De­siree See­baran

The saga held our at­ten­tion for days: On March 21, Cheryl Miller was tak­en away from her work­place at the Min­istry of Gen­der Af­fairs to the St Ann's Psy­chi­atric Hos­pi­tal. Miller's con­tro­ver­sial con­fine­ment and re­lease has raised larg­er ques­tions in the pub­lic con­scios­ness about T&T's men­tal-health sys­tems: Do they work the way that they should? "We in psych al­ways say that psy­chi­a­try is the bas­tard child of the Min­istry of Health," said Jen­nifer Wears-De­four. She be­lieves lo­cal men­tal-health sys­tems need se­ri­ous at­ten­tion; in­ci­dents like what hap­pened to Cheryl Miller just high­light flaws that are al­ready there. As a psy­chi­atric nurse and for­mer men­tal health of­fi­cer at the North West Re­gion­al Health Au­thor­i­ty (NWRHA) for near­ly 30 years, Wears-De­four said health sys­tems need­ed to be set up to pre­vent men­tal ill­ness­es, not just treat them. "Then you wouldn't need all these jails. The po­lice wouldn't be over­worked be­cause the prob­lems that they are deal­ing with in so­ci­ety would have been caught at an ear­li­er stage," she ex­plained

Up­swing in men­tal ill­ness

Near­ly two weeks ago, act­ing Health Min­is­ter Dr Tim Gopeesingh said be­tween six and eight per cent of the pop­u­la­tion was de­pressed. Sec­re­tary of the As­so­ci­a­tion of Psy­chi­a­trists of Trinidad and To­ba­go (APTT), Dr Var­ma Deyals­ingh, added that ac­cord­ing to World Health Or­gan­i­sa­tion es­ti­mates, de­pres­sion could be the sec­ond lead­ing cause of dis­abil­i­ty world­wide by 2020. "So we are aware that de­pres­sion is go­ing to be a ma­jor is­sue, if not al­ready," he said, list­ing prob­lems with in­ter-per­son­al re­la­tion­ships, loss of job, and post-trau­mat­ic stress dis­or­der due to vi­o­lent crime and ac­ci­dents and grief as some of the trig­gers. But de­pres­sion is not the on­ly men­tal-health dis­or­der that con­cerns lo­cal doc­tors. "We are see­ing an in­creased in­put of younger pa­tients, be­tween 20 to 45 years old, who are com­ing in with drug-abuse psy­chosis from al­co­hol or sub­stance-abuse psy­chosis from mar­i­jua­na. "I think this catch­ment of pa­tients is what we need to be aware of, that we still need an acute cen­tre to house these pa­tients. So this is prov­ing to be a chal­lenge," Deyals­ingh said.

Com­mu­ni­ty men­tal health­care

St Ann's Psy­chi­atric Hos­pi­tal was com­mis­sioned in 1902. It still bears the brunt of the coun­try's men­tal-health needs. So far, ex­perts say it is cop­ing. But they al­so say some­thing should be done be­fore the fa­cil­i­ty be­comes over­whelmed. The hos­pi­tal's Chief Med­ical Of­fi­cer Dr Ian Hy­po­lite could not be reached for com­ment but Deyals­ingh and Wears-De­four agreed on a pos­si­ble so­lu­tion: "De­cen­tralised com­mu­ni­ty clin­ics are where the na­tion's men­tal-health sys­tems need to go, for the pa­tients' sake. "The whole idea about these clin­ics is to have them out in the com­mu­ni­ty where peo­ple can come in, not just on clin­ic days to see the psy­chi­a­trist.

"Some­one who has a re­la­tion­ship prob­lem, a child who has a prob­lem with a teacher or at home, we are try­ing to en­cour­age them to come in," Deyals­ingh said. The Min­istry of Health and the NWRHA have set up two mod­el clin­ics on Pem­broke Street, Port-of-Spain, and at 135 East­ern Main Road, Barataria, he added. Pa­tients deal­ing with men­tal ill­ness­es "can come in and get that group ther­a­py; they can come in and get a sense of be­long­ing, that place of refuge. "It's re­al­ly a com­mu­ni­ty men­tal-health well­ness clin­ic. If we can get these cen­tres right through Trinidad and To­ba­go, it will help the sit­u­a­tion a bit." Wears-De­four and her col­league, Wal­ter Mur­phy, were in­stru­men­tal in set­ting up the Barataria Com­mu­ni­ty Men­tal Well­ness Cen­tre. Now pres­i­dent of the As­so­ci­a­tion of Men­tal Health Work­ers (AMHOTT), Mur­phy said psy­chi­a­trists and psy­chi­atric nurs­es at the Barataria clin­ic treat­ed schiz­o­phren­ics, peo­ple with bipo­lar dis­or­der, el­der­ly peo­ple with de­men­tia and de­pressed peo­ple. He said: "A num­ber of our clients were in homes. A num­ber of school­child­ren were in cri­sis. "We thought that they would form our next gen­er­a­tion of pa­tients, so we or­gan­ised lec­ture ses­sions for them. "We al­so looked at stig­ma re­duc­tion, which is key," he added.

Pol­i­cy changes need­ed

But some be­lieve that our men­tal-health sys­tems are not ready to deal with the re­al is­sues. Op­po­si­tion Sen­a­tor Fitzger­ald Hinds is one of the lawyers rep­re­sent­ing Cheryl Miller in a court case to de­cide whether or not it was law­ful for men­tal-health of­fi­cers from St Ann's Hos­pi­tal to re­move Miller from her desk at the Min­istry of Gen­der Af­fairs. Hinds said the hos­pi­tal ad­min­is­tra­tion jus­ti­fied its treat­ment of Miller un­der Sec­tion 15 (1) of the Men­tal Health Act which states: "A per­son found wan­der­ing at large on a high­way or in any pub­lic place and who by rea­son of his ap­pear­ance, con­duct or con­ver­sa­tion, a men­tal health of­fi­cer has rea­son to be­lieve is men­tal­ly ill and in need of care and treat­ment in a psy­chi­atric hos­pi­tal or ward may be tak­en in­to cus­tody and con­veyed to such hos­pi­tal or ward for ad­mis­sion ..." Hinds is not con­vinced. "It struck me that they could have tak­en Cheryl Miller so prompt­ly," he said, "be­cause they would have known that when you try to take up the so-called 'va­grants', you can't just take them up off the streets. "There are is­sues of their con­sti­tu­tion­al rights and it is now clear that they have to be as­sessed to see if they are men­tal­ly ill and sat­is­fy the leg­is­la­tion in or­der to be tak­en for psy­chi­atric treat­ment."

He added that in light of re­cent cas­es where street-dwellers, who may have been suf­fer­ing from un­treat­ed men­tal ill­ness­es, at­tacked pedes­tri­ans in ur­ban ar­eas, a more ur­gent area of con­cern may be as­sess­ing these home­less peo­ple and en­sur­ing that they are not a dan­ger to the pub­lic or to them­selves. Hinds in­tends to use his po­si­tion in Par­lia­ment to call for law­mak­ers to write poli­cies that make the Men­tal Health Act clear­er to the par­ties who need to ex­e­cute it. A draft Men­tal Health Bill, which may give this need­ed clar­i­ty, has been re­port­ed to be in cir­cu­la­tion since 2000, but was nev­er passed. Nei­ther the Min­istry of Health's Na­tion­al Men­tal Health Com­mit­tee nor the St Ann's Hos­pi­tal Chief Med­ical Of­fi­cer could tell us whether or not the draft bill does give clar­i­ty on these is­sues, or even if it al­lows for the es­tab­lish­ment of more com­mu­ni­ty men­tal-well­ness cen­tres.

But Hinds sup­ports the idea of com­mu­ni­ty care for the na­tion's men­tal well­ness. He said: "You heard Min­is­ter Gopeesingh say that the place is over­run by per­sons who ought not to be at St Ann's and that many per­sons are de­pressed but not such that they need to be kept in an in­sti­tu­tion. "Rather, they should be en­joy­ing com­mu­ni­ty care. So these are the kinds of things that we should be look­ing at."

Dr Gopeesingh al­so said near­ly 70 per cent of pa­tients at St Ann's Hos­pi­tal should not be there. And Health Min­is­ter Dr Fuad Khan told re­porters in late March he was seek­ing Cab­i­net ap­proval to sell the St Ann's Hos­pi­tal. But ex­perts agree that be­fore that is done, strong sup­port sys­tems need to be set up in the com­mu­ni­ty to re­ceive these pa­tients. Wears-De­four is con­cerned about those pa­tients whose fam­i­lies have them com­mit­ted to the hos­pi­tal for "spu­ri­ous" rea­sons. "These are the kinds of pa­tients who are there be­cause of their rel­a­tives' wicked­ness or greed. They don't have to be there but they are there. Then there are those whose rel­a­tives aban­don them," she said. Deyals­ingh added: "Their fam­i­lies prob­a­bly couldn't cope, and then they left them at St Ann's. So by putting them out there in the com­mu­ni­ties, their fam­i­lies may not want them again. "But if we have places built for them, ful­ly staffed with oc­cu­pa­tion­al ther­a­py go­ing on, this is a plan that could work." "Their rein­te­gra­tion has to fol­low a process," said Mur­phy. "It's one thing to say that you can find a job; it's an­oth­er to try to find a will­ing em­ploy­er. So my sug­ges­tion would be to in­crease the num­ber of com­mu­ni­ty health and men­tal well­ness cen­tres in the com­mu­ni­ty," he added. The stig­ma at­tached to men­tal ill­ness al­so needs to be tack­led, and tack­led soon.

If oth­er com­mu­ni­ty men­tal-well­ness clin­ics, like the Barataria and Pem­broke Street clin­ics, are es­tab­lished, en­tire com­mu­ni­ties can not on­ly ac­cess men­tal treat­ment and sup­port but be ed­u­cat­ed to re­ject the stig­ma sur­round­ing men­tal ill­ness. Deyals­ing said: "If some­body doesn't un­der­stand men­tal ill­ness ful­ly and they just have a brief ex­po­sure to it, they may fear these pa­tients. "I try to tell pa­tients to come out and say, 'I'm a bipo­lar, but I'm a vi­su­al artist.' 'I'm bipo­lar but I'm a suc­cess­ful ca­lyp­son­ian.' "We're try­ing to des­tig­ma­tise it by let­ting peo­ple see that they're cop­ing."