Community Mental Health Care, is more effective and cheaper to provide than institutional care, but in order to have a successful system, all the critical institutional services, must be available at the community level.
In addition, there is an urgent need for specialised branches of psychiatric services, including forensic psychiatry, geriatric psychiatry, and child and adolescent disaster psychiatry, Senior Medical Officer (SMO), at Bellevue, the country’s largest mental health care institution, Dr. Myo Kyaw Oo, tells JIS News, in an interview.
He points out that in 2006, the development of the Mental Health Services and Deinstitutionalisation Plan was approved by the then Cabinet, and out of that plan came the Mental Health Strategic Plan (2008-2012), which fell in line with the World Health Organisation’s recommendation, that community-based services be developed to reduce the stigma and to introduce more of the best practices approach.
This strategic plan envisions the availability of all the necessary mental health services, in each of the Ministry’s health regions, headed by a Regional Psychiatrist. “Each region should have a general hospital and parish hospital, with psychiatric beds or wards in those hospitals. You don’t need to come to Bellevue if you are living in Cedar Valley (St. Thomas) or Bog Walk (St. Catherine), or any remote area. You need to be able to go to the nearest parish hospital or general hospital and get psychiatric care,” Dr. Oo argues.
The plan also includes consultation liaisons, where a psychiatric ward in the general hospital is assigned psychiatrists to deal with cases of mental illness, including post-partum depression, and provide pre-surgery counselling, among other services. Presently, Bellevue provides consultation liaisons to the Kingston Public Hospital, the University Hospital of the West Indies, and the Spanish Town, Princess Margaret and Linstead Hospitals.
Emphasising the need for specific types of psychiatric care, Dr. Oo notes that between Bellvue and the country’s prisons, there is no forensic psychiatric hospital.
“One major area lacking is a forensic psychiatry hospital. Mentally ill offenders should not be in prison at all. Being in prison is not therapeutic. Prisons are built to punish people who did the wrong thing. They should be between Bellevue or a forensic hospital,” he says. To this end, preliminary discussions have been held between the Ministry of Health and the Ministry of Justice. “The Ministries need to agree on a consensus, to get this forensic psychiatric hospital, because we desperately need it,” he adds.
Dr. Oo tells JIS News, that persons are living longer and there is also a need for geriatric psychiatric service to address disorders, such as dementia, depression, and anxiety, particularly for the ageing population, who suffer from chronic lifestyle illnesses, including diabetes and hypertension, as these individuals tend to suffer from depressive disorders.
Turning to what is termed ‘disaster psychiatry’, he notes that with Jamaica often affected by natural disasters in the form of floods and hurricanes, as well as man-made disasters, such as crime and violence, many people re-live this stress, and suffer from post-traumatic stress disorder.
For natural disasters, he says that, “we should be able to provide debriefing, critical incident stress management and follow-up services, and also the continuation of services. Those are the things in the strategic plan.”
Dr. Oo notes that despite the fact that these and other basic mental health services in the community setting are not adequate, improvements have been made since the early1960s.
The SMO acknowledges that the services may never be completely adequate, as there may never be enough psychiatrists, community mental health officers, or community psychiatric aides. “What we want to see is the integration and co-ordination with others, meaning that not only the professional group can do it. Other professional groups must join the mental health team, and most of all, the community members must join the team. Without community involvement and community acceptance, no plan is going to be successful at all,” Dr. Oo emphasises.
Therefore, he says that what is being sought is the integration of mental health services into the health care system. “This means that you don’t need to see a psychiatrist only when you become mentally ill. You can go to your family doctor, (or) the nearest health centre and see any doctor to talk about your mental health, and those doctors, not psychiatrists, should be able to recognise mental illnesses, and to initiate treatment. Only when there are severe cases and selective cases, which need specialist services, that they report to the psychiatrist. That is also in the plan,” he points out.
Staff at the Bellevue Hospital in Kingston, discuss literature on display with students, at an Open Day, held at the institution on October 8, in observance of Mental Health Week (October 5 to 11).
He notes that as a result of the plan, the Ministry of Health has developed a protocol manual for the treatment of common mental disorders. It also targets general physicians, who are not psychiatrists, to be used as a guideline.
“What I would like to see is that the policy decision makers are aware of our challenges, and also the communities need to understand our challenges and that we are trying to provide the services,” he says.
The SMO points out that some of the challenges include not enough budget and staff shortage.
Dr. Oo says the move to integrate mental health care into the community, through clinics, parish and general hospitals, is absolutely necessary, as mental illness always brings with it, stigma and discrimination.
“When persons are admitted to Bellevue for long term treatment, usually they are socially disconnected, socially dislocated, and then finally they are abandoned. When they are ready to go home, they can’t find their family anymore, and some of them, we can still find their families, but their rooms are rented out, so their position disappears within the family. With the development of community health service at Bellevue, we were able to gradually discharge some of the population, from 1,500 to the current 800 in-patients,” he tells JIS News.
“In treating mental illness, it’s not just taking the pills and injections. They need to be supported by rehabilitative services. Generally, the majority of the Jamaican population provides support…but we still have to do a lot to decrease the percentage of people who probably feel very stigmatised, and those who feel that the mentally ill should not be in their community at all,” Dr. Oo says.
He informs that the Ministry of Health is now doing health education and health promotions, and is encouraging communities to form advocacy groups, so that these groups, in collaboration with the Government, can form a kind of alliance to deal with the stigma surrounding mental illness.
As for Bellevue, he explains that the institution is under constant reform. “I don’t like to use the word down-sizing or scaling down of service. Our vision in the future is that Bellevue is still a significant place to provide the comprehensive range of mental health services. All the services over the years that Bellevue has been providing, must be available in the community. Community Mental Health services in the initial stage is not cheap. We have almost a skeletal structure. We need to develop all the services that Bellvue provides,” he stresses, noting that more manpower and more facilities are needed in the community.
He points out that rehabilitative services are critical in the treatment of the mentally ill. These include occupational therapy, culture therapy, drama therapy, psycho therapy, counselling services, social worker services, and social welfare facilities.
“If you look at the chronicity of illnesses, there are some, including schizophrenia…when you are treating schizophrenia, if the person is having acute symptoms, you have to stabilise the symptoms. Some of the symptoms can be stabilised within a short period, some of them cannot be stabilised, so therefore, there is a period during which there needs to be a medium supervision level. Some of them need maximum supervision. Based on these levels of service management, we need facilities, such as halfway houses, shelters and infirmaries. Those are the services that we would like to see in the communities,” Dr. Oo tells JIS News.
He stresses that for community mental health care to be successful, the system must have psychiatrists, psychologists, social workers, occupational therapists, psychiatric aides, and community mental health officers, who are provided with the necessary equipment.
“Once you are called, you should be able to assist those disturbed families for a short period of time. Crisis calls should be supported by the hospital beds. Community based approach can save money, there is no doubt about it, in the long term, once you develop complete and adequate service within the community,” Dr. Oo argues.
“Our services are insufficient, so we need to develop those services in the communities first. So, we don’t want to scale down services in a short period at all. We don’t want to see that kind of aggressive approach,” the SMO says.
According to Minister of Health and Environment, Rudyard Spencer, the treatment of mental illnesses costs the health sector $600 million annually, with some 29 per cent of the 15 to 74 age group suffering from a mental disorder.
Mental Health Week was observed this year from October 5 to 11, with a series of activities strategically spread across the Ministry’s four health regions, as part of its inclusive approach to encourage community, and by extension, national ownership of mental health as everyone’s responsibility.