OCHO RIOS, St Ann — Psychiatrist at the Port Antonio and Annotto Bay hospitals, Dr Terrence Bernard, has backed Government’s plan to close the doors of the 130-year old Bellevue hospital in Kingston as, he says, the institution has failed to address the needs of the mentally ill.

“If we are going to spend money to provide a service,” he argued, “the service we provide has to benefit the people who it is provided for. And the fact of the matter is that an asylum does not benefit the mentally ill. It has not improved the plight of the mentally ill.”

Dr Bernard echoed the Government’s assertion that community-based care — which is the trend worldwide — was a better alternative. All that is needed, he contended, was a paradigm shift in the way the island treats its mentally ill.

“We have the resources; we only need a rethinking,” he told a gathering of 20 health professionals from St Ann, St Mary and Portland at a recently concluded health seminar, held at the Village Hotel in Ocho Rios.

The seminar was the second in a series staged as part of the Health Ministry’s mental health awareness campaign.

But while supporting the government in its plan to close Bellevue, Dr Bernard lashed out at the administration’s failure to adequately prepare for the closure. Like other mental health care professionals before him, the psychiatrist urged the Government to put the facilities in place before it is too late.

“Anywhere you go across the world, once they are going to close down or scale down (an institution) they put an alternative in place and so the leaders need to address that. Just saying you are closing Bellevue will cause panic,” he said.

The Bellevue hospital, built in 1873 to house 800 patients, was home to over 3,000 by 1972. As the government took the first steps towards community-based care, the total was reduced to about 1,500 by 1978.

With de-institutionalisation, treatment of the mentally ill was not confined solely to Bellevue, but also included psychiatric units in the Cornwall Regional and University hospitals, then to medical wards in Type B and C hospitals, also to Type II, III and V health centres.

The health ministry has made it clear that it intends to completely phase out Bellevue and have mentally ill persons treated at public hospitals across the island, in specially prepared wards. That announcement was greeted with skepticism and concern, as critics pointed to the deficiencies in the community-based care now offered.

But according to Dr Bernard, the government’s proposal is workable if:

* Patients with chronic mental disorders are treated, in the health centres on a daily basis, by the medical officers and district medical officers who will also continue to treat other chronic medical disorders, such as diabetes and hypertension;

* Patients with acute mental disorders are treated on the medical ward and the out patient clinics of the general hospital and if

* In primary health care service, close attention is paid to depression, anxiety and medical disorders affected by psychological conditions.

In order to realise this vision, Dr Bernard explained, there are two critical elements — the need for re-orientation, and the need for integration.

The need for re-orientation, he said, includes a change in thinking and behaviour, while integration addresses issues such as utilising the services of an assertive outreach team.