LEFT: Dr. Earl Wright, director of Mental Health Services in the Ministry of Health. RIGHT: Dr. Maureen Irons-Morgan, senior medical officer, Bellevue Hospital.
WHEN EDWARD Rochester met Bertha Mason, he thought she was one of the most beautiful women he had ever seen. Sparkling and gregarious, Bertha soon captivated him and the two were married.
It was then he discovered Bertha had a dark side. Beneath the sparkle lay a mentally unsound mind.
In the gothic novel, Jane Eyre, the story continues. Mr. Rochester keeps his mentally ill wife locked up in a room, away from public eyes and the rest of society. The novel shows that under old paradigms, it was thought that mentally ill persons should be locked away, if not at home, in a mental institution built like a fortress.
PARADIGM CHANGING
These days, the paradigm is changing. More countries, including Jamaica, treat most persons with mental health problems in community settings instead of institutions.
They are following three principles outlined by the 2001 World Health Organisation report, "Mental Health New Understanding, New Hope." It identified three essential components of de-institutionalisation, namely,
Prevention of inappropriate mental hospital admissions through the provision of community facilities.
Discharge to the community of long-term institutionalised patients who have received adequate preparation and
Establishment and maintenance of community support systems for non-institutionalisation of patients.
"All studies show that the outcome of the treatment process is much better at the community level without the institutionalisation," said Dr. Earl Wright, director of Mental Health Services in the Health Ministry.
Statistics on patients being treated in Kingston and St. Andrew, St. Catherine and St. Thomas in 2002 showed that most are already being treated outside institutions. There were more than 2,500 patients being treated via community- based mental health clinics, almost three times the 800 or so patients at the Bellevue Hospital.
There are plans being made now to scale back activities at the Bellevue Hospital based on this paradigm shift, but the process of providing alternatives to institutions will take more time.
ACUTE CARE UNITS SET UP
Dr. Wright said health officials have been improving community mental health services in the island's four health regions.
He said the ministry has increased the number of regional psychiatrists, psychiatric aides and community mental health officers. Emergency outreach and acute care units have been set up in various health regions to support patients on anti-psychotic drugs.
But there is still more work to be done. While there are crisis response teams in sites such as Spanish Town and Kingston and St. Andrew, "These are often the same teams working in clinics so when you call, you may not get them. We are still short of resources," said Yvonne Miller, chief executive officer at Bellevue Hospital.
The Ministry has also spearheaded the training of police officers, correctional officers and primary health care workers, Dr. Wright said.
The training of the police is good news for Dr. Maureen Irons-Morgan, senior medical officer, Bellevue Hospital, who said that under the law, only a mental health official and a police officer can take persons who appear mentally ill to the nearest facility or hospital.
Community mental health services
NORTH EAST REGION:
One highly supervised
living facility
Three supportive living facilities, one per parish
WESTERN REGION:
One highly supervised living facility
Four supportive living facilities: (one per parish)
WASP on the infirmary grounds in Westmoreland
SOUTHERN REGION:
One highly supervised living facility per region
Three supportive living facilities including Ebenezer Home for the Mentally ill /street people, on the Infirmary grounds in Royal Flat for persons in the parish of Manchester; and CLASP on the infirmary grounds in Clarendon
SOUTH EAST REGION:
At least one highly supervised living arrangement / facility per double health zone in Kingston and St. Andrew and one for St. Catherine, plus four living arrangements
One supportive living arrangement facility per zone in and one for St. Catherine plus seven living arrangements.
Source: Mental Health Services Unit, The Ministry of Health
Example taken from 'Wide Sargasso Sea' by Jean Rhys and 'Jane Eyre' by Charlotte Bronte.
