- RUDOLPH BROWN/CHIEF PHOTOGRAPHER
Fire at a section of the Central Police Station in Kingston believed to have been started by a person of unsound mind.
Leonardo Blair, Staff Reporter
This is the first of a four-part series on the treatment and care of mentally ill persons.
PROFESSOR FREDERICK Hickling is adamant that community-based mental health care works. It is a view he has held for the last 30 years; and he is prepared to quit medicine if anyone tries to force him to go back to locking away the mentally ill in institutions like the Bellevue Hospital.
"I know it (institutionalised care) does not work. I was with Bellevue for 10 years and I saw what that did!"
No one has asked him to quit yet, but many of his colleagues think that implementing the thrust towards community based mental health care without a good plan and the appropriate funding is a recipe for disaster. It has been tried in some areas already and many health workers say that it is a model that the Government simply cannot afford.
Last month alone, two persons suspected of being mentally ill caused nearly $50 million in damage after they set fire to the King's Plaza along Constant Spring Road in St. Andrew and a section of the Central Police Station in Kingston.
ENGAGED IN WRONGDOINGS
But this and other incidents where mentally ill persons have engaged in wrongdoings will not change Hickling's view on the care of mentally ill persons.
Everyone still remembers Caston Haase from Mavis Bank in St. Andrew who hacked to death three of his nieces and injured several others last year. His neighbours replied by mincing his body with machetes and burning his belongings.
Some mentally ill persons have even been reportedly gunned down for various reasons by police officers and criminals alike.
Last June, 25-year-old Kevin Dixon, said to be of unsound mind, was shot dead in Boon Hall, St. Andrew after he reportedly attacked a constable with a knife.
In July, Mark Whylie, 36, also mentally ill was shot dead by gunmen.
But don't tell that to Professor Hickling.
"So what! The majority of the island's mentally ill are being helped," he says. The island's community-based mental health care system is taking care of 20,000 of the nation's estimated 500,000 victims of mental illness every year. And that's very good considering the shoestring budget they have been working with. "If we had more money we could have helped the ones who made the headlines too," he says.
Professor Hickling, who heads The Section of Psychiatry at the University Hospital of the West Indies, strongly believes that the mentally ill can be better cared for in the community at less cost. And it stands a better chance of keeping them in touch with reality and the love of their families.
"We have been spending less on the mentally ill because of the community-based approach," he says; and not in costly operations such as the Bellevue Hospital in Kingston.
This institution, he says, is a waste of money and what the country needs at this point is to save money or use it more efficiently. The hospital, he says, currently has 900 patients a reduction from 3,000 in 1970. As a result of that, over half of Bellevue's land has already been cut up and sold. Right now, he explains, only about 250 of the patients at Bellevue are legitimate. The other 750 are patients who have been there for over 40 years, abandoned by their families.
Studies in first world countries such as Spain show that the community-based approach works and it can prevent the kind of situation that currently exists at Bellevue. It can facilitate a reunion. In the United States, however, the Government there has slashed funding of its programme. Studies there have shown that a breakdown in the community-based approach usually results in an increase in the prison population unless the funding for the model is sustained.
POLICY SHIFT
In Jamaica, this approach to caring for the mentally ill, is fully endorsed by the Govern-ment, at least on paper. In less than three years, the Government expects to make a full policy shift from institutionalised-state care to community-based care for the nation's mentally ill. Already, the budget for Bellevue was significantly slashed to $380 million in 2004/2005 from $499.5 million the previous year. The argument is that more people can be helped with the limited funds that the Government has to spend.
At the same time, the 1,600-bed hospital is expected to achieve a number of efficiencies including increasing the number of patients involved in occupational therapy from 15 per cent to 30 per cent, relocating and upgrading of emergency rooms, training of psychiatric aides, and continued upgrading of the grounds.
But many of Professor Hickling's colleagues in the field think that Jamaica is not the place for that model. They all agree that the community-based approach is a good idea, but in the 30-odd years of the shift into the community-styled care there has been very little sustainability. And no matter what the official figures show, mentally ill patients are just not ready to deal with the reality of the communities they once fled from. Many are currently not even getting any form of care and they have remained as ghosts on the fringes of society.
BIG STIGMA
"Sometimes we copy the metropoles and we don't remember that we are just a little satellite," says Patricka Thompson-Morgan, a mental health nurse for over 30 years and a nursing supervisor at the Bellevue Hospital. I am not against community-mental health, but there is still a big stigma out there that we have to fight. You think we have not tried"
Even the Ministry of Health (MoH) had tried. In 2003, the MoH launched a $5 million mental health promotion and educational campaign, aimed at raising public awareness about the importance of maintaining good mental health and de-stigmatising mental illness.
"But I don't even know what has happened to that." "Things haven't changed much."
Matron Merle Rochester-Riley, also from Bellevue, said too that Jamaica is in no position to embrace the model.
One time, she said, they returned a patient to his nearby community. A few days later he was chased back to the Bellevue compound by angry residents who dug out his eye and left him in pain. "All that for a biscuit," she says. "Some of them (mentally ill), if they are not in institutions they would have to be in prisons," she explains. "One of the things we have been saying to the Government is that public education is needed. Otherwise, we are going to have patients losing their lives."
NO ADEQUATE PREPARATION
Joy Crooks, a director and administrator of the Committee for the Upliftment of the Mentally Ill (CUMI) in Montego Bay, says the idea of community based mental health care is modern and more therapeutic for victims of mental illness, "But as a country, I don't think adequate preparation for this transition is in place," she says.
"The Government stated that they were going to upgrade the infirmaries and that has not happened. The training of the stakeholders, if it has happened any at all, is inadequate. Some areas don't have adequate mental health officers. In St. James, we have only one ambulance dedicated for the mental ill," she said.
"You cannot move into community-mental health care like that. What happens when there is a crisis? Even sometimes when you call the police, they don't turn up and they are supposed to be a part of this."
Carole Narcisse, spokesperson for Mensana, a mental health support group said, keeping mentally-ill patients at institutions like Bellevue, "does in fact potentially cost less, but treatment is much more effective under the community-based model. However, "we can't just send people home like that. You really need people to be informed about those things."
