“..She will benefit from placement in a group home for rehabilitation and reintegration ” were the words written by a counselor in response to a mothers cry for help for a daughter diagnosed with Schizo-affective Disorder, in the Saturday Gleaner. Chills ran up my spine!
I have a stern warning! the conditions in the group homes in Jamaica provide neither Rehabilitation nor Reintegration for the majority of their clientele. What we observed last Saturday is akin to providing cages for tigers.
What do I mean? well its simple really, a cage is meant for protection of the persons outside the cage, not really for the Tiger. There is nothing about the cage that is caring for or nourishing the Tiger. It is meant to confine the Tiger in a small space that makes it easier for man to control the beast without being eaten.
My visit to private group homes for the mentally ill in Jamaica lead to some disturbing insights, especially when compared to government regulated criteria for group homes in the United States of America. Note well, I understand the caveats in using the USA as a Jamaican measuring stick but I found their government regulation standards to be within the norms we should expect if you want to cover basic human rights. Not to mention rehabilitation. Thanks to Mrs. Mccalla-Sobers for coming up with this table of comparisons for the criteria all privately operated group homes must fulfill under their regulations. Its long but well worth the read. The comments reflect the conditions we found measured against the standard set in the USA.
|Standard||Met partially or fully||Not Met||Comments|
|1. Philosophy with respect to rehabilitating the mentally ill.||–||3||The signs were evident: the group homes were intended to keep the mentally ill unseen, unheard, and unhealed. In one of the homes, an informant stated that in his view, mental illness is incurable, short of direct intervention from God.|
|2. No more than 8 mentally ill individuals in group home.||1||2||HO (2); RH (11); AN (26); OS (44)|
|3. Preferably no mix of young mentally ill individuals and the elderly. Concerns have been raised about being able to maintain a rehabilitative agenda for the young with mental illness alongside hospice care for the older patients with Alzheimer’s.||1||2||HO has a majority of elderly residents (10:2) and OS has a majority of mentally ill residents (44-15). AN and RH have mentally ill residents only.|
|4. Nurse – resident ratio 1:6 or 7||1||3||HO 1:4; RH 1:11; OS 1:16; and AN 1:26|
|5. Home-like atmosphere simulated.||–||4||The homes felt like holding areas.|
|6. Enough living space, based on apparent needs of residents.||4||–||AN, RH, and OS seemed to have reasonable space for eating and watching television. However, residents at AN seemed caged in by a padlocked grill that kept them permanently in the house. Residents at RH were also behind padlocked grills, but the living and dining areas as well as some bedrooms had scenic views of Kingston from the hills.
Residents at OS were free to move around the grounds behind a high wall topped with razor wire.
|7. Privacy and access to quiet areas||–||4||Residents seemed likely to feel like goldfish in a bowl.|
|8. Bedrooms to accommodate no more than two individuals||2||2||All residents at HO were two to a room. At RH, residents were three or four persons to s room, and one room accommodated two females only.
AN seemed packed to capacity with three to four and as many as six or seven persons in a room. OS also had up to six or seven residents in a room, many with bunk beds.
|9. Bedrooms allowing about eighty square feet per individual
|2||2||HO and RH has reasonable space in the bedrooms for each individual.
Bedrooms at AN and OS were cramped, probably allowing space for residents to turn around in the rooms, but not all at once.
|10. Rooms located on outside walls, to allow for light and air.||2||2||Most of the rooms at OS seemed to be on outside walls. From my recollection, some rooms in HO and AN were not located on outside walls. All but one of the bedrooms at RH were located on outside walls.|
|11. Furnishings appropriate to the emotional, psychological, and developmental needs of residents.||Bedroom furnishings at HO and RH were basic: each person had a single bed and storage facilities. At AN and OS each person had a single bed or a bunk bed, but storage facilities were in short supply. There was nothing in the furnishing in any of the homes to lift the spirits or simulate a home environment.|
|12. Separate beds||4||–||In all the homes, each resident had a bed.|
|13. Place for personal belongings||2||2||Residents at HO and RH has place for personal belongings and built in closets. .
Most residents at AN had metal lockers for their property, and but there were more residents than lockers available. OS was supposed to have one chest of drawers per room with drawer space for each resident. However, several chests of drawers were damaged and unusable, and residents stored their belongings in laundry baskets or in their suitcases. The rare room had a built in closet.
|14. Individual furniture||(see 10 above)|
|15. Individual closet with clothes rack and shelves||(see 10 above)|
|16. Living room area attractively furnished intended to promote a pleasant and home-like environment.||–||4||The living areas were functional – chairs and television set. At AN, the living area had photographs of residents on an outing to the beach.|
|17. Enough kitchen space to permit staff and residents to take part in preparing food.||–||4||Kitchens were generally out of bounds.|
|18. Dining room furnished to stimulate self-development, social interaction, comfort, and pleasure.||–||4||Dining areas were basic and functional – tables and chairs.|
|19. Showers, bathtubs, and lavatories approximating those found in homes||1||3||Bathrooms at RH seemed run down with toilet seats absent or broken; the bathroom for female residents had a shower stall only. Bathrooms at HO and OS were functional. Bathrooms in AN seemed attractive and recently refurbished.|
|20.Bathrooms serve only up to four individuals each||HO had one bathroom to serve at most four residents. RH had one bathroom to serve three female residents, but one bathroom for all eight male residents. There was one bathroom for the 4 females at AN, and two bathrooms for the 22 males.
The 29 male residents at OS shared two or three bathrooms. Not surprisingly, many of the males relieved themselves against the wall beside the main building.
|21. Laundry space||–||4||There was laundry space, but residents were not allowed to do their own laundry.|
|22. Staff qualification and availability: Registered Nurse on 8 hour shift; licensed assistant nursing staff (practical nurses) around the clock. Mix of male and female nurses, especially where the ratio of male residents is high.||–||4||HO had female practical nurses only, all reportedly with psychiatric training. These persons were on 8 hour shifts around the clock
At AN and RH, there were female practical nurses only, and an RN on call. The AN informant said she had four years’ experience, but with no specific training in psychology or psychiatry.
OS had an RN on call, and a mix of male and female nurse’s aides. One of the males was a practical nurse. The other two were security guards had been enlisted as “attendants”, one of whom was currently in training to be a practical nurse.
|23. Staff training: annual training programmes||–||4||There were no indicators of structured staff training programmes.|
|24. Staff on call: registered nurse, psychiatrist, psychologist, case manager, social worker||The homes had RNs and psychiatrists on call, but no psychologist, case manager, or social worker.|
|25. Support staff: psychiatrist, psychologist, counselor, occupational therapist, vocational instructors.||The homes had support from psychiatrists, but no psychologists, occupational therapists, or vocational instructors|
|26. Staff accommodation||HO and OS informants met me in their offices. There was no staff office at AN or RH. I did not see any sign of accommodation for the comfort of staff, except for a door with “Staff Only” at OS.|
|27. Staff workload not more than eight hours on a shift||1||3||Staff at HO worked 8 hour shifts; at OS 12 hour shifts; and AN and RH staff routinely worked 12 or 24 hour shifts.|
|28. Management/supervision: a manager is present on the property for at least 8 hours per day, and each shift has a supervisor.||Managers were present at the homes when I visited OH and OS.
The RN who supervised AN and RH also supervised three other group homes. She visited the homes periodically to administer injections and conduct rap sessions with the residents. Other than that, the single practical nurse was on her own unless she needed to call for help.
|29 Programme for managing substance abuse||–||4||Informants at AN and OS acknowledged problems of substance abuse among residents. The estimate, at OS, was that 85% of residents abused drugs.
AN and RH allowed residents to smoke cigarettes in restricted areas inside the homes. Staff at AN and
However, there were no drug rehabilitation programmes in any of the homes.
|30. Water supply||OS had serious water problems, and there were signs of water storage in bathrooms. RH relied on stored water as the public water supply was unreliable. Residents did not appear to have running hot water, not even at RH where temperatures can be low.|
|31. Outdoor activity areas||1||3||Only OS had provision for outdoor activity: tennis, football, and basketball. In the other homes, residents went outside by exception.|
|32. Chores/indoor activities aimed at helping residents to function independently||–||4||Residents had chores such as making their beds, sweeping their bedrooms, and washing dishes.
AN and RH had duty rosters for residents. There were no arrangements for residents to engage in gardening, skills training, or creative/educational activities.
|33. Organized activities outside the home||AN took residents to the beach on the first and only outing so far. RH and OS used to take residents on outings to places like Hope Gardens or Devon House, but stopped for various reasons, including control.
Sometimes the cook at RH takes some residents for walks.
|34. Provision for residents to personalize their portion of the living unit and mount pictures on the walls.||–||4||I saw no sign that residents could personalize any part of the units where they lived.|
|35. Access to some modern technology||4||–||Residents were generally allowed to have cell phones, and laptop use was possible.|
|36. Access to reading material||1||3||Only OS had books available in a small reading area on a verandah.|
|37. Access to television||4||–||All the homes were equipped with television sets.|
|38. Location in residential neighborhoods with access to shops, commercial facilities, and other community facilities.||3||1||HO, AN, and RH are in residential areas.
OS is in a commercial area, next door to a large bakery, and across the road from a church and a school.
|39. Plans and procedures for meeting emergencies such as fire, serious illness, severe weather, and missing person are written, communicated, and reviewed for the benefit of staff and residents||–||4||There were no clear plans and procedures for dealing with emergencies. For example, at AN, where 26 residents are on lock down for 24 hours at a time, what would happen in the event of a fire? What if a resident had a psychotic episode? What if a resident harmed himself or others?
A hopeful sign was that OS had a prominently displayed list of phone numbers to call in the event of an emergency.
|40. Church activities||4||–||All three homes had prayer meetings and church activities. Attendance was obligatory at HO only. OS allowed some residents to attend the church across the road from the home.|
|41. Networking with other institutions, local or overseas||–||4||There were no indicators that these homes sought to access services of interns or other volunteers from universities or charitable groups in Jamaica or elsewhere.
Could there, for example, be links with substance abuse agencies? A suicide prevention agency such as Choose Life International? Edna Manley school for art/music/drama therapy? University of the West Indies for counseling and social work? Sports bodies for sports therapy? Gyms for donations of equipment and volunteer trainers?
|42. Observed behaviour of residents||–||4||At HO, residents were seated on the verandah staring into space.
At AN and RH, a few watched television or played dominoes while most were lying in bed or wandering aimlessly around.
The passivity of residents at AN and RH seemed to me to be consistent with pharmaceutical sedation. Mention was made of monthly injections given to residents.
Residents at OS seemed less caged, perhaps because they had the chance to be outdoors.
|43. Involvement of families||–||4||Although my visits to three of four homes was on a Saturday morning between before 10 am till about 1 pm, I saw no sign that any of the residents in any of the three homes had visitors.
Nine of eleven persons at RH came from outside of Jamaica, and so their family visits were rare. There were apparently no scheduled reviews of patient care and progress with family members.
|44. General appearance of the homes.||All the homes seemed clean and tidy, with room for upgrading the appearance outside and inside. HO, RH, and AN had gardens, and OS had a large shed that provides an all-weather recreational area.
OS had a high wall topped by razor wire.
|45.Rate of recovery||HO: nil. Both patients are long-stay, one for 5 years and the other for 10 years
AN: perhaps nil. Some residents have been in the home for 10 years. Some have left (but not necessarily recovered) after one or two months.
RH: perhaps nil. Residents have been in the home for between 2 and 4 years.
OS: low. Some residents have been in the home for 7 years, and the rate of recovery (usually measured in the resident’s ability to migrate to the USA) seemed minuscule)
The Jamaican Government at this time does not have a legal regulatory board supervising the standards of care and rehabilitation in private group homes for the mentally ill. This means there is no where to turn if you have a problem with the way your relatives are treated in these homes.
If you have no idea of what I am talking about this problem is large people. If our choices of where and how we treat our mentally ill community are limited, if no rehabilitation takes place, then these ‘homes’ and other holding pens will grow and more useful minds will waste away in them. I will leave the venerable Mrs. Sobers to deal with the Human rights issues pronounced in these homes.
So the short warning is : NO these homes will NOT provide rehabilitation or reintegration for your beloved daughter madam. That may only come through sheer willpower on her behalf despite being caged.
p.s.in my humble opinion Tigers die a miserable death in a cage. Their only dignity may come if they chose to eat/maul the keeper first. Also realize my comparison is meant to highlight the sad state of human beings in group homes and not that mental illness turns people into Tigers/animals. That’s just silly.
Look out for my blog on what needs to happen with private rehabilitation homes in Jamaica.