Mental health laws reviewed

A task force set up to examine
mental health issues is advising a major overhaul of the law governing the
treatment of the mentally ill in Cayman.

The task force, established in May,
comprises psychiatrists, psychologists, nurses, doctors, social workers,
teachers and government policy makers.

Psychiatrist Marc Lockhart, a
member of the task force, said the team had recently finished a report on the
Mental Health Law, which he said needed to be modernised and amended to take
into account the growing problem of mental health issues locally.

“We have just completed a major
undertaking… to review the whole Mental Health Law. It was a complex
challenge,” he said, adding that the task force’s recommendations are being
passed to Cabinet and the Legal Department.

The Mental Health Law was drafted
in 1979 and last revised in 1997.

Among the elements of the law that
need to be updated are the involuntary detention and the right to appeal
against involuntary detention, Dr. Lockhart said.

Under the existing law, if people
are considered to be a danger to themselves or to others, they can be
involuntarily detained as an inpatient at the hospital. Between January and
August this year, 44 people were involuntarily detained under the Mental Health
Law and admitted to the Cayman Islands Hospital short-term mental health unit.

Dr. Lockhart said there is a common
misconception that some patients are sent to prison if they aere involuntarily
detained. “There have been a few cases of people that have had criminal
histories along with psychiatric histories… They have been committed to
prison because of their crimes,” he said. However, he added that in some cases,
once prisoners reach their release date and are deemed to still be a danger to
themselves, they may be held for longer.

Under the Mental Health Law
regulations, Northward and Fairbanks prisons are considered prescribed places
of safety to which mentally ill people can be committed.

According to the Health Services
Authority, between January and August this year, there were 3,361 “patient
contacts” relating to mental health outpatients, but some of these included
patients who may have met with mental health staff two or three times, so there
were at least 1,000 individual patients who required outpatient care. Of those
encounters, 31.8 per cent were with a psychiatrist, 53.6 per cent were with a
community mental health nurse who would have visited patients in their homes,
and 14.6 per cent were dealt with by psychologists.

The Cayman Islands Hospital has an
eight-bed short-term care unit for inpatients with mental health problems. It
also has a day hospital programme for patients who have been discharged from
the care unit but who still need monitoring and additional support – they visit
the hospital two to three times a week, Dr. Lockhart said.

On average, 124 patients a month
avail of the short-term care unit and the day hospital programme, the doctor
said.

There are no long-term care
facilities for the seriously mentally ill in Cayman. Those who require
long-term care are sent off Island, usually to Jamaica, and it is estimated
that between 10 and 15 people from the Cayman Islands are in long-term care
there. “Many have been there for many years,” said Dr. Lockhart.

“From a short-term inpatient
standpoint, I think that our facilities and our staffing availability scores a
B, or above average. From the standpoint of long-term care, I would rate us an
F. Put the two together and we average a D, or below average,” Dr. Lockhart
said of Cayman’s mental health facilities.

National mental health policy

Reviewing the law is just one
element of the task force’s remit. It is also being called on to draft a national
mental health policy for Cayman.

Health minister Mark Scotland, in a
message to mark Mental Health Day this week, said the ultimate goal of the task
force is to produce a legal framework to “better protect patients and reflect
statistical trends, as well as accommodate advances in psychiatric treatments”.

He cited “disquieting” statistics
from the Pan American Organisation which showed that mental disorders account
for 24 per cent of diseases in the Caribbean region and of these, depression by
far is the most prevalent. The organisation also warned of a strong link
between mental illness and poor long-term health.

“There are no quick fixes, and for
the foreseeable future mental illness will continue to challenge individuals,
society and government,” Mr. Scotland said.

Mr. Scotland said that while health
officials and others are working toward finding solutions, people can help curb
negative impacts of mental illness by seeking help when they need it, joining
an awareness drive or helping a friend get through depression.

“Many still perceive mental health
issues as belonging on the periphery of health care, particularly since they
feel that the numbers involved are limited to only a small percentage of the
total population. However, these PAHO findings should dispel that myth and at
the same time serve as a wake-up call to make mental health care far more
accessible to everyone.

“Sound mental health is vital to
optimal well-being and just as we guard our physical health, we should also be
mindful of our – and others’ – mental health. And in this regard, I do commend
our local mental health practitioners who are already working towards
integrating mental and physical treatments, to the benefit of all patients,”
Mr. Scotland said.

The minister said while health
practitioners are now recognising mental disorders as a major health concern,
authorities in the Caribbean had underestimated the prevalence, impact and
associated costs of mental illness.

“This has led to deficiencies in
treatment, but it has also resulted in a public awareness gap that has in turn
led to stigma and stereotyping that so often seriously undermine effective
management and recovery,” Mr. Scotland said.