In 2014, in the innermost part of West Bay, along a stretch of Finch Drive, stood a tiny house obscured by thick, overgrown hedges.
Its concrete walls, made bare by the peeling pink paint and fading white trimmings, still supported an unhinged door, smashed windows and a leaking roof.
Inside the ramshackle house lived lifelong resident Ella May Powery who, at 73 years old, was left sleeping exposed to the elements for three months – after a family member, who had been living with her, developed a sudden and significant mental disorder that resulted in him destroying the home.
Eight years on, Powery has since died, her home sold, and her relative sent to a facility for treatment. Her story has been relegated to the chapters of time, but it is an all-too-common occurrence that Mental Health Commission Chairman Dr. Marc Lockhart says is very much on the rise.
“These are the types of cases that go on behind the scenes, that people hardly ever hear about,” Lockhart told the Cayman Compass.
He said authorities often receive calls from family members saying their son or daughter is destroying their home and they need help. “But when the police show up, the person pretends to be sleeping, and/or simply stops the destructive activity, so the officers say there isn’t anything they can do,” he said.
One such case is that of a 26-year-old George Town man, who was due to be sentenced before the Summary Court this week for a 2014 matter, but he was a no-show, which resulted in the magistrate issuing a warrant for his arrest.
The man, who is now homeless, suffers from an undisclosed mental illness coupled with ongoing substance abuse.
The court heard that, after having made no progress over several years, he was put out by his parents after he was startled by his reflection and lashed out, damaging the home.
“Giving the circumstances of the matter… I would not dissuade Your Honour from issuing a warrant,” Oliver Grimwood, the man’s attorney, told the court. “However, I fear there is little good this will do, because there are four outstanding matters at the detention centre for him, and police know where he is, but they simply will not arrest him.”
Lockhart told the Compass that police inactivity often resulted from uncertainty around whether officers had the power to detain a person of unsound mind, who was accused of committing offences. However, recent changes to the law have since clarified that ambiguity.
Initially drafted in 1979, the Mental Health Law was revised in 1997. A further review commenced in 2010 which has resulted in the newest iteration – the Mental Health Act (2022 Revision).
“We took our time to review varying laws, from several jurisdictions, and what we have now is a more inclusive law that helps to strike a balance for persons’ rights and liberties, while protecting them from harming themselves and/or others,” said Lockhart, who noted that the new law has been praised by the Pan American Health Organization.
Under the amendment, a new protective custody form is being created, which aims to streamline the process for police when acting on a protective custody order made by a medical officer – a registered psychiatrist or a clinical psychologist.
“Family members can now report a person who is having a mental episode, and police can now detain that person and have them brought for assessment and treatment, if necessary,” said Lockhart.
Increased social pressures
According to data from the Mental Health Commission, between 2019 and 2021 the Health Services Authority treated 36,289 clients for a variety of mental afflictions, including anxiety and depression. In 2021 alone, 13,078 people were treated, which represents a 23% increase over the 10,616 clients recorded in 2019.
“During this time, our population has been growing and with that growth we have seen increased stressors, such as a higher cost of living and housing shortages. We have recently endured the global pandemic, among other everyday challenges, which are all part of one side of the coin,” Lockhart said. “On the other side of the coin, which often goes unseen, is this large upswelling of mental illnesses, which are manifesting in all types of ways for different people.”
Lockhart noted that the manifestation of a mental illness might not always result in physical harm; instead, it can develop into disruptive behaviour outside of the person’s normal character – such as unprompted protesting.
One person who is known in the community for frequently protesting is Lovell Marriott, who has repeatedly demonstrated on the steps of the Government Administration Building, at the gates of the governor’s residence, and across several parts of George Town.
In one instance, she was recorded blocking a main road with rocks and sticks. In others, she was recorded shouting and gyrating, waving signs claiming mental health professionals were trying to kill her. Marriott has also taken to social media to openly protest her arrests.
Her actions have led to her being charged with multiple offences, for which she is on bail awaiting trial. Her bail conditions prevent her from protesting and/or “being an idle person” along the main streets of George Town, and her social media access has been restricted. She has also been ordered not to protest, to keep the peace, and be of good character.
Lockhart acknowledges that instances involving demonstrations like the ones carried out by Marriott could result in the person being detained by police and brought for assessment – which could constitute a breach of their constitutional rights to peacefully demonstrate.
“When drafting this law, this matter was anticipated,” said Lockhart. “But proper checks and balances were put in place, which also includes an amendment to the Mental Health Commission Act.”
Pointing to an earlier incident during which a man went on a hunger strike outside the Government Administration Building, Lockhart said, “He reached a state that caused medical officials to be concerned about his health, and upon assessment it was determined that he was of a sound mind and therefore allowed to continue his protest.”
But in the event a protester is detained and taken into custody for treatment, that person will now have the ability to appeal to the Mental Health Commission, which comprises a human rights attorney, a psychiatrist, and a layperson, as well as other related professionals.
“What’s good about this is that the appeal can also be made by someone else, such as a close friend… a family member, an attorney or someone designated with that power,” said Lockhart. “Ultimately, if the appeal is refused, the person then has the right to challenge said appeal by way of the judicial system through our courts.”
New reforms only part of the process
Although the new legislation does make it easier for mentally afflicted persons to be detained and/or treated, that deals with only half of the problem, Lockhart said.
“The other half is that we need the long-term mental health residential facility to be opened and brought online,” he explained, who stressed that Cayman’s eight-bed acute mental health facility was simply not fit for its current use.
According to the World Health Organization, 60 psychiatric beds are considered optimal per 100,000 persons, with 30 beds being the minimum. In Cayman, there are eight beds to service a population of 80,000 people.
“On average, we have 12 persons per week,” said Lockhart, who noted that in 2021, suicide attempts jumped by 72%.
“Some persons who are admitted don’t want to leave, and so we have to shift them to a different part of the hospital when someone else needs a bed,” he said. “The flip side is that sometimes persons are admitted and should remain in custody, but they say ‘Oh, I need to go smoke a cigarette’, and then take that opportunity to run away. This is why we are in dire need of the facility.”
According to Lockhart, all the major construction on the $15 million, 15-acre facility has been completed, with its projected March 2023 opening dependent on “final touches” of staff, electricity and internet.
The facility has been turned over to the civil service, and Lockhart says he is confident the government will get it across the finish line in time to help those most in need of treatment.
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