By Eulalee Thompson, Staff Reporter Two times per week, health professionals leave the familiar
setting of hospitals to meet their patients those who are
homeless and mentally ill on the streets of Kingston.
AT LEAST two times per week, an assertive outreach team from the Bellevue Hospital leaves the familiar setting of their hospitals and other health institutions to meet their homeless, mentally-ill patients on the streets.
The team comprising community mental health experts mental health officers, nurses, psychiatrists, supported by the police in an expanded and more aggressive programme has been on the streets assessing and treating mentally-ill persons who are homeless.
"We try to gather, for instance, at the places where they (the homeless, mentally-ill persons) would gather to be fed, for example, the Salvation Army feeding programme. We actually go out on the streets and escort them to these programmes where they can be fed, they have their personal hygiene needs met and they are assessed by a psychiatrist," said Dr. Maureen Irons-Morgan, Bellevue Hospital's senior medical officer (SMO).
Some of the homeless, mentally-ill persons, after assessment, are admitted to hospital for more intensive treatment while others, who do not require admission, are intoduced to existing shelters. In a survey, conducted one night in downtown Kingston by Bellevue's health team and other agencies, 92 people were identified sleeping on the streets 71 males and 20 females (the gender of one person was not stated). (There was another group of about 52 persons sleeping in night shelters).
As part of the strategy to tackle homelessness, the Bellevue Hospital has also started a register, complete with photographs, names and other socio-demographic information and treatment strategies, of all the mentally-ill persons on the streets of Kingston and St. Andrew. Since the start of the July outreach programme, Dr. Irons-Morgan said that 433 contacts with homeless people have been made, 137 of them are on the register (124 males and 13 females) and 20 of them were admitted to hospital.
This Assertive Outreach Programme, being more aggressively developed in South East Regional Health Authority (SERHA) to tackle the problem of the homelessness and mental illness, conforms with the current Health Ministry's strategy to reform mental health services and decentralise the care of mentally-ill people.
There have been many attempts to deal with the ongoing problem of homelessness in Jamaica. The problem persists, Dr. Irons-Morgan said because homelessness is a multifaceted phenomenon, with the country's 600 homeless persons consisting not only of mentally-ill individuals but 'deportees', drug abusers and poor and destitute individuals. The solution, she said, should therefore rest upon a comprehensive and integrated approach.
"The problem is multifaceted and has been attacked in different areas and what we need now is to put everything together because from time to time there have been different plans aimed at picking up mentally-ill people, having them assessed and treated but the issues of housing and ongoing living are not really addressed," said Dr. Irons-Morgan.
In terms of a comprehensive mental health programme, she said that mental health experts are looking at two important strategies 'continuity of care' and 'an integrated care approach'.
"By continuity of care, we are saying that wherever the homeless person goes, the amount of care needed should follow them and by integrated care approach, we are looking at the issue of medication, rehabilitation, supported housing and employment and occupational therapy," Dr. Irons-Morgan explained.
The recent initiative the stepped up assertive outreach programme started last July, therefore, sees the Bellevue Hospital Health team working alongside other important social security agencies and non-governmental organisations such as the Ministries of Health and Local Government, the Salvation Army, Food for the Poor and representatives acting out of a subcommittee of the Kingston Restoration Committee.
As part of the more proactive initiative, the health team has also been liaising with the civic groups, in areas affected by the problem of homelessness such as the New Kingston Civic Association, recommending that they employ an outreach worker. The New Kingston Civic Association has taken on this initiative and their outreach worker is working with the homeless persons and drug abusers in that business district.
DROP-IN CENTRE
The CHASE Fund has approved $4.28 million to refurbish and equip a building to act as a drop-in centre for homeless persons, which Dr. Irons-Morgan said will offer a more structured rehabilitation programme on an outpatient basis.
To put a dent in the problem of homelessness, however, the housing issue must be addressed and so the health team is working with other agencies to provide housing solutions taking into account whether the homeless person can live independently. One such initiative has been taken on by Food for the Poor with the renovation of Cluster B of the Golden Age Home.
Institutionalisation is not the best option for persons who cannot live independently but Yvonne Evans, Bellevue Hospital's social worker, said that often relatives cannot be found. Sometimes, those who are found are unwilling or unable to care for their mentally ill relatives.
