The health care system, it appears, has never gone out of the spotlight in recent times. Having been a part of the political platform of the current Jamaica Labour Party Government with the promise of free health care, it has, in some measure, become the target of attack by those who, for partisan interest, would like to prove that it is a totally unworkable idea in order to score points and discredit the party.

At the same time, there is clear evidence that there are interests within and outside of the health care system itself who have expressed serious concerns about the way in which the system has operated since its implementation, highlighting some of the deficiencies which leave some of the users of the system without the benefit of the care which the system is supposed to deliver.

The junior doctors have, from time to time, stated their dissatisfaction with the operation of the system as it is perceived to stretch the material and human resources beyond the limits and hence is compromising the promised quality of care which the population has been offered. The nurses have added their voices to this perspective, and in more recent times there have been questions related to the provision of pharmacists and pharmacy services within the system.

The minister of health, Mr Rudyard Spencer, and his staff have tended to respond with the expected defence of the system, pointing usually to statistics to show how many persons have been served by the system and developments which are in the pipeline. Unfortunately, when it comes to the matter of human life, it is not enough to simply point out how many have benefited from the system but how many have been left vulnerable or victims of the system, resulting even in the loss of life.

In recent weeks we have witnessed the revelation of the negative experience of persons of the health care system which constitutes a major critique of what now exists and which cannot be put under the carpet with any amount of statistics. The National Youth Council has brought to the attention of the nation the tragic death of one of its female leaders in the Spanish Town Hospital, in circumstances which seem to point precisely to the area of concern which has been articulated by so many others in terms of the lack of adequate medical supplies for the efficient functioning of the health care institutions and the delivery of quality care to the population.

A life has been lost, and this is, of course, one too many. To date there has been no denial from the authorities to indicate that the allegations are unfounded and that the resources were present and the options available to the now deceased patient were presented to her.

In recent weeks this newspaper has carried a series of articles on mental illness, sharing the very personal story of a mother’s struggle with a son who was diagnosed schizophrenic, and a subsequent article in which Yvonne McCalla Sobers, a well known figure in the society, chose to share her experience with the public. Commenting on her decision to go public, the newspaper said: “McCalla Sobers decided to share her story with the Sunday Observer after seeing our February 13 and 20 articles in which the mother of an adult son diagnosed with schizophrenia complained about the lack of residential care for persons with mental illness and the physical, emotional and financial toll it was taking on her small family.”

Mrs McCalla Sobers also shared with her audience the conclusion to which she came after having her experience with a mentally ill relative. This she expressed as follows:

“I realise that when there’s a crisis with mental health it is difficult to find where to go. Part of the reason is that the emergency beds in hospital have been cut and the biggest cut is at Bellevue.”

The report went on to state further that “McCalla Sobers was referring to the scaling down of operations at Bellevue Hospital as the Ministry of Health adopts a community approach to care of the mentally ill, rather than institutionalised care”.

Mrs McCalla-Sobers continued: “It took us two weeks to be able to get a bed. It means then, that if you have a crisis with a relative, and it’s acknowledged by the health professionals but there are no beds, the best they can do is to sedate the person at the particular time and send the person home with you.”

There is a sense in which some persons may view these stories as interesting reading or even question why she should go public, preferring themselves to opt for privacy in dealing with such matters. I want to suggest, however, that contrary to such perspective, the situation with the mentally ill and the provisions for their care must be a matter of public concern, especially so in light of recent research published in the print media which points to a high incidence of schizophrenia among the Jamaican population.

Mentally ill persons, depending on the degree of such illness, represent persons with a sense of diminished responsibility, and other persons within their social network, as well as professionals, must assume a measure of responsibility for their care, as without this, they not only will deteriorate, but can sometimes be a threat to their own lives and those of others.

Additionally, we must ask ourselves this question: can we be comfortable and satisfied as a people just watching mentally ill persons roaming the streets of our land, rummaging in the garbage and drinking the water from the drains that run along some of our roadways, and simply assume that they must go to the nearest health facility and receive the necessary care from the mental health officers?

It was only a few days ago that the nation received an apology from the Chaplain of the Jamaica Constabulary Force, Assistant Commissioner Gary Welsh, over the killing by the police of two mentally ill persons within days of each other. The killing of these two persons who went by the nicknames of ‘Ram Puss’ and ‘Kartel’ sparked some public outcry. The question we must face is, how do these things come about and can they be prevented?

Apart from the fact that the police will need to continue to examine how they deal with mentally ill persons, by the time these persons get to the point of being violent, many of their family members are overwhelmed by their behaviour and may even feel relieved when such a family member takes to the street.

Clearly, there are different degrees of mental illness, and some victims will co-operate with family members and go to seek medical attention, but many may show paranoid features and not even trust their closest family member who offers such an option. It is also true that as a society we will need to change our attitudes to mental illness and be more supportive of those who need assistance in such situations.

In light of the current publicity around the care of mentally ill patients and the service which the Ministry of Health has to offer, a release has been issued by Dr Maureen Irons-Morgan which was carried in this newspaper and which acknowledges in part that, “although the department had come a far way since it began its reform programme 40 years ago, it had deficiencies and was presently undertaking a multi-disciplinary review of mental health policy and legislation to “ensure congruency with international norms and standards and human rights requirements”.

The release continued further by saying that, “Despite the many strides that have been made (however), there are some areas that have been identified as needing critical attention”.

As expected, the release presented a lot of statistics in an attempt to demonstrate the effectiveness and reach of extant programmes.

From time to time I correspond with persons and officials in public life on matters of national concern in my personal capacity and not as a spokesperson for my church. Such correspondence is usually a matter of confidentiality. In view of some of the things coming to light in regard to the care of the mentally ill, I have chosen to share with my readership one such bit of correspondence which I sent to a former minister of health and which may indicate anxieties about the direction of the care of the mentally ill which have been expressed for years and which still need to be addressed.

“I write to express my concern regarding announced changes to the care of the mentally ill in Jamaica. I write not only as one who has a leadership role within the Christian community as a caregiver but as one who has worked closely with mentally ill persons and has lived in the same home with such a person who eventually committed suicide.

In the 1950s when the current block of buildings near the gate of the Bellevue Hospital was being officially opened, the late Bishop JT Clark, then a member of the board of management, declared that the authorities had put up the building so that the public could not see what was happening to the mentally ill on the rest of the compound. It was a harsh comment, and for it he was fired from the board. Nevertheless, the point he was seeking to make, as he later shared the story with me, is that the mentally ill constitute a vulnerable group which cannot advocate for themselves and agitate as others can, and therefore can easily be neglected, abandoned and abused.

“I have watched Jamaica follow the trend in societies of the north in de-institutionalising the care of the mentally ill but without implementing the policy in full. The community care support on which the policy was predicated was never seriously undertaken in Jamaica. We may debate the issue, but it is clear that this development is not unconnected to the number of mentally ill persons being held in prisons and the number of street persons evident in every community throughout our nation.

“I am using this medium to urge you to consider the following:

1. Not to attempt any further de-institutionalising of the care of the mentally ill until the community resources (human and material) are in place and ready to receive patients.

2. To make adequate provision for the institutionalising of the severely mentally ill persons who need such care. It is all good and well for bureaucrats and technocrats to talk about caring for the mentally ill at home, but there are persons whom the average family cannot and will never be able to handle. I speak passionately as one who has known this reality in a very personal way.

3. Families who feel overwhelmed in caring for the mentally ill person will at times abandon the mentally ill or refuse to search for them if they wander away from home. The society needs a functional and effective system which allows any citizen to call the mental health facilities in the community and to get a positive response to calls for help and attention for mentally ill persons.

4. The Government of Jamaica needs to consider how the proceeds from the sale and development of the Bellevue lands are to be applied to the development of the care of the mentally ill in Jamaica. It seems to me that the resources of this facility (should be) set aside for the care of the mentally ill and should not be utilised merely as a source of revenue for other agencies, not as a substitute for budgetary allocations, but as a source for capital development and endowment. No other institution in this society would allow this to happen, and this violation of the resources for the care of the mentally ill should not go unnoticed.”

Readers can probably decide the extent to which we have progressed over the years and whether the mentally ill are still vulnerable and victims of the health care system and of an often insensitive society.

— Howard Gregory is the Suffragan Bishop of Montego Bay