THE EDITOR, Sir:
I READ Professor Hickling's article on deinstitutionalization in The Sunday Gleaner (27 July) with interest. However, in seeking to make the case that deinstitutionalization represents a process of decolonization, he misses a number of important points.
First of all, institutions were developed throughout Europe and around the world as a response to a problem for which there was no other solution at the time. Society had few other options for dealing with people exhibiting bizarre behaviour who represented a danger to themselves and others (chaining relatives up in a spare room was another popular option).
Since the 1950s powerful anti-psychotic medications and anti-depressants have been developed which are very successful in reducing the incidence of bizarre and threatening behaviour in patients. Thus patients with schizophrenia can now frequently be managed in the community, and it is this, rather than any enlightened action on the part of psychiatrists, which has massively reduced the populations in long-stay hospitals.
However, patients frequently pay a heavy price for their new freedom. Even a fairly cursory reading of the literature will reveal that anti-psychotic medications, when used long-term, often result in lasting brain damage. Older patients often exhibit early parkinsonism and tardive dyskinesia.
Few professionals would disagree that well-resourced community care is a better option than the human warehousing which has gone on in the past. However, there are many caveats. For some patient groups, such as the frail elderly, care will always involve intense 24-hour supervision, and attempts to place these patients in the community frequently resemble long-stay hospital wards set up in a residential area.
Doing community care well involves small supervised units with 24-hour assistance and centralised provision of activity and recreation. The process towards deinstitutionalisation has been in progress in Europe now for several decades. It has quickly become apparent that community care, done well, is a far more expensive option than the previous centralisation of resources.
Rather than seeing Professor Hickling's proposal as some new exciting venture toward decolonization and restructuring, it could be seen as following in the European footsteps. It is to be hoped that professionals here in Jamaica will learn from the mistakes which have happened elsewhere, and maybe even arrive at a distinctly new Caribbean model of care which reflects Caribbean realities.
I am, etc.,
DR. TONY WARD
Senior lecturer in psychology
University of the West Indies
E-mail: tward@uwimona.edu.jm
