Reviewing the international trends, one can only conclude that large, prison-like mental health institutions are fast becoming...
THE INTERNATIONAL trend to reform the treatment of mentally-ill patients was stimulated, in the last few years, by newer, though more expensive, types of antipsychotic drugs and antidepressants that produced fewer side effects than the older drugs. Old, prison-like psychiatric hospitals, have become redundant because this pharmaceutical development facilitates quicker re-adjustment of persons living with mental illnesses.
Reports coming out of the 54th World Health Assembly, ministerial roundtable (2001), "Mental Health: A Call for Action", also indicate innovative developments in psychosocial therapies such as cognitive-behavioural therapies (altering patients' faulty thinking processes) and family therapy along with drug therapy have improved outcome in adult patients with a variety of mental disorders.
The Assembly reports too, that even in countries with well-established services, fewer than one-half of those individuals needing them make use of them. The underutilisation is related to the stigma attached to individuals living with mental disorders and behavioural problems. The World Health Organisation (WHO) therefore advocates the integration of psychiatric care within general health care (including the opening of psychiatric admission wards in general hospitals). The advantage of this approach, the WHO states, is the reduction of the stigma attached to an admission for a mental disorder.
The ministerial roundtable (2001) documents indicate further that, in developed countries, it is now rare for patients with non-psychotic conditions to be admitted to hospital, as the majority of these patients are treated by primary care physicians. Jamaica's mental health officials also indicate that the majority of persons living here with mental disorders and behavioural problems are being treated, not in the mental health institution, Bellevue Hospital, but at their private doctors' offices and in outpatient care. This figure amounts to about 20,000 patients being treated in the primary care system.
Dr. Earl Wright, director of Mental Health Services, Ministry of Health states that the plan for the relocation of mental health services from the Bellevue Hospital is in keeping with international standards for cost-effective mental health care and is part of a five-year strategic plan in mental health reform.
Dr. Wright indicated that a menu of mental health, psychiatric treatment and support services will be offered in the country's four health regions including
Emergency Crisis Intervention and Assertive Outreach Programme
Acute inpatient care provided in general hospitals islandwide
Developed and improved vocational and psychosocial rehabilitation in each region
Follow-up care in outpatient clinics islandwide
Child and adolescent mental health programme
Improved forensic service developed in association with the Justice Ministry
Improved Substance Abuse Treatment and Rehabilitation programme in collaboration with the National Council on Drug Abuse
Various levels of supervised and supportive living arrangements.
De-emphasising institutional care shifts the focus to community-based facilities. The ministerial roundtable (2001), however, indicates that "closing mental hospitals without community alternatives is as dangerous as creating community alternatives without closing the mental hospitals. Both have to occur at the same time."
The roundtable further stated that "in most countries where deinstitutionalisation has occurred, the process began with local initiatives and was only officially endorsed as government policy at a later stage... for the transition to community care to be successfully achieved, it is essential to have the full backing of the government so that there is equity of
services nationally.
