Areas of unmet needs in the care of the mentally ill are now being unmasked by the recently-introduced community mental health service - Sister Veroina Deslandes, University Hospital of the West Indies.
THE WORLD-WIDE movement to reduce the "warehousing" of mentally-ill patients in large mental institutions and to instead care for them in the community, has been popular since the 1960s.
The Bellevue Hospital, the largest mental health institution here, has been following this trend, reducing its patient load between 1970 and 1980 from 3,500 to about 1,500. The patient population is currently about 1,000.
It is in the wider context of this movement toward community mental health services (CMHS) that the University Hospital of the West Indies (UHWI), established its community services last October. Sister Veroina Deslandes, Matron of the hospital's psychiatric ward (ward 21), said, in a review of the first nine months of the services, that it has "unmasked areas of unmet needs in mental health services in Kingston and St. Andrew".
Sister Deslandes and her multi-disciplinary team travel the nook and cranny of the Corporate Area administering health care to mentally-ill patients. In her study, presented at the University of the West Indies' Faculty of Medical Sciences 11th annual research conference, she described the geographic catchment area as representing about 30 per cent of the Kingston and St. Andrew region. The availability of an ambulance allows the team to assess and treat patients in their homes.
Between last October and May 2002, this psychiatric emergency service facilitated the admission of an average of two emergency patients each month from their homes a total of 18 emergency patients over the period of review.
Sister Deslandes also indicated that the primary liaison service received 185 (nearly 21 patients each month) by telephone referrals and made 212 or nearly 24 visits per month to the homes of patients requiring assessment and treatment. The community mental health service was also able to refer 79 patients to day hospital and provide counselling services for another 247 persons during the period under review.
The community mental health service must also be assessed in terms of the prevention of the readmission of patients who suffer chronic mental illness to hospitals. Sister Deslandes described for instance, the case of a 35 year-old patient, suffering acute schizophrenia, who defaulted on her clinic appointments. The assertive home visits provided by the hospital's team saved this patient from further deterioration and hospitalisation.
The introduction of this community service, she concludes, is meeting service demand that would otherwise escape the notice of mental health system.
The descriptive study also supports World Health Organisation's (WHO) data indicating that community care has a better effect than institutional treatment on the outcome and quality of life of individuals with chronic mental disorders. It has also been found that shifting patients from mental hospitals to community care is more cost-effective and respectful of their human rights.
The WHO also advises that large custodial mental hospitals should be replaced by community care facilities, backed by general hospital psychiatric beds and home care support, which meet all the needs of the ill that were the responsibility of those hospitals.
