the Council for Professions Allied with Medicine, the licensing board, and holds a role in the Cayman Islands Psychological Association, told TCJ the islands are not short of practitioners. Cayman had roughly 120 licensed therapists in March 2026, she said, against an international recommendation of 18 per 100,000 people. "There is an abundance of therapists in Cayman," she said. "The difficulty is not having a full continuum of care."

What is missing, on her account, is everything between the ward and an hour a week. In the United States, where she trained, a patient leaving hospital steps down through a partial hospitalisation programme of roughly 20 to 30 hours a week, then intensive outpatient programming of nine to 15 hours, before reaching ordinary outpatient care. Neither tier exists on island for mental health. "Clients drop right back from 24/7 care to 1 hour per week," she said, "which is a very tricky process and often predisposes them to relapse." The same gap meets patients returning from months of residential treatment overseas.

The effect, she said, is that the hospital ward absorbs demand that should sit below it. The unit is often full, and clients who cannot be admitted are either held in the community or placed on a ward without the mental health unit's support and safety protocols. With a fuller continuum, she said, the ward could concentrate on imminent crises and patients would have a better chance of sustained recovery after discharge.

After hours

The Authority's behavioural health page lists crisis intervention among its services and carries three telephone numbers, for a general line, the Smith Road clinic and Alex's Place. None is identified as a crisis line or an after-hours contact, and no out-of-hours pathway is set out. Its community services close in the evening: the outpatient clinic at Smith Road at 4.30pm, Alex's Place at 6pm and the day centre at 2pm.

Pathways nonetheless exist. The psychologist said the Authority's accident and emergency department has a psychiatrist on call, so a person who calls 911 or attends in a mental health crisis will be assessed and directed to admission, medication or therapy. CayMind, a non-profit mental health helpline, operates in the evenings during the week, and the Crisis Centre, set up for domestic violence, takes mental health calls on its hotline and is, she said, "available 24/7". None of those routes appears on the Authority's page.

The other commitments

The mobile mental health nursing team announced in November 2025 is not yet operating. The Ministry said nurse recruitment is in progress and the service is aimed to begin in early 2027, operating from 7am to 7pm. On the new mental health facility for young people, it said project planning is under way, with preliminary geotechnical assessments begun and an initial consultancy and professional services tender expected in the final quarter of this year.

The National Mental Health Policy will not be published on its own. The Ministry said it is updating the previous policy and creating an implementation plan, and that it now forms part of the National Health Strategy and Plan, with both expected before the third quarter of 2027. On the suicide-risk campaign, it pointed to a Signs of Suicide training pilot making the module available to teachers, parents, youth workers and other professionals through 31 August 2027.

What is spent

The Ministry gave budgeted expenditure on mental health services, covering the Department of Counselling Services and Poinciana, as $13.14 million for 2025, $17.93 million for 2026 and $19.21 million for 2027. Actual expenditure for 2025 was $14.70 million.

Put to it that a young person's realistic options can be to wait for public support or pay privately for treatment insurance may not fully cover, the Ministry said it recognised that some families may perceive their options that way, but that "this characterisation does not fully reflect the range of supports available". It said insurance decisions are generally determined by the terms of individual policies, acknowledged "the challenges that delays in accessing services can place on young people and their families", and encouraged families having difficulty to engage with providers and agencies so options can be explored case by case.

The Health Services Authority and the Ministry of Education and Training were emailed on 15 October and had not answered at the time of publication. The Authority was asked for bed occupancy, how often a patient assessed as needing admission could not be given one, waiting times from referral to first appointment, vacancies by discipline, and its out-of-hours pathway. Education was asked how many school counsellor and school psychologist posts exist, how many are filled and how many are vacant, and how long a pupil waits to be seen once a school refers them. The Office of the Premier, asked on 15 October what sum is appropriated to mental health across all entities, said on 16 October that the question fell within the Ministry of Health's remit and forwarded it there. The Ministry's figures cover the Department of Counselling Services and Poinciana.

Anyone who needs support can contact the Health Services Authority's behavioural health services, or Alex's Place for young people. The Alex Panton Foundation also works on youth mental health in the Cayman Islands.