Recommendations to improve the administration of care and housing for the mentally ill in the Cayman Islands have not been implemented more than two years after they were put forward.
The issue deals with how a mentally ill patient should be handled if they are determined to be a safety risk to themselves or others. Regulations of the Mental Health Law [1997 Revision] set out how a “place of safety” can be designated for a mentally disordered person, but, put simply, Cayman lacks sufficient facilities to suit that purpose. Usually, the “place of safety” has been a prison lock up.
Complaints Commissioner Nicola Williams said Tuesday that the issue is not only one of conscience and social responsibility for the Cayman Islands, but one that could land the territory in legal trouble when the 2009 Constitution’s Bill of Rights comes into effect later this year.
Ms Williams is not the first person to make such a claim. In fact, her report on the matter – made public last week in the Legislative Assembly – cited statements in 2009 by the late Commissioner of Corrections and Rehabilitation William Rattray who noted that current prison facilities weren’t the solution to the territory’s mental health problems.
“It is my view that Fairbanks [women’s prison facility] is not adequate as a place of safety for mental health patients who have not been committed to prison as an untried prisoner, waiting for sentence or sentenced to imprisonment by a court,” Mr. Rattray opined during an April 2009 investigation by the complaints commissioner’s office. Ms Williams’ recent report was done as a follow up to that investigation.
Chief Medical Officer Dr. Gerald Smith, speaking to investigators in 2009, generally agreed to that statement at the time, but noted that “it is the best we can do with what is and is not currently available to us”.
Dr. Marc Lockhart also noted during the complaints commissioner’s 2009 investigation that the Cayman Islands Health Services Authority has an eight-bed mental health care facility at the Cayman Islands hospital. However, that facility is too small to meet the needs of all three Islands in Cayman and is not necessarily appropriate to treat and care for all types of mental disorders, Mr. Lockhart stated.
Essentially, public safety authorities are still being forced to find “somewhere else” to put mentally ill people who may pose a risk to society, but who have committed no offence.
At the time of the 2009 investigation by the complaints commissioner, an “ad hoc” process was used to evaluate a place of safety for a mentally ill person. That process included no inspection of the place of safety before a recommendation was made to send a mental patient there, potential violations of a person’s rights by false imprisonment if they had committed no crime and lack of adequate treatment for various mental health issues.
“The [complaints commissioner’s office] firmly believes it is not appropriate to incarcerate the mentally ill who are not convicted of crime,” Ms Williams wrote in her 2012 follow-up report, which sharply criticised what she perceived as government’s lack of action or delayed action on the issue since the issuance of the 2009 investigation.
“Imprisonment is a punishment for a crime, and prison is not equipped to treat mentally disordered patients. At this point in time, this is the only option available for specific cases with particular need for a place of safety. This is not a lawful excuse, it also unnecessarily exposes the prison service to legal claims should something go wrong.”
The initial report that recommended the government Ministry of Health develop a process to administer the designation of a place of safety for the mentally ill, ensuring that those individuals’ identities are kept private.
That report was made public in October 2009 after it was tabled in the Legislative Assembly.
A series of e-mailed promptings between government officials and the complaints commissioner’s office led to the formation of a Mental Health Task Force in May 2010. The task force came up with draft provisions to change the Mental Health Law requirements and sent them to the Legal Department for drafting.
In July 2011, Commissioner Williams e-mailed Ministry of Health Chief Officer Jennifer Ahearn stating: “I am concerned that this is now of some age with relatively little forward movement in 21 months [since the issuance of the complaint’s commissioner’s 2009 report].”
It wasn’t until October 2011 that the commissioner heard back from Chief Officer Ahearn who indicated that she had not heard from the Legal Department on a re-draft of the Mental Health Law.
In December 2011, Ms Williams wrote Health Minister Mark Scotland about the matter. Ms Ahearn responded that work on the draft bill was still progressing.
“It has not been the case that we have not taken any action,” Ms Ahearn wrote to the complaints commissioner on 12 December, 2011. “Once we complete the review, the country will have a Mental Health Law that not only addresses the issue of the designation process for a ‘place of safety’, but also puts in place a robust and updated legislative framework that addresses many other important aspects of mental health and protects the rights of the patient and the public.”
In April 2012, citing “no substantial compliance” with complaints office recommendations, Ms Williams issued a special report. That report was made public in the Legislative Assembly last week.