Mental health crisis teams could be embedded with police services in a novel new way of tackling a growing challenge in the Cayman Islands, according to psychiatrist Dr. Marc Lockhart.
The recommendation, which comes from a consultant’s report highlighting numerous problems in the prison system, could be pivotal in changing Cayman’s approach to dealing with both crime and mental health challenges, Lockhart told the Compass.
The former head of the Mental Health Commission was speaking during a wide-ranging interview, as part of our reporting on the ‘Strange Case of Travis Webb’ – a former athlete detained indefinitely on a hospital ward after mounting a successful insanity defence to an attempted murder charge.
Webb’s family reached out for help in vain in the months before he attempted to bury a child alive, after suffering a serious psychotic episode linked to his undiagnosed schizophrenia.
Lockhart cautioned that Cayman’s prisons are filled with people with unmet mental health care needs.
And he argued that the solution starts with early detection and diagnosis. Investment in psychiatric nurses and in mobile mental health teams could help prevent the next serious incident before it happens, he said.
Lockhart also advocates for greater resources across the system to tackle mental health problems, improved facilities at the prison and the Health Services Authority and broader public understanding of mental health challenges.
Here are some of the key comments and recommendations from Lockhart.
On mental health intervention teams:
Back in 2009, we identified the need for mobile mental health teams. There are similar type teams in many parts of the UK and the United States. Some of those teams work independently. But what’s happening now is that there is a major move towards incorporating them with the police services, and I think that is something we could consider.
On current community mental health outreach:
We only have three community psychiatric nurses, whereas 20 years ago when our population was around 30,000, we had double that number. (Those nurses) work in the community. On a day like today, they would go to somebody’s house, check in on them, give them medications and make sure they’re doing OK. They are able to provide the early intervention and recognition before things deteriorate.
On resource needs:
We need more community psychiatric nurses, we really should have one in every district. We need to get the long-term care facility up and running to take the burden off of the 11 beds in the hospital, so that that can again become an acute unit. We need to continue to develop and have more mental health group homes.
On Travis Webb’s incarceration in the hospital and the challenges for people with mental health issues in the judicial system:
It’s a situation that should not be happening in the Cayman Islands or anywhere else. On the other side of the coin, it is a situation, unfortunately, that happens in many jurisdictions because of the lack of focus on solving challenges with mental health, especially when it deals with the those that are defined as criminally insane, or in cases where their illness affects them and they break the law.
On the likely impact of the new long-term mental health facility:
When that facility gets built, 50% of the problem (for patients like Travis Webb) is solved because at least we would have a designated area that has the space, that has the programming, that has the treatment options that would benefit somebody like this young man. It would be in a setting where he gets the occupational and the life skills that he would require to function. And then other types of treatment could be augmented to help get him prepared to go back into society.
On the challenge for the governor in authorising the release of anyone pardoned for a criminal act because of mental health challenges:
It’s not easy. And it requires, again, that we have the proper tools in place to be able to provide a certain amount of surety to the governor that the general community is going to be safe, and that there are policies and procedures in place to create that dual protection – protection for Travis himself and anyone else that falls under that type of situation, and for the community at large. That’s the balance that the Governor’s Office is weighing at this point, in my opinion.
For this reason and many others, we need to continue to amplify and develop our mental health system. We’ve made major gains, but we have quite a way to go in terms of ensuring that we do have the proper facilities and support required so that everyone’s rights are protected.
On the risk posed to the community by people with mental health disorders:
Patients or people with serious mental illness, like schizophrenia and serious forms of bipolar disorder and others, are at greater risk of being abused or taken advantage of than the regular population. It is an extremely small percentage of those with mental illness that actually harm or hurt others.
On the link between mental illness and criminal behaviour:
Mental illness is on a spectrum, from mild to severe – very similar to a physical illness… You can have some people with schizophrenia where it affects aspects of their thinking and cognition and you can have others where it completely deteriorates their ability to understand what they’re doing, or to comprehend the consequences of their actions and behaviours.
On mental health challenges among prisoners:
If we were to ask what entity or facility in the Cayman Islands has the largest number of people with diagnosed mental illness that are under treatment, it is not the hospital. Unfortunately, it is the prison system. The second largest group of people with serious mental illness or mental health concerns that could benefit from care and treatment is just in the community (without support or treatment).
Compass Investigation: Travis Webb
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