Some years ago, I visited a colleague who was living in Saipan in the Northern Mariana Islands, which is a self-governing United States commonwealth located in the western Pacific Ocean. I felt attracted to the innate generosity of the people, challenged by the unmet needs that I saw for mental health services, and stunned by the beauty of the verdant foliage contrasting with the cerulean sky and turquoise sea. I decided to relocate there. As a general psychiatrist with credentials in addiction, forensics, traumatology, and administration, I found numerous ways to fit in and to apply my skills and knowledge.

For the past three years, I have been working as part of a newly established team dedicated to developing culturally appropriate community care for people with severe mental illness. We started out by trying to identify every individual with serious mental illness who was homeless or at risk for homelessness. We offered treatment to them, and we continue to approach those who do not currently want treatment. We've also directed our efforts to the education of clients, their families, and the community—through village meetings, Friday-night potluck dinners, appearances at health fairs, and promotion on radio and television—to encourage acceptance of treatment and to reduce the stigma associated with mental illness.

A major constraint on community mental health is the recruitment and retention of professionally and culturally competent staff. We have worked with existing resources by starting to develop a network of supervisory support for the numerous members of the clergy of several denominations who already counsel mentally ill people in the community and by forming alliances with local healers. We hope these activities will become part of providing comprehensive, collaborative, and socially acceptable interventions.

We are now planning a network of residences for chronically mentally ill patients, with varying intensity of treatment and supervision. We have begun to train nursing staff in the smaller islands so that facilities there can directly serve their own severely mentally ill populations. It has been very rewarding to begin developing the type of mental health system that we've come to think of as the standard of care on the mainland of the United States within the cultural context of Micronesia.

Until recently Dr. Post was medical director of the Division of Mental Health and Social Services, now Guma Ani Ayuda, of the Commonwealth of the Northern Mariana Islands. For more information, contact her at Marianas Psychiatric Services, P.O. Box 5424, Saipan, MP 96950-5424, U.S.A. (e-mail, [email protected]), or contact Guma Ani Ayuda at P.O. Box 409 CK, Saipan, MP 96950-0409, U.S.A. (e-mail, [email protected]).