No refuge for Cayman’s criminally insane

Earlier this year, Travis Webb was found not guilty by reason of insanity on charges he buried a child alive in 2018. Despite years of discussion around building a mental health facility in Cayman, however, options for people in his situation remain very limited.

Housing and treating people found to be criminally insane present a legal and moral conundrum for Cayman’s judicial and medical systems.

Webb, 28, was charged with attempted murder for the November 2018 incident and was eventually acquitted in the Grand Court, after two psychiatrists agreed he had met the test of insanity and had not been in his right state of mind when he committed the offence.

After the acquittal, he was taken to the Cayman Islands Hospital’s mental health unit in accordance with Section 159 (1) of the Cayman Islands Criminal Procedure Code, which says “Where any person is found to be insane before or upon arraignment or a special verdict made against him… the court shall order [the defendant] to be conveyed to any hospital or other place… appointed under any law to be a mental hospital or for the reception of criminally insane persons.”

Cayman does not yet have a facility solely dedicated to housing the criminally insane, or those deemed to pose a threat to themselves or others.

Dr. Marc Lockhart

The hospital’s eight-bed unit is not appropriate for long-term treatment, said Cayman Islands Mental Health Commission chairman and psychiatrist Dr. Marc Lockhart.

“If someone has a stroke, they would be taken to the hospital where they would be treated and, once released, they would be sent to physiotherapy,” said Lockhart.

He added that, in an ideal situation, Webb would not have to reside at the hospital, and would only be taken there if he required urgent attention. But with nowhere else to go, that is where he is being housed.

“This is now a challenge, because the law states that if someone is acquitted of a crime by reason of insanity, they are to be taken to the hospital, where they are to be held for life, or until the governor decides they are to be released,” said Lockhart, who was consulted on Webb’s sentencing.

Construction is currently under way for a long-term residential healthcare facility in East End, but it will be a year before the doors open to potential patients. Webb, who was assessed as having a low risk of reoffending, would have qualified to reside at the facility.

“Not every person who has been convicted or declared not guilty by reason of insanity is a danger to themselves or the public,” said Lockhart.

While housed at the mental health unit, Webb has been allowed to walk around the hospital grounds under the supervision of security and medical staff.

“Although the hospital is able to adequately treat Webb’s mental health issues, it does not provide the other important aspects, such as occupational therapy,” said Lockhart. “A rehabilitation facility would have security, programming, assessments and monitoring of progress above and beyond what you will find at the hospital.”

For the last 20 years, successive governments have entered into an agreement with a long-term mental-health rehabilitation facility in Jamaica, where Cayman’s patients have been sent.

“The problem with these facilities is that we can’t truly control the treatment the patients receive,” said Lockhart. “You never know what is going to happen, this can change quite easily; COVID is a clear example.”

Since Cayman’s facility will not open until October 2021, Lockhart said sending Webb overseas is the difficult decision that will most likely have to be made in his case.

“Talks were ongoing with Bermuda, a sister Overseas Territories, to try and get Webb in a facility over there, but they are full. Now we are trying to see if we can secure a place for him in the UK… but with the country experiencing their second wave of COVID, it’s proving difficult.”

There is also a second patient facing the same issue in Cayman, who used to reside at a long-term facility in the US, but is currently being housed at the mental health unit at the Cayman Islands Hospital.

“This means we are now down from eight beds to six beds for 60,000 people, which works out to one bed for 10,000 people” said Lockhart, who added the situation for these patients and future ones will not improve until a proper long-term solution is available.

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