Mental health providers, JLP opposed to Bellevue closure
Montego Bay – Some mental health providers and the Opposition Jamaica Labour Party (JLP) have rubbished the Government’s planned closure of the Bellevue Hospital, saying it is purely a cost-cutting measure that will translate into more mentally ill persons roaming the nation’s streets and would mean a breakdown in the level of care now provided.
Their reactions come on the heels of concerns raised last week that there will be job losses as a result of the closure of the 140-year-old institution. According to the health ministry, the plan is to transfer patients and workers to other facilities, but union representatives say they have been informed that job cuts have not been totally ruled out.
Despite these concerns, the gradual closing of Bellevue’s doors is slated to begin later this year, with general hospitals in the Corporate Area absorbing about 330 acute patients who need immediate care.
The entire timetable for the winding down of operations is still being worked out but the general plan is to then transfer the 300 remaining patients, who have been deemed to need only limited supervision, to infirmaries and similar facilities that are to be developed. This phase will begin with the transfer of 200 geriatric patients now at Bellevue.
“For the Kingston and St Andrew area, we will develop a unit to treat those acute patients,” said Dr Earl Wright, the health ministry’s director of mental health service and substance abuse. “We cannot remove the services from Bellevue until that unit is developed; I want to be absolutely clear about that. (The unit will be in place) some time this year. But that is the first step, and then we proceed from there.”
According to Wright, health officials had known for a long time that a large number of patients should not be at Bellevue. “This (type of confinement),” he said, “is not in their best interest, and it’s not what we would like to do, but we haven’t the facilities outside to do that. But we are saying we are going to develop these facilities to take care of these individuals.”
He said there has been a slow phasing-out of the Bellevue Hospital over the past 30 years, when initial steps were taken to treat patients as close to their communities as possible. Fifty-five per cent of Bellevue’s 1,400 mentally-ill patients, he said, were receiving treatment at general hospitals in the rural sections of the island, while Bellevue physically houses the other 45 per cent.
“The days are gone when you hold people for long periods of time in a mental hospital,” said Wright. “The recommended treatment is a shorter stay and getting them rehabilitated, and the overarching principle is treating patients in a general hospital facility as close to their community as possible.”
But some health-care providers have pointed to what they said were inefficiencies in the support systems now in place in rural areas and argued that the closure will lead to an overload of the already limping mental health system.
In St James, for example, the Psychiatric Emergency Response Team (PERT) that is supposed to be available in emergency situations and forms part of the support services, is less than adequately equipped, the Sunday Observer was told.
“Most of the time there is nobody there to put on the team,” complained nurse Joy Crooks. “The poor mental health officer might be across the parish or completely in a different parish when the emergency is occurring here and now.”
Crooks is the administrator for the Committee for the Upliftment of the Mentally Ill, a Montego Bay-based non-governmental organisation that cares for the city’s mentally-ill street people.
She said that PERT is hampered by a single, broken-down ambulance and a shortage of staff, and she is fearful that Bellevue’s closure will mean more pressure on an already strained system.
“The way it is now, if you call (PERT), you have to either wait till you can get some private person to help you or if you can get the police, or you may be lucky enough for the ambulance and a mental health officer to be around,” she added.
Dr Wright admitted that PERT was less than perfect. However, he told the Sunday Observer that attempts are being made to address its shortcomings. He also stressed that the patients transferred from Bellevue would not have an impact on rural areas as they would be absorbed within facilities in the Corporate Area.
But some critics have pointed to the tendency of the mentally ill to slip through the cracks, unless they were under strict supervision, and their penchant for roaming the island.
“The future of the mental health system across the island is dark, dark.
It’s already in a mess, and if closing down Bellevue doesn’t mean putting things in place first, we are in for problems,” warned Crooks.
“I don’t look forward to this at all,” she added. “But it’s still not too late to put things in place. Otherwise, you’re gonna have a revolving door where eventually the system is gonna totally clog up. Or there are some who are gonna get treatment and some who are just going to be left to survive in their madness by themselves.”
Jamaica Labour Party spokesman on health, Dr Ken Baugh, described the planned closure as a bad move aimed at cutting costs and said it would only lead to the mistreatment of the disadvantaged.
“There was a study done by KPMG in January 1999, ostensibly to reduce waste in the public sector, and with regards to health services there was a proposal to reduce the patient load in the Bellevue Hospital,” he said.
“We (unsuccessfully) appealed the decision at that time because in reality what they were doing was cutting cost. I really believe that what is happening now is as a result of serious economic constraints on the Government. But it’s a bad decision to close the Bellevue Hospital; it’s going to have serious consequences. We do not believe that community psychiatry or other hospitals are in any way physically prepared to accommodate such patients. The patients are going to end up on the streets and many are already on the streets,” Baugh said.
But Wright insisted that Bellevue’s closure would not translate into more mentally-ill persons roaming the streets, as steps, he said, would be taken to ensure that systems are put in place to provide quality health care for those released.
He said the infirmaries will be upgraded, and there will be follow-up sessions to ensure that those needing medication remain medicated.
“What I am saying is that the discharge of those patients from Bellevue won’t increase the numbers on the street, because one of the things that we are ensuring is that the services are there for some of those individuals,” he said.
Wright explained that they would work in conjunction with agencies like the state-run City Spirit Foundation in Montego Bay, the Westmoreland Association for Street People, the National Council on Drug Abuse and there was the expectation that the private sector would provide some level of assistance.
While some persons have expressed concern that it will be hard to reintegrate Bellevue’s patients – some of whom have been there for over 20 years – into a society that attaches negative stigma to mental illness, Wright believes that the closure of the facility makes sense, both economically and from a mental health point of view.
“What we are really doing is providing the highest level of care for the mentally ill in the most cost-effective way,” he said. “But it’s not only cost effective, it also has to be tied in with what is the best way of treating the patients to get them to their highest level of functioning and not get them remaining in an institution for the rest of their lives.”