Address Jamaica's mental-health situation

Wendel Abel, I AM WHAT I THINK

The article in The Sunday Gleaner of January 29, 2012 was shocking and disgraceful. The majority of employees, from ancillary staff to the professionals, at large institutions such as Bellevue Hospital are well intentioned and hard-working.

However, the problem is that large institutions are outdated and difficult to manage. Here are my solutions to deal with the Bellevue Hospital situation.

1. Strengthen primary care

Primary care or community services includes mental-health care offered in health centres, local hospitals, home visitation and crisis-response teams. Research shows that treatment in community settings has better outcomes. It is cheaper, provides care closer to people's homes, keeps families together and allows people to maintain their daily activities and work. It also reduces the risk of stigma, discrimination and human-rights violations that often occur in large mental hospitals. An increased number of nurses in the community would improve the community service.

2. Reorganise Bellevue

I am not calling for the closure of Bellevue Hospital. However, we need to reorganise this institution to provide care in keeping with modern mental-health practices and human-rights standards.

3. More efficiency

Large mental hospitals are outdated, function as human warehouses and are expensive. Bellevue Hospital's budget is $1.42 billion or $146,000 per month for each patient. Bellevue Hospital is 150 years old and is situated on 37 acres of land. These institutions are being phased out worldwide. Belize and Dominica, for example, have successfully phased out their mental hospitals and shifted care to community care. Similar trends occurred in Europe and North America.

4. Residential patients

Ministry of Health data indicate that 70 per cent of the patients in Bellevue Hospital are stable, but do not have family support or are homeless. These patients should not be in an expensively operated hospital but in lower-cost institutions such as CUMI and The Open Arms.

5. Very sick people

With so many residential patients, the institution has fewer beds to care for the very sick (from 300 to fewer than 100 beds) and it functions as a large nursing home. Many seriously ill persons are sometimes denied admission to Bellevue Hospital.

6. Deploy staff

There are fears that if Bellevue is reorganised, jobs may be lost. This is not necessarily so. In the 1970s, Jamaica reduced the size of Bellevue from 3,000 to 1,500 and staff were deployed to work with patients and families in the community service.

7. Address human-rights concerns

Mental hospitals are associated with human-rights violations worldwide. Jamaica has signed several human-rights conventions safeguarding the rights of people with disability. The pictures in The Sunday Gleaner of January 29 raise human-rights concerns. Jamaica may be exposed to lawsuits if these human-rights concerns are not addressed in our mental-health institutions with alacrity.

8. Implement Cabinet decision

The World Health Organisation recommended the phasing out of large mental hospitals and the strengthening of community (primary-care) services. The Cabinet approved a plan for mental-health reform in 2006 to develop community mental-health services. This plan was not implemented. Professionals in the field have worked on a reasonable plan of action which will save money, spare jobs and improve the system. This is a great opportunity to overhaul our mental-health system. If we continue to ignore the recommendations of experts in the field, we do so at our own peril.

Dr Wendel Abel is a consultant psychiatrist and head, Section of Psychiatry, Department of Community Health and Psychiatry, University of the West Indies; email: yourhealth@gleanerjm.com.