When health officials signed a nearly $900,000 contract 10 days ago to design a long-term home for the mentally ill, Cayman offered hope to dozens of people and their families.
While modest to start, the nine-cottage, 42-bed residential community will provide a dedicated, modern facility for those who have long suffered the stigma of an illness no one can see and some do not understand.
The shame of being shunned by their neighbors and sometimes even their families is often felt, and the institutional alternatives for care are inadequate. The Cayman Islands Hospital has eight short-term beds for stabilization of acute cases; Northward Prison, ill-equipped to manage mental illness, currently holds as many as 12 mentally ill inmates; and an estimated 15 people are in residential settings in Jamaica and Florida, where treatment is hard to monitor and family contact sporadic, according to a report weighing creation of a residential facility. Others are cared for by families, while others are indigent.
“I’ve been saying this for 16 years, that the community needed a long-term facility” said Dr. Marc Lockhart, head of the Mental Health Commission and Cayman’s most prominent advocate for people with mental health issues. “In the last five years or six years, though, there has been a groundswell that has started to resonate in the community.”
He estimates that 4,000 people in Cayman are plagued with some degree of mental illness, though the new facility will not treat all of them.
Jennifer Ahearn, chief officer at the Ministry of Health, long a supporter of the project, said, “The chronically mentally [ill] or the severe mentally ill will be accommodated … [that is], persons who have serious and persistent mental illness requiring care in a holistic, safe and secure environment using a therapeutic approach.”
According to the Ministry of Health, the $898,285 design contract on the 15-acre East End site would be followed in June 2018 by a tendering process for construction. Ms. Ahearn hopes that six cottages and a central administration building will open in early 2019. Other cottages would follow as needed, possibly housing overseas medical tourism patients.
Dr. Lockhart said the facility will provide occupational therapy, offering gardening, animal husbandry with goats and cows, woodworking, a bakery, cheese-making and a public gift shop.
The vision is based on Gould Farm, a Massachusetts-based residential community founded in 1913 on 700 acres in Monterey, near Boston. The farm houses 40 “guests” – as patients are called – in three units with 11, 14 and 16 beds. Residents have their own room and share bathrooms and living areas.
The residents are at least 18 years old and, according to Gouldfarm.org, “we help adults with depression, bipolar disorder, schizoaffective disorder, schizophrenia and other challenges begin to rebuild and regain their lives.”
Daily activities include a range of jobs: collecting eggs, preparing meals, clearing trails, feeding animals, tapping trees for maple syrup, planting and harvesting produce, baking bread and “flipping pancakes” at the farm’s commercial Roadside Store and Café.
”Working on various teams inspires a sense of dignity, self-worth and pride in doing for oneself and others,” the website says. Gould Farm Executive Director Lisanne Finston told the Cayman Compass that the jobs rarely change, but the “guests” do “as they gain skills, and begin to settle into new patterns of relationships, activities, etc., over time.
“They move through various work teams as they increase their comfort and competencies,” she said. “For example, a guest who has some cognitive impairment as a result of medication or trauma may move from simple repetitive tasks like chopping wood [and] slicing vegetables to more complex tasks like milking cows and making cheese, which require higher cognitive functioning, memory recall and multiple steps, remembering and following sanitation procedures, etc.
“As guests progress and start thinking about next steps, they begin working with our transition counselor who helps them identify interests and goals and begin exploring life after Gould Farm.”
Ms. Ahearn said the farm was “recommended as a potential model for the [Cayman Islands facility] … intended to be a therapeutic facility with a range of occupational therapy offerings that we anticipate will include some farming activities.”
“However, it is not intended to be solely a farm,” she said, referring to the model in KPMG’s Outline Business Case.
The document is a study of design, administrative, rehabilitation and treatment, staffing, education, security, maintenance, expansion, cost and technological issues.
Treatment scenarios vary
Both Ms. Finston and Dr. Lockhart cautioned against ambitious expectations for residents.
“Some people need several years of treatment,” Dr. Lockhart said. Treatment is ongoing and “cures” are qualified, seeking modest, stable productivity and a return to the community, augmented by ongoing maintenance and monitoring.
KPMG notes an average stay at the mental health facility at between 12 and 18 months, although some may require a stay that could exceed 24 months.
“A few outliers will stay virtually indefinitely,” the consultants said. Ms. Finston estimates the average stay at the farm is 12 to 15 months. Most make some degree of improvement, she said, but recovery is not easy to define.
“Recovery is not linear,” she said. “Recovery is a journey and each person manages their recovery differently.
“What we do see is most people gaining skills – life skills, emotional regulation skills etc. – [and] reducing symptoms, expanding relational, social and supportive networks, increasing cognitive functioning, strengthening pre-vocational skills, etc.”
Dr. Lockhart estimates overall building costs between $10 million and $15 million, and annual operating costs of $1 million. Funding will come solely from government, according to consultant KPMG,
“We don’t get this all at once,” Dr. Lockhart said, meaning costs will be spread across several years, “but [we] have enough to get this up and running.
“We are saving money, because we no longer have to send [patients] abroad,” nor will government pay monthly fees between $2,000 and $3,000 for at least 11 patients in Jamaica – some of whom, Dr. Lockhart said, have been there for two decades – and another $9,500 per month for four patients in the U.S.
“Cayman spends more than $1 million each year” – largely funded by the Cayman Islands National Insurance Company – sending people overseas, he said. “Now we can keep it in the Cayman Islands and we can employ people.”