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Mental-health systems need serious attention

Tuesday, May 1, 2012
Secretary of the Association of Psychiatrists of Trinidad and Tobago (APTT) Dr Varma Deyalsingh speaks during an interview


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.”


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