Mental health task force tackles amended regulations

A month after a Complaints Commissioner’s report criticising the government’s failure to implement recommendations for caring for mentally ill patients was made public, the government released a statement saying revisions of the regulations of the updated Mental Health Law are underway.

According to a statement released Wednesday, a task-force committee set up by health minister Mark Scotland more than two years ago to revise the law is now developing related regulations. The Mental Health Task Force Committee, along with the Ministry of Health and legislative drafters, have already reviewed four drafts of the proposed law.

The task force of psychiatrists, psychologists, nurses, doctors, social workers, teachers and government policy makers, is reviewing regulations to address various detention orders, the role of the responsible medical officer, the appeals process, and the statistical reporting forms, the statement read.

The Mental Health Law was drafted in 1979 and last revised in 1997. Under the revised law, a Mental Health Commission can designate a “place of safety”, which is different to a “safe facility”. A place of safety can be designated when patients are “so ill that they are likely to become a danger to themselves or others, and they cannot be safely managed in the standard accommodation provisions,” according to the government release.

Under the current regulations, prisons in Cayman have been designated as places of safety for mental health patients.

The Cayman Islands Hospital has a “safe facility” – an eight-bed, short-term in-patient mental health ward – but no local long-term care option for chronic patients, most of whom are placed at facilities off-island.

A report by Complaints Commissioner Nicola Williams, made public in the Legislative Assembly in late August, criticised the government for not implementing recommendations to improve the administration of care and housing for the mentally ill more than two years after the proposals were put forward.

Ms Williams said not only did Cayman have a social responsibility to provide suitable accommodation for the mentally ill, but when the Bill of Rights is introduced next month, the lack of facilities could land the territory in legal hot water.

Former Complaints Commissioner John Epp carried out an investigation in 2009 that highlighted an “ad hoc” process of evaluating a place of safety for a mentally ill person. It included no inspection of the place of safety before a recommendation was made to send a patient there; potential violations of a person’s rights by false imprisonment if they had committed no crime; and lack of adequate treatment.

“The [complaints commissioner’s office] firmly believes it is not appropriate to incarcerate the mentally ill who are not convicted of crime,” Complaints Commissioner Williams wrote a follow-up report this year.

“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,” she said.

A private group is looking into the feasibility of building a mental health facility in Cayman for patients needing long-term hospitalisation.

Proposed changes to the law include provisions for orders for detention, observation and treatment. Other orders, such as “temporary holding power” and “emergency medical treatment order” are for those who appear to have a mental illness and are likely to leave the hospital when unfit to do so, or those undergoing treatment and requiring urgent treatment for a medical condition but unable or unwilling to give consent.

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

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