A change to the law is planned to create new options for the treatment, monitoring and eventual release of people detained indefinitely in prison after being deemed ‘criminally insane’.
The planned change to the Criminal Procedure Code is one of the first steps in what officials in the Ministry of Home Affairs hope will be a sea-change in how Cayman handles mental health issues throughout the criminal justice system.
The amendment, approved by Cabinet, will be accompanied by changes to regulations which will help ensure the governor – who has ultimate responsibility for deciding if and when such prisoners can be freed – has access to a range of well-informed advisors through a transparent process.
The aim, says Michael Ebanks, chief officer in the Ministry of Home Affairs, is to provide a clear and fair mechanism that balances the needs and rights of the patient with public safety. The governor will retain ultimate decision-making authority in such cases.
Ebanks acknowledged putting in place a revised legal framework was simply a first step and that additional resources, infrastructure and expertise were needed to address mental health challenges in the community, the prison and beyond.
The planned reforms follow an investigative series by the Cayman Compass which highlighted areas of concern across the judicial system.
Compass Investigation: Travis Webb
Our reporting focused on ‘The strange case of Travis Webb’, a former track star, currently detained on an inpatient ward at the Cayman Islands Hospital with no imminent hope of being discharged. Webb was found not guilty ‘by reason of insanity’ in a notorious attempted murder case in which he attempted to bury a child alive in 2018.
His case revealed significant gaps in the mental health support system in Cayman.
Doctors on both sides accepted that Webb was suffering from schizophrenia and had experienced a ‘serious psychotic episode’.
He was initially detained at Northward Prison but was transferred to the acute mental health care unit at the hospital where he has remained ever since. A planned new long- term mental health facility, still under construction and now expected to open 30 Sept. after numerous delays, could be another option for him in future.
Doctors, including former Mental Health Commission chair Marc Lockhart, have indicated that Webb is now on medication and is considered fit to be discharged.
Despite that recommendation, the governor has not authorised his release. Lawyers and doctors familiar with the case told the Compass that there are legitimate concerns around the monitoring and outpatient support for patients like Webb once they are released.
Proposed changes to law
Currently, officials acknowledge, the law envisions binary options for prisoners like Webb – detention in a ‘mental hospital’ until ‘discharged by order of the Governor’.
Lisa Malice, deputy chief officer in the Ministry of Home Affairs, said there is no statutory means to mandate any intermediary step between incarceration on a mental health ward and total freedom.
“That’s really not the most effective way to deal with this kind of situation,” she said.
New language to be added to the Criminal Procedure Code, being worked on by the Attorney General’s Chambers, will create scope for community supervision orders in an effort to provide support and conditions around the release of people in Webb’s position.
Those orders would necessarily be tailored towards the needs and circumstances of the patient but could include, for example, measures to ensure they take medication as prescribed, receive support from community psychiatric nurses or report to hospital for monitoring at mandated intervals.
Changes to the regulations will flesh out how that could work in practice, said Malice.
“We have to look at the process around how that happens and ensure that any decision that the governor makes is done in consultation with the right experts and with advice from specialists in that area.”
She said this would ensure any decision on conditional release or continued detention is based on the correct information, bringing experts together to ensure there is a comprehensive care plan.
Another issue under consideration is the review period. Webb and his family highlighted their anguish at not knowing if or when he might be released.
Further tweaks to the legislation could include a statutory review period where a patient’s incarceration is reconsidered.
Resource challenges
Our reporting also highlighted resource and expertise challenges in the mental health system across Cayman.
Both Ebanks and Malice acknowledge that more community psychiatric nurses are needed as well as new facilities and additional experts both in the private and public sector.
Ebanks said mental health issues impacted every aspect of the judicial system and a ministry-wide effort was taking place to ensure staff were properly trained to identify and handle mental health challenges, including potentially clinical issues.
“Everyone needs to be more trauma aware, from prison and police officers to policy analysts. We need a set of skills that are trauma-informed.”
One of the most innovative recommendations from a consultants report on issues in the judicial system was for mental health first responders to accompany police on call-outs.
Malice said there is growing recognition in Cayman and worldwide of the links between mental health and criminality.
Often police are called to situations where a doctor or a psychiatric nurse would be more appropriate.
Malice said the idea of mental health first responders attending 911 calls alongside police officers was a longer term goal.
“That is something we should really be pushing hard for here.
“We don’t see it as far-fetched. It is not something that can happen overnight but I think that coordinated response team approach is important.”
More immediately, seeking to increase the number of community psychiatric nurses is considered a priority.
Ebanks said the current alignment of the health ministry and the home affairs ministry, which includes the uniformed services, created greater scope for collaboration.
With key departments, from the prison and probation services to the Health Services Authority and the hospital, under one bureaucratic ‘roof’, he said, “We have as good a shot as ever to make real inroads into this issue.”
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