“There is no research that I have looked at that says that mental illness can be cured!” so said the owner of a private mental health facility in Kingston, Jamaica last Saturday. I visited several private facilities for persons with varying mental illnesses on the weekend to locate the one with the best rehabilitation program. What I discovered can only be called “warehousing” for the mentally ill.
To be fair, all of the homes visited were clean, persons were well fed and most were set in a garden of some kind. However, most of them had a staff to client ratio of 1: 17 or in one case 1:25; the staff in 90 percent of the homes were made up of female practical nurses with little or no training in how to manage persons with mental disorders; None of the homes visited had a serious emergency plan to deal with “inmates” who became violent as one caregiver called them. One plan consisted of locking everyone up in their rooms away from the violent one and waiting. None of the homes had a clear policy on sexual contact; many of the representatives of these facilities were unable to state what the diagnosis of the patients were. Dominoes was the choice of rehabilitation for the experts put in charge of these homes.
Glaringly absent was a rehabilitation plan. The answer to the question of on staff or on call clinical psychologists or occupational therapists was consistently “NO”. Most persons in the homes were allowed to do whatever they felt like doing as long as it was inside the grilled house. At the time of one of the visits at noon, that was sleeping while waiting for lunch, or pacing. It felt like I was in a time warp circa 1750 A.D.
It was during the last home visit that I finally understood the ideology: there is no cure for mental illness so why waste resources on rehabilitation. I also understood that $45,000.00 – 75,000.00 (USD $523 – 827) per month was the price range to rid oneself of a mentally ill relative if you were not interested in having them rehabilitated.
I and perhaps the over 1 million persons in mental healthcare can see that the opinion of incurable mental illness ignores some simple facts.
Firstly, there are four types of mental disorders: Personality disorder such as Borderline Personality disorder (a recently highlighted societal problem in Jamaica); Psychotic Disorders, such as Schizophrenia; Organic brain disorders such as Alzheimer’s type Dementia; and the Mood and Anxiety Disorders such as Major Depression.
Secondly, the severity and outcome of each of mental disorder is different and highly individualized. Even those with dire prognosis of Schizophrenia can recover. Stories of recovery can be found throughout the world. There are persons in Jamaican society who are living with or recovering from a variety of mental disorders who live independently and run large organisations as well as small enterprises; they even have families of their own! Imagine that.
In Jamaica, the prognosis for Schizophrenia after ten years is 30% full recovery even with our meager resources and lack of standardized rehabilitation programs.
In the U.S.A, Professor Elyn Saks [pictured here] is possibly the most well-known. Elyn was diagnosed with chronic paranoid schizophrenia in her early college days, promptly held in a mental institution, and given a “grave prognosis”. She was told she would not be able to live independently at any point in her future life. She subsequently earned her J.D. from Yale Law School and is currently not only Orrin B. Evans Professor of Law, Psychology, and Psychiatry and the Behavioral Sciences but also Associate Dean at the University of Southern California Law School. She is the recipient of both the Associate’s Award for Creativity in Research and Scholarship and the Phi Kappa Phi Faculty Recognition Award in 2004.
She writes about her experience in her book ““The center cannot hold: My Journey through madness”. In an interview with National Public Radio’s (NPR: August 7, 2007) program FRESH AIR, she reports wishing her parents understood her need for treatment when she first told them her symptoms.
This highlights the most important fact sadly missed by the erudite owners of these homes. Rehabilitation of any mental disorder is extremely important in improving the persons chances of recovery. It is an integrative team effort composed of Case managers, Psychiatrists, Psychologists, Occupational therapists, Social workers and sometimes Physical therapists which provides the best care practices for our patients. Worldwide, the benefit of rehabilitation is clear, in the use of these clinical teams providing individual, group and family therapy as well as medication, occupational therapy and re-socialization. As Professor Fred Hickling, once said, “80% of mental disorders require more than medication”. Some in Jamaica know it, we just don’t practice it.
Lets not lose hope though. Dawning on the horizon of mental health care in Jamaica, are small privately owned team-oriented healthcare clinics. These ventures are driven by integrative rehabilitative healthcare specialists and strive to include the whole person. Medical, Psychological, Neurological, Psychiatric, Physical and Occupational care are very much on the menu!
Hopefully, this emerging mentality will provide the well needed breath of fresh air over the torture chamber staleness witnessed this weekend.
Think about it! More anon.