JAMAICA is said to be in contravention of the international treaties on human rights for not having a mental health facility dedicated to the criminally insane.
But it's not just the criminally insane whose rights are being abused, says co-founder of the mental health support group Mensana, Carol Narcisse. It's all categories of people with mental illnesses.
"Before you even get to forensics, the rights of people with mental illness to access appropriate care and in a timely manner are being contravened daily. There are no facilities, and where we do have facilities the access to care is a major concern. There are very few care facilities.
Article 12 of the International Covenant on Economic, Social and Cultural Rights says everyone has the right to the highest attainable standard of physical and mental health, and article 25 of the universal declaration on human rights says everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. However, Narcisse said the country is in breach.
"Jamaica is in serious breach of the right of the mentally ill to appropriate health and appropriate services based on their disability," she said.
Consultant forensic psychiatrist Dr Clayton Sewell agreed. Using the example of Stephen Fray, who in April 2009 attempted to hijack a plane at Sangster International Airport, and who was sentenced to 83 years in prison for the act, Dr Sewell said had the crime been committed elsewhere, Fray would have been sent to a forensic mental health hospital instead of prison.
In a psychiatric evaluation, Fray, then 21 years old, was found to be schizophrenic.
"If Fray was Canadian and had done that in Canada, he would not end up in prison. He would have been sent to a forensic mental health hospital. I don't think it speaks well of the Jamaican forensic mental health services and how the issue was disposed of in court, especially for him to serve such a lengthy sentence," Sewell told the Sunday Observer in a recent interview.
"In fact, I think it's a violation of the human rights convention to which Jamaica is a signatory," added Sewell who works with mentally ill persons accused of crimes and who are locked away in our nation's prisons.
He described the psychiatric services in prison as "rudimentary". The medication is limited, there are little or no activities geared towards rehabilitation, and the psychiatrists who treat the inmates are only available on a part-time basis.
"(Mentally ill inmates) get limited medication, limited rehabilitation, if at all, so what you will find is that once (Fray) and others like himself are released they will be a shadow of their former selves because he will lose a lot of social skills. He will get medication, but never enough to make him close to what he was before he went to prison," said Dr Sewell.
"He's not the first one to have faced that kind of disposal from the courts. There have been many others before and once they remain the way they are, there will be others after him," the doctor added.
Repeated attempts over the past two weeks to get comments from Bellevue CEO Dr David Dobson, the South East Health Regional Health Authority (under whose authority Bellevue falls), and the Ministry of Health on the general state of the mental health care system were unsuccessful.
Other Caribbean nations such as Trinidad, Barbados and The Bahamas have forensic mental health facilities. The Sandilands Rehabilitation Centre in The Bahamas has a maximum security unit that accommodates patients remanded by the courts. In Barbados, the Black Rock Psychiatric Hospital has a forensic psychiatric unit, and there is one at St Ann's Hospital in Trinidad and Tobago.
There was once a wing at Bellevue Hospital for forensic psychiatric cases but it was closed and the inmates sent to prison, the Sunday Observer has learnt.
"Jamaica should be ashamed of itself because it can do better. It has the resources to do better, it has the people with the know-how to do better, and it has sufficient best practices to draw on to do better... There is absolutely no political will," Narcisse said.
For the past five months, the University Hospital of the West Indies (UHWI) has been running a forensic mental health clinic which sees about three patients per week who were referred either by the courts, lawyers or fellow psychiatrists.
While it is useful, Sewell said it is not nearly enough.
There are other deficiencies in terms of facilities. UHWI's Ward 21 is the only institution that caters to children and adolescents with mental disorders on an inpatient basis, and only about four or five of its 20 beds — excluding the eight in the substance abuse unit — are for that group. The 800-bed Bellevue Hospital has a wing for geriatric patients, but the facility is oversubscribed, despite the health ministry's stated policy shift from institutionalised care to community mental health services.
Ambulances are also in very short supply, and certain drugs are often not available.
"We do have a challenge with ambulances," consultant psychiatrist at Bellevue Dr Myo Oo admitted. "Mental health officers and the crisis team try their best to respond based on the situation. We have a crisis line for 24 hours and then calls are screened based on severity."
"From time to time we have issues with transport. It's usually a bus or an ambulance that takes the team out for visits but from time to time it may not be in operation or can't manage the terrain," added Dr Sewell.
A source with knowledge of the operations of the Kenneth Royes Rehabilitation Centre in Spanish Town told the Sunday Observer that "pretty often" some medications are "unavailable to the clients so they sometimes relapse".
When that happens, the patients get an injection to sedate them, our source said.
The Kenneth Royes Centre is a wing of Bellevue with the responsibility of rehabilitating acute patients so they will be able to live and function normally in society. It uses arts and craft as well as farming and cattle rearing as occupational therapy. It has 44 patients and is located on the same lands formerly used by the old leper colony.
"Unfortunately, we haven't been able to achieve that so much," the source said of the intended objectives.
The Spanish Town centre is also hampered by the number of geriatric patients on its roll.
Of the UHWI, which receives up to 60 per cent government subsidy, Dr Sewell acknowledged that "the 20-bed unit is no longer sufficient", given the demand. He said, however, that there are plans to expand and improve the St Andrew facility.
Patients are usually admitted for between 14 and 28 days, but the unit also has several categories of outpatient clinics and programmes.
Major hospitals and some government health centres also offer mental health clinics on particular days but the gaps in the system are wide, a major reason mentally ill people roam the streets.
To its credit, in 2006 Bellevue opened the Open Arms Drop-in Centre to address the high number of street people in the city — half of whom staff members say are mentally ill. It operates a day centre for homeless adults and a dormitory facility for males. Patients are fed three times per day, given medication if necessary, and they have access to showers, laundry facilities and clean clothes.
But as far as Sewell is concerned, it is just a drop in the proverbial bucket.
"The facilities in Jamaica are not in keeping, arguably, with the human rights standards to which we have agreed," Dr Sewell said, assessing the general conditions.