In December, the Cayman Islands government decriminalised suicide in the islands. The move has been hailed as a victory that helps remove the stigma often associated with mental illness. But campaigners say it is just the beginning of the legal and mindset changes required to ensure people with serious mental health conditions get the help they need.
Jane Panton knew her son Alex needed professional mental health support from the time he was 12-years-old. He was a quiet, intelligent boy who, in her words, “over thought everything”.
Despite the support of his parents, the stigma of “going to a shrink” was difficult to overcome for a young teenage boy.
“We tried year after year and got psychologists to visit him at home but he would lock himself away from them as he would not admit he needed help,” she said.
Though Alex did eventually agree to seek professional support, his illness was, by that time, deeply ingrained. He died by suicide at age 16.
Until recently, his death was technically a crime.
Following lobbying from the Alex Panton Foundation – the youth mental health support group set up by his mother – lawmakers officially decriminalized suicide in December.
Though no-one in recent times has been prosecuted for attempting to take their own life, Attorney General Sam Bulgin acknowledged that the Cayman Islands were among a minority of countries that still treated suicide as a crime rather than a consequence of mental illness.
“Treatment rather than prosecution is the appropriate and recommended response to persons struggling with a mental health crisis,” he said as he introduced the amendment to the Penal Code in December.
For Jane Panton, the legal change brings not only a sense of justice for her son, but an opportunity to remove the stigma from mental illness and prevent another child from suffering the same fate.
She also hopes that it will open pathways to more complete health insurance coverage for people needing mental health treatment.
“I do feel that if there was less stigma surrounding mental illness and seeking treatment when Alex was 12 and it could be like going to the doctor for a cold, he could have externalised his pain, expressed what he was feeling and got medication to regularise his brain chemistry, I feel that his life could have taken a different path.”
She added, “I see the decriminalisation of suicide as a big step towards a better understanding of mental illness in the Cayman Islands community.”
Though decriminalisation is a major legal and symbolic step forward, advocates believe there is much more work to be done for mental health to be given parity with physical health.
Hailee Robinson, a deputy chair of the foundation, said more inclusive insurance coverage was the next goal.
She said decriminalisation “allows for insurance companies to cover medical expenses as a result of an attempt or act of self-harm, preventing further stress and financial burden being added on the survivor and their families.”
That is not something that happens automatically, however.
For example, anyone who sustains serious injuries trying to take their own life is still not covered for treatment under most policies. Similarly, life insurers do not automatically pay out when someone dies by suicide.
Annikki Brown, country manager for Generali and the chair of the Health Insurance Standing Committee, said self-harm was among the permitted exclusions from coverage outlined in the Cayman Islands Health Insurance Regulations.
The traditional insurance principle at stake is connected to risk and damage. As an analogy, she said home insurance polices would not cover someone who burned down their own home.
Though cases of suicide and attempted suicide are obviously more complex, she said they had traditionally been viewed in the same light from an insurance perspective.
“With health insurance, your home is your body. It is one thing to not be made a criminal for making an attempt on your life. It could be seen to be quite another to not be allowed to draw from the pool of benefits to cover the consequences of it.”
Brown said insurers recognise this is ‘an oversimplification’ and that suicide is often the result of mental illness. She said the industry was contemplating the implications of the legal change and was considering how greater coverage could be provided for mental health challenges in general.
“Health Insurers are already in discussion about what this decriminalisation could mean for the future of how mental illness is viewed, and how healthcare exclusions may be applied in the future. We remain open to further discussions on this point with lawmakers,” she added.
Push for change
Robinson hopes the change to the Penal Code will serve as a catalyst for a new approach to insurance.
“It is essential that insurance companies recognize the growing need for support in areas of mental health. The decriminalisation of suicide should encourage private insurance companies to change their policies when it comes to attempted suicide, “ she said.
More generally, she believes healthcare plans should provide mental health disorder benefits that are comparable to benefits for other health concerns. Increasing the minimum financial out-patient coverage under the Health Insurance Regulations is one immediate goal.
“If we are to reduce the rates of suicide, we need to have greater availability and access to mental health care, both in-patient and out-patient treatment,” she said.
The campaign for mental health to be covered more completely by health insurers is just one aspect of the advocacy work being done by the foundation.
Panton said education and awareness of mental health challenges, particularly among youth, were also part of its mission.
She said, “Although, it really hurts to go back there and think that Alex could possibly be alive today, I started the foundation in his name with an aim to educate the Caymanian public that mental illness is a treatable illness and not an evil spirit that has taken over your mind and should be swept under the rug as a bad thing that you would “grow out of”.
“The mission of the foundation is to reduce the stigma of mental illness through education.”
COVID an extra-stressor
Globally, suicide rates are growing and the coronavirus crisis has put even more stress on mental health.
According to statistics from the US Centers for Disease Control and Prevention depression and anxiety have become rampant in the US since the coronavirus arrived.
Young adults have been the hardest hit with one-in-four reporting that they had considered killing themselves in the past 30 days.
According to Robinson, The Cayman Islands Student Drug Use Survey undertaken by the National Drug Counsel in collaboration with the Alex Panton Foundation in 2020 found that 27% of all students surveyed reported in engaging in self-harming behaviours, 17% reported experiencing suicidal ideation and 8.9% of all students surveyed reported attempting suicide. However, only about 5% of young people who have reported attempted suicide sought help.
She said, “The work of the Alex Panton Foundation and others like it is more important than ever. The personal and school lives of children have been significantly disrupted over the past 11 months so a lot of attention to their mental health is needed.”
She said the Emotional Literacy Program, also offered by the foundation for younger children, would be expanded and enhanced in the coming year to help more children.
“The 2020-2021 cycle includes a national roll-out and collaboration with the Department of Education to address social and emotional issues relation to transition, change and emotional difficulties in response to the COVID-19 pandemic.”