By Eulalee Thompson, Staff Reporter 
On the inside looking out at Bellevue Hospital. - Junior Dowie/Staff Photographer
Dip them Bedward, dip them, dip them in the healing stream...
BACK IN April 1921, Bedward, the popular black activist from August Town, St. Andrew, was committed to Bellevue Hospital and he never again saw the light of day. He died in that institution on November 8, 1930. The British colonial authorities of the day claimed that he was a mad man but the common belief was that he was locked away because his inciting the black masses to action and his other goings-on had made him a thorn in the side of the colonials.
This snippet of Jamaica's history still remains controversial, speaks to many issues but is also an indication of the history of Bellevue Hospital entwined with mental healthcare and echoes of imprisonment.
"The British have been using it (mental health institutions) as a custodial sentence and they are still using it mainly to lock up black people. It is a big issue in England where you have institutions of varying levels of security housing mentally-ill patients...because they want to be able to scrape up black people and put them under tremendous straightjacking," said Professor Freddie Hickling, now head of psychiatry at the University of the West Indies but had been the controversial senior medical officer at Bellevue Hospital in the 1970s.
In the 1860s (not too long after Emancipation) when the mental health institution was built by the British, the treatment of and stigma attached to people with mental illness was at its lowest ebb, not only here in Jamaica but also in Britain.
In Britain, patients were housed in large, noisy, chaotic, 'madhouses' or warehouses; patients were unkempt and chained and their antics were a source of pleasure to others. Tickets were sold to tourists, who would observe the patients as part of a tourist attraction. A parliamentary inquiry into the madhouses by the British House of Commons in 1815, is said to have ushered in the modern era of humane treatment for mentally-ill patients.
The architectural design of Bellevue, mental health director Dr. Earl Wright said, is along the lines of a prison, reflecting the era when it was built. However, the more modern care of mentally-ill patients requires a shift into a more mentally-supportive architectural design.
Controversy is now brewing around the plans to shut down Bellevue, re-directing the $400 million per year budgetary allocation into other aspects of mental healthcare, but Professor Hickling said that this is a critical step that must be taken to improve the country's mental healthcare and change the national attitude toward madness.
"Bellevue and madness have become synonymous. The minute that Bellevue is no more, our stigma to the treatment of mental illness will change. When a person is treated on a hospital ward with acute schizophrenia and is released in 10 days, their family will say 'oh he had a little nerve trouble and it was sorted out' but if he was sent to Bellevue for three weeks, they say 'oh, Johnny was mad and was in madhouse. When the patient is treated in the community the perception is that it was a little nerve problem," he said.
He says that psychiatry is moving away from locking people up and throwing away the key. International health organisations such the World Health Organisation and the Pan American Health Organisation have been urging this shift. They indicate that patients are better treated closer to the community. Newer, fast-acting medication makes this possible together with other therapies such as psychotherapy, occupational therapy and family therapy.
"It is the delusion to say that those warehoused will be out on the streets once Bellevue is closed down. The people who are warehoused are stabilised, they don't have active mental illness and they don't need a mental hospital; most of them are over 60 years old. The idea that Bellevue will release 800 mad people on the streets is so far from the truth," Professor Hickling said.
