THE care of mentally ill persons has again taken the spotlight, following allegations that private medical facilities are turning them away from their doors.

At a recent function in Kingston, President of the Medical Association of Jamaica, Dr Aggrey Irons, complained that private medical facilities are contributing to the stigma attached to mentally ill persons by refusing to attend to them.

“We cannot continue to talk about this stigma thing without realising that we health workers help to stigmatise our patients,” said Irons, describing as unacceptable that psychiatrists and mental health nurses, who are trained to deal with unstable patients, can turn a blind eye to them.

Also unacceptable, Irons said, are “private hospitals that refuse to admit mentally ill patients on the grounds that they will destroy their hospitals.” He said such occurrences are unlikely.

The Sunday Observer last week attempted to find out whether or not private hospitals and medical practices were indeed turning away mentally ill persons. This newspaper made telephone calls to seven private hospitals; five in the Corporate Area, the others in Manchester and Montego Bay.

A string of private practices were also contacted.

Inquiries were made of the staff at these facilities about their policy on admitting or treating a mentally ill patient who had recently become violent.

The hypothetical scenario received mixed reactions.

At the Medical Associates Hospital in Kingston, an employee explained that while the institution accepts mental cases, they only do so on Tuesdays and Wednesdays commencing at 1:00 pm.

The fees, the staff member said, starts from $5,000 for the first hour of a preliminary visit, and increases by $3,000 every half-an-hour thereafter. Additional charges were required for admittance.

At St Joseph’s Hospital, also in Kingston, we were informed that mentally ill patients are seen and admitted only after they have visited a psychiatrist.

Patients are charged upwards of $130,000 for admittance, a sum which covers a variety of expenses, including accommodation and nursing fees, the employee said.

Stricter procedures are followed at the Tony Thwaites Wing at the University Hospital of the West Indies (UHWI) in St Andrew. There, a female staff member said mentally ill patients were admitted only after being referred by a consultant.

“Each patient that comes here has their own doctor who admits them to the unit. If you don’t have a consultant or doctor assigned to you (then) you have to go through Accident and Emergency where a doctor can be assigned to you,” said the woman.

“The patient has to be housed in a private room, the patient has to have 24-hour sitter service available to them, and the patient has to be a bit stable; not anyone that is boisterous and requiring a lot of sedation,” she continued.

Among the hospitals which did not cater to the mentally ill was Andrews Memorial in St Andrew.

There, a female staff member explained: “We don’t see those kinds of patients because we don’t have any doctors qualified to deal with those types of cases,” she said.

When contacted, Errol Holmes, assistant administrator with responsibility for human resources at the hospital, confirmed the employee’s claim.

“We don’t have the facility, nor do we have the physicians who are trained in that area,” said Holmes, citing this as the only reason mentally-ill persons are not admitted at the facility.

“Nobody is turned away from Andrews. If somebody comes here and they need attention we will stabilise them, do the trials, get them to a point where they need to be moved, and then move them to an appropriate facility,” he said.

At the Nuttall Memorial Hospital in Kingston, a staff member explained to this reporter that: “We don’t really have any facility or doctors for that. Those cases call for specific facilities and personnel, and we don’t have those persons assigned here.”

Megan Deane, chief executive officer at the hospital, explained later that there is no discrimination against mentally ill persons, but also pointed to a lack of resources to accommodate them.

“This is a private hospital, we don’t have doctors and staff,” said Dean. “The way we operate is that doctors have practising privileges, and the doctors admit their patients here for care.”

“A patient just can’t come here and say they want to check into the hospital, that is not possible,” she continued.

“The doctors would have to send the patient, they would have to indicate what kind of service the patient needs, and then they (patient) come in to the hospital,” she explained.

According to a male employee at the Hargreaves Memorial Hospital in Manchester, the hospital simply did not have wards on which to admit mentally ill patients.

“We don’t have wards to deal with that, all our patients are mixed together. He will have to go to a doctor; we can’t accept him here,” he said.

On Thursday, chief executive officer at the hospital, Chetwyn Chuck, explained that the hospital simply does not have the facilities to deal with mentally ill patients.

When further questioned, however, Chuck declined to be quoted and insisted that the Sunday Observer send him the additional questions in writing. The questions were emailed to him, however, a response was not received in time for publication.

The explanation of a lack of resources was offered by a male employee at one Montego Bay-based medical facility. That employee referred this reporter to the Kingston Public Hospital and the University Hospital of the West Indies, which, he said, “were better suited to attend to the relative”.

Of 10 private practices located in the Corporate Area which this newspaper contacted, only three said they did not treat mentally ill patients.

An explanation offered by a female employee at one of them was that the location was served only by a mental health counsellor, and thus was not able to deal with the hypothetical case related by this reporter.

At another practice just outside Half-Way-Tree in St Andrew, the employee who answered the phone said: “No, we do not see mental health cases.”

When repeatedly asked “Why not?”, the woman responded, “I cannot say why, sir. We just don’t see mental health cases. You will just have to take that person to the hospital,” she replied, a hint of frustration in her tone.

According to Dr Irons, increased calls for the population to regard mental health care as equally important as the treatment of physical illnesses are futile until private institutions discontinue the practise of turning away patients.

Dr Wendel Abel, consultant psychiatrist at the University Hospital of the West Indies, is however of a different view. Abel said it is understandable why some private institutions turn away the mentally ill.

“A number of private hospitals have had bad experiences in the past with patients becoming aggressive and boisterous. You have even had instances where patients have beaten up other patients in private hospitals,” said Abel.

“If it can happen then it stands a possibility, and if it does happen [then] the hospital could be sued. Hospitals take these decisions as part of their risk management to protect themselves as an institution, and to protect the other patients,” said Abel, who operates a number of community-based group homes for the treatment of the mentally ill.

“So the reality is that the hospitals do not like to take people who are aggressive and are unmanageable, even after referrals,” he continued, stating that several of the private hospitals are not equipped to deal with the mentally ill.

Checks by this newspaper revealed that patients in one of Abel’s private homes paid $50,000 per month for care.

In September, the life of a year-old baby was put in serious jeopardy when a pregnant, mentally-ill woman who is HIV positive, wandered into the nursery at the Victoria Jubilee Hospital and allegedly breast fed the child.

The incident sparked serious security concerns at the hospital, and has resulted in an ongoing investigation into the incident.