The island’s psychiatric nursing aides have voiced strong opposition to calls to shutter Bellevue Hospital, arguing that doing so will usher in a wave of critically ill people wandering the streets.

“If Bellevue is closed, I’m telling you, Jamaica will have its epidemic of mentally ill people just going around and doing all kinds of craziness,” president of the Psychiatric Nursing Aide Association of Jamaica Gary Hemmings said last week in an interview with the

Jamaica Observer.It’s the latest salvo in a decade-long debate over the relevance of the island’s only mental health hospital in an era where the decentralisation of mental health care is being increasingly practised.Government began implementing a community health care approach to treating mental illness across the country some 20 years ago. The new strategy features health professionals travelling into communities to administer health checks and medication to patients, rather than have them housed in the residential facility. That, some people argue, renders the hospital obsolete.But the psychiatric nursing aides — who are the front-line soldiers if mental illness is a war — argue that the facility, which opened at its present location at 16 ½ Windward Road Kingston in 1861, is a symbol of safety, refuge and trust for the mentally ill and has to operate in tandem with the community approach, fraught as it is with staffing, transportation and other constraints.“There’s a need for greater resources; however, I think that the community mental health service or the community-based care for persons who are mentally ill is working awesome!” Hemmings said.As he and his team of first vice-president Dennis Delisser and public relations officer Elsie Palmer explained it, the community approach allows clients to be treated in the privacy and comfort of their homes. Critically, too, they said it eliminates the need to commute for people who either cannot afford the transportation costs or who find it physically difficult based on location.“There are some patients who just cannot afford to get to the treatment centre and that plays a factor in that client becoming delinquent so we offer that service to that person…There are cases where patients can’t afford food, much less bus fare to come to the treatment centre. I work in the community-based system and it is working awesome,” Hemmings reiterated.The debate over closing Bellevue surfaced publicly back in 2003 when then Health Minister John Junor argued that the move would allow more resources to be channelled to the community-based initiative. Noted psychiatrists, some of whom operate group homes for the mentally ill, have sexpressed similar opinions as well, but subsequent government administrations have disagreed.At the time of writing current Health Minister Chris Tufton was off the island and head of the Mental Health Unit in the Ministry Dr Irons Morgan did not immediately return our calls.Hemmings maintains that “most of these people or organisations lobbying to have Bellevue closed have their own personal interests and not that of the people”.“Bellevue cannot be closed. It should not be closed and no one should ever think that Bellevue should be closed. Bellevue is ‘the university of the west indies’ for mental illness in Jamaica, meaning that nine out of 10 patients who are being treated in the mental health system in Jamaica have gone through Bellevue Hospital at some point.“It is the only institution where they feel a sense of security, a sense of safety, trust, and feel like somebody there cares for them,” vice-presdient Delisser said, adding that patients have been known to bypass the community apparatus and head for Bellevue if they feel a crisis is imminent.He argued further that Bellevue is more than a hospital; it is a holistic centre that helps people with mental disorders recover to a place of medical functionality where they can return to the community. It also provides care for people who have no relatives, Delisser pointed out.Last year, a government performance audit found that 673 of the 795 inpatients at the facility were clinically stable, but remained at the hospital because they had no family support.“Bellevue is a home within a home. The staff is like family. The patients that we care for, we watch them come in and when you look at them three to four weeks’ time going out, you’re amazed to see the difference. Many of them leave Bellevue after being admitted two, three times and go out there and get jobs, make something of themselves, start a family,” Delisser continued.Added Hemmings: “It would be a sad day in our history if Jamaica allows Bellevue to be closed.”The hospital’s current name was adopted in 1946. Before that, it was known as Jamaica Mental Hospital, and before that, the Jamaica Lunatic Asylum.