Bellevue Decentralising Delivery of its Services

A new era is dawning for mental health care in Jamaica as the Bellevue Hospital moves to decentralise the delivery of its services and expand patient care to include the country’s four Health Regions.
The hospital, which is currently celebrating its 145th anniversary, is now in the midst of a transition process, and officials at the institution say that the re-organisation underway is much wider than Bellevue, “as it is in keeping with the whole mental health care reform plan for the island”. In a recent interview with JIS, Senior Medical Officer (SMO) of Bellevue Hospital, Dr. Maureen Irons Morgan, explains that the rationale for decentralising mental health care from being solely restricted to Bellevue is that, “over the years.it has become clear that a more appropriate way to deliver services would be if they are delivered at the community level”.
She adds that the reason for expansion of mental health services in the island is predicated on the basis that the accessibility of the services by patients within communities where they reside, helps to fight the stigma associated with mental illnesses.
“It also facilitates the early recognition and treatment, so it counteracts the tendency of chronicity in mental illness,” Dr. Irons Morgan points out.
The decentralisation of Bellevue’s services is not a newly devised plan, as it dates back four decades when it was initially introduced.
“In the 1960s when it was implemented, the in-patient population at Bellevue was over 3,000. At this time, we are down to just about 814 patients, so we can see how far we have been going in terms of de-institutionalisation and of increasing the availability of services at the different regions and at the community level, and so decreasing the burden of care on the mental hospital,” the SMO tells JIS News.
“We have the south east health region then there is the north east health region, the western and the southern health region. Each region has its own mental health team,” she points out.
A regional psychiatrist herself working in the Health Ministry’s south east health region, Dr. Irons Morgan notes that each region is assigned its own psychiatrist, while the overall plan is to have a range of mental health officers, including specialist nurses, psychiatric nursing aides, social workers, psychologists, child and adolescent psychiatrists working in each region.
She explains that the Health Ministry’s vision is for each region to eventually have appropriate in-patient services as well as out-patient services that run the gamut, from rehabilitation to occupational therapy.
“We are moving along [that path] we are not there yet in terms of everything being available, but that is where we are moving,” the SMO says.
The long-term plan which the government is seeking to implement, she adds, is for in-patient care to be integrated into general health care.
“In fact, mental health care should be integrated into general health care at all levels; that is the long term plan, meaning that at the hospital level, at the clinic, at every level, mental health care would become one of the health services, just like any other health service,” Dr. Irons Morgan argues.
She says that of the 814 persons now housed at Bellevue, there is a substantial number of them who have been residential patients for sometime but are not acutely ill, and so, could live at home, or with minimum support in the community.
The SMO adds that until facilities such as direct community support is available for the more than 700 patients who are not acutely ill, they would remain in the care of the mental institution.
Dr. Irons Morgan, who has been working at Bellevue for 13 years, notes that the annual budget for the Bellevue Hospital is $500 million, including funds for mental health services, such as community based services rendered outside of the mental hospital.
“It is one mental health budget and is very hard to separate how much goes to community and Bellevue at this time, because we are under one sort of administrative body and we have a flow back and forth of workers,” she explains.
The staff complement at Bellevue include some 15 doctors and 80 nurses, as well as administrative staff and ancillary workers.
She points out that in respect of services offered at the Windward Road premises, there is an emergency room for acute mental health care where “people can walk in with emergencies or some people may be brought in by the police, if it’s a forensic psychiatric case or if it goes through the courts people are seen on a daily basis in our emergency room”.
“We admit persons through the emergency room or they may be admitted and treated and sent home. We have out-patient clinics where we see over a thousand patients per year in our out-patient clinics, and they receive out-patient care and pharmacy care and they go back home, and then we admit patients for short-term stabilisation who return home for different mental health problems or they may be here for a longer term, depending on the particular diagnosis,” Dr. Irons Morgan says.
There is also a psychology department at the mental institution that provides in-patient and out-patient therapy, as well as an occupational therapy department that is referred to as a ‘rainbow centre’, where occupational therapy is offered to prepare patients for employment and independent living.
The SMO tells JIS News that in regard to the community mental health service, this particular component of healthcare is being executed in close partnership with hospitals across the island.
Consisting of psychiatrists and a team of mental health officers and psychiatric nursing aides, these persons visit community based clinics and general hospitals in communities to see patients with mental illnesses.
“We have special outreach programmes to homeless mentally ill persons, and as we speak, we are having a drop-in centre developed right beside the Windward Road health centre, where we will focus on homeless mentally ill persons, treating them, rehabilitating them, and getting them functioning as much as possible back into society,” Dr. Irons Morgan says.
On the issue of the stigmatisation of persons with mental illnesses who, more often than not, are treated with disdain by the wider public, she points out that, “stigma has a lot to do with ignorance and mystery surrounding all illnesses”.
“More and more we are coming to understand that mental illnesses are simply brain diseases, [so] just like any other part of your body, the brain can also be affected,” she says.
“[Therefore], because it is the brain that controls your emotions, your thinking, your decision making, your memory, all of those faculties, all of those different abilities can be impaired if the brain is impaired,” the SMO adds.
Mental illnesses span a wide range of illnesses, with schizophrenia being the most commonly identified severe mental illness. Other mental illnesses, she says, include bipolar disorder, depression, anxiety disorders, and substance abuse disorders.
A residential rehabilitation facility known as the Kenneth Royce rehabilitation centre, is currently operational in Spanish Town. Some 49 residents live there, who were previously patients at Bellevue but who are capable of living in the community. Residents at the rehabilitation centre are provided the opportunity to participate in vocational programmes.