Forensic psychiatric expert Dr Myo Kyaw Oo says while the death of former inmate Noel Chambers in 2020 triggered vast changes in the mental health services available to mentally disordered offenders at the Tower Street Adult Correctional Centre in Kingston, the service, while still not up to his standard, can only qualify as 50 per cent therapeutic.

The 81-year old Chambers died at the prison after being incarcerated there since February 1980 without being tried or convicted for an offence.

Dr Oo, who is currently a sessional consultant psychiatrist with the Department of Correctional Services and has been practising in Jamaica for more than two decades, took the stand last Thursday in the ongoing trial of Lieutenant Kyodia Burnett, the former Jamaica Defence Force (JDF) physiotherapist who stabbed his attorney-at-law wife Nordraka Williams Burnett to death in December 2018.

Burnett, after that incident, was taken to the psychiatric ward of University Hospital of the West Indies (Ward 21) but was subsequently sent to the Tower Street Adult Correctional Centre after a court appearance. He was placed at a community group home after a successful bail application and has been there since.

His defence team has been contending that the former army man, who has a history of mental illness dating back to 2008 and was later diagnosed with “schizoaffective disorder – the depressive type”, stands a better chance of rehabilitation if he is given a non-custodial sentence as the current correctional facilities are unfit.

Dr Oo, under questioning by Burnett’s attorney Jacqueline Samuels-Brown, King’s Counsel, said while mental health services in the prisons “increased to a level and improved to a level” since the 2020 incident, “it’s not to my level of satisfaction yet”.

Asked by the attorney whether he considered the therapeutic environment at the Tower Street facility to be at the bottom of the scale when compared to what exists at other entities, he said, “It is not at the bottom, it would be third from the bottom.”

Asked by the attorney what is fourth and at the bottom of the scale, he said, “Some of the private nursing homes”.

When the attorney suggested to him that, taking into account the opportunities for abuse by other inmates, lack of privacy, the absence of therapeutic activity, inadequate mental health services among other things, the facility does not provide a therapeutic environment, he said, “I do not agree; I would say around 50 per cent.”

Under further questioning by the attorney he admitted that even though the section of the facility dedicated to housing mentally ill inmates (the George Davis Centre) is being refurbished, when complete it will still not qualify as a “therapeutic environment”.

Dr Oo
— while agreeing with several observations of the Mental Health (Offenders) Inquiry Committee, which was commissioned by Chief Justice Bryan Sykes in 2020 to assess how the court treats with the mentally ill or disordered in conflict with the law who are detained
— spurned assertions by Samuels-Brown that inmates who enter with a diagnosis emerge in “a worse condition than when they went in”.

“I reject that,” Dr Oo said.

In the meantime, Dr Oo
— who said he first treated Burnett as a patient, starting in 2019, on a total of six occasions
— testified that in his first assessment on March 15, 2019 Burnett’s mental status was alert, oriented and rational. In describing Burnett as “emotional” on that occasion, he said his mood was “appropriate”.

He said the physiotherapist denied any hallucinations, expressed suicidal thoughts at times, and said he had “thoughts about hanging a couple of weeks ago” but his children (two daughters from the marriage) stopped him from doing so.

Dr Oo said his diagnosis of Burnett then was schizoaffective disorder, which is a mixture of psychosis and mood disorder. “Psychosis” means the presence of illusions, hallucinations, disorder of thoughts, disorder of behaviour, lack of judgement, and lack of insight.

The forensic psychiatric expert said when he last saw Burnett, who had been placed in the hospital dorm at Tower Street Adult Correctional Centre, he was “alert, well in thought, quite appropriate in his mood”, and had heard no recent hallucinations, with his last auditory hallucination being May 2018.

He heard the same male voice, he cannot recall the details, he denied any suicidal thoughts and he denied any homicidal thoughts, the doctor said.

He said on his last assessment of Burnett in July 2019, he was “doing well and was fit to plead”.

According to Dr Oo, a person suffering from mental illness
— depending on the type, based on family and social support, treatment, and medication
— could expect some type of improvement, if not a complete cure.

Asked by the prosecutor leading the evidence whether the hospital dorm at the prison in question could be considered a “therapeutic environment”, Dr Oo said therapeutic environments are defined in different ways.

A therapeutic environment in a First World country is different from one in a Third World country he said, then argued that the therapeutic environments in all the spaces where Burnett has been kept “are quite different”. He said this difference depended on budgetary allocations, the person, and the political will of decision-makers.

Dr Oo said the Department of Correctional Services now has five sessional psychiatrists who cover all the institutions, including the juvenile facilities. He said while there had only been one registered psychiatric nurse from 2003 to 2020, the situation changed after the death of Chambers as there was a reform of psychiatric services inside the correctional department and more psychiatrists were employed.

He said to date the department has four permanently employed consultant psychiatrists, three sessional psychiatrists, one psychiatric nurse mental health officer, one senior psychiatric nurse, three psychologists, and one sessional psychologist.

The doctor said for the first time four civilian psychiatric nursing aides were permanently employed and 20 correctional officers trained as psychiatric nursing aides. He said the department also employs sessional pharmacists and a dental surgeon.

Asked whether the environment at the prison can be considered therapeutic, given all the improvements, he said, “It is more therapeutic than before.”

Asked whether he agreed that the absence of therapeutic elements will cause a patient to deteriorate, Dr Oo
— who said he has treated “thousands of psychiatric patients
— stated, “It depends…if certain conditions are not met, then any patient will deteriorate.”

Burnett, who had been charged for murder, pleaded guilty to manslaughter on the basis of diminished responsibility when his trial began earlier this month.