MEN­TALLY ILL

It is mad­ness how, as a so­ci­ety, we treat the

Jamaica Gleaner - - HEALTH - Dr Al­fred Dawes Dr Al­fred Dawes is a Gen­eral La­paro­scopic and Weight loss Sur­geon at the Is­land La­paroscopy and Med­i­cal Care; Email: info@is­land­la­paroscopy.com; yourhealth@glean­erjm.com.

AS MEN­TAL Health Week ap­proaches in Oc­to­ber, we may only take a passing note of the planned ac­tiv­i­ties. Af­ter all, the fact that we, as a coun­try, are poorly treat­ing men­tally ill per­sons is an in­con­ve­nient truth only ac­knowl­edged when­ever there is an act of vi­o­lence in­volv­ing them.

It is an awk­ward topic, and fam­i­lies hide the ill­ness of their loved ones to pro­tect them­selves from the stig­ma­ti­sa­tion that of­ten oc­curs. It is mad­ness how, as a so­ci­ety, we treat the men­tally ill and we have barely evolved in more than a hun­dred years.

LU­NATIC ASY­LUM SCAN­DAL

In 1860, there was a scan­dal in Ja­maica that rocked the very foun­da­tions of health care in the Bri­tish Em­pire. The ac­count of a pa­tient who was ad­mit­ted to the lu­natic asy­lum in Kingston was hor­rific enough to war­rant an in­ves­ti­ga­tion that re­sulted in changes in how psy­chi­atric pa­tients were treated in the Bri­tish colonies. The pam­phlet, ‘Seven Months in the Kingston Lu­natic Asy­lum, and What I Saw There’ by a former pa­tient, Ann Pratt, de­scribed in de­tail the hor­rific con­di­tions in the asy­lum, in­clud­ing the tank­ing of pa­tients. In tank­ing, the pa­tient was force­fully im­mersed in a tank of dirty wa­ter used to wash pa­tients un­til they stopped re­sist­ing.

This first scan­dal to hit the health sec­tor prompted an au­dit of the asy­lum. The al­le­ga­tions were found to be true and, in some in­stances, worse and more wide­spread than al­leged. The colo­nial of­fice in Eng­land con­ducted a sim­i­lar re­view that found con­di­tions through­out the em­pire were equally ap­palling. Pa­tients were be­ing locked up and re­strained rather than be­ing treated.

In Mar­garet Jones’ ar­ti­cle ‘The Most Cruel and Re­volt­ing Crimes: The Treat­ment of the Men­tally Ill in Mid-Nine­teenth-Cen­tury Ja­maica’, she de­scribes a so­ci­ety where the men­tally ill were locked up in jails whether or not they were crim­i­nally in­sane. Pa­tients in asy­lums had a high death rate and were phys­i­cally abused reg­u­larly, with the au­thor­i­ties turn­ing a blind eye. The scan­dal re­sulted in such out­rage that, ac­cord­ing to Jones, the abuses in the Kingston lu­natic asy­lum trig­gered re­form not only in Ja­maica, but also through­out the Bri­tish Em­pire.

Guide­lines on man­ag­ing hos­pi­tals and in­sane asy­lums were dis­trib­uted in the first real at­tempt to im­prove health­care in Ja­maica and the Bri­tish colonies. Con­di­tions im­proved and the fore­run­ner to the Bellevue Hos­pi­tal was con­structed, ush­er­ing a new era in the care of psy­chi­atric pa­tients.

Grow­ing up in the ’80s and ’90s, “mad peo­ple” were ob­jects of ridicule. Ev­ery now and again, they would “give trou­ble” and would be beaten by mobs of­ten com­pris­ing their own fam­ily mem­bers. The po­lice oc­ca­sion­ally would be called in to take them to the hos­pi­tal.

In 1999, the street peo­ple scan­dal placed the treat­ment of the men­tally ill on the fore­front of the na­tion’s con­scious­ness. Thirty-two home­less per­sons in MoBay, many of them men­tally ill, were rounded up, tied and pep­per-sprayed be­fore be­ing dumped near a mud lake. Some of these in­hu­mane prac­tices con­tinue to­day where there are men­tally chal­lenged per­sons roaming the streets, in­vis­i­ble, un­til they give trou­ble.

PSY­CHI­ATRIC CRI­SIS

What we call giv­ing trou­ble is a psy­chi­atric cri­sis. At this point, the per­sons may be a dan­ger to them­selves or oth­ers. Sui­ci­dal thoughts or ac­tions, ag­gres­sive be­hav­iour, steal­ing, or dis­or­gan­ised be­hav­iour against so­ci­ety’s norms are some symp­toms char­ac­ter­is­ing a cri­sis. These per­sons need to get treated fast. That is the only way to get them back into a func­tional state. Be­tween these crises, the ma­jor­ity of men­tally ill per­sons are fully func­tional mem­bers of so­ci­ety. They are not to be feared, ridiculed, or stig­ma­tised in the same way we don’t ridicule di­a­bet­ics or per­sons with other chronic dis­eases.

Care of the men­tally ill has slowly im­proved over time, with bet­ter treat­ment meth­ods. In 1965, the leg­endary mu­si­cian Don Drum­mond was con­victed of the mur­der of his girl­friend Anita Mah­food. He was found crim­i­nally in­sane and spent his last years in the Bellevue Asy­lum. Ru­mours abound of his poor treat­ment and ul­ti­mate death from his med­i­ca­tions.

One ther­apy used dur­ing that pe­riod was elec­tro­con­vul­sive ther­apy, ECT, pop­u­larised in the movie One Flew Over the Cuckoo’s Nest, which de­picted life in an in­sane asy­lum. In ECT, the pa­tient is shocked with high doses of elec­tric­ity with the in­ten­tion of caus­ing chem­i­cal changes in the brain. Pa­tients un­der­go­ing ECT suf­fered many se­ri­ous side ef­fects, in­clud­ing frac­tured bones and mem­ory loss.

To­day, ECT is much safer; med­i­ca­tions have fewer side ef­fects, and are bet­ter tol­er­ated by pa­tients. The main is­sues are get­ting treat­ment to pa­tients who need it most. The role of the fam­ily and sup­port groups is crit­i­cal. The ef­forts of the Min­istry of Heath in ex­pand­ing com­mu­nity-based psy­chi­a­try are ham­pered by a crit­i­cal short­age of staff and re­sources. This is a symp­tom of the se­vere lack of fund­ing of the health sec­tor that needs to be ad­dressed yes­ter­day.

This, how­ever, does not ab­solve the com­mu­nity from play­ing our part in the care of the men­tally chal­lenged. We can­not con­tinue to stig­ma­tise the men­tally ill and shun them from so­ci­ety. They need jobs. They need fam­i­lies and friends. They need per­sons who can recog­nise when they are head­ing to­wards a psy­chi­atric cri­sis and get help for them ASAP. They need to feel like they are pro­duc­tive mem­bers of so­ci­ety. So­cial in­clu­sion and sup­port for the men­tally chal­lenged is the key­stone upon which rests the en­tire treat­ment of these spe­cial pa­tients. We must, as a so­ci­ety, grow up and stop the mad­ness.

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