Mental illness is no laughing matter By Claude Mills, Staff Reporter The madman who knows that he is mad is close to sanity.- Ruiz de Alacron It stops being funny when it starts being you. That's the unspoken constant when it comes to dealing with mental illness in Jamaica, where prejudice, discrimination and abuse are only a heartbeat away. You don't believe it? Just mention the words "my shrink" and "disorder" in a sentence, and a grenade of melodrama explodes in your universe. Eyebrows go skyward, acquaintances avoid eye contact in the closed space of the elevator and fellow employees roll their eyes at you behind your back. "All of a sudden, you lose your Christian name, and you become the 'madman' from so-and-so department," one man, a recovering psychotic, said. "They made cruel jokes about me, it was hell. That's why I was glad when my company offered me a medical redundancy...I couldn't take the stares and whispering anymore." Or maybe he was just being paranoid. Most cases of mental illness are due to a chemical imbalance in the brain. Experts will tell you that mental illness is a treatable disease and some people recover completely from mental and neurological disorders. But try telling that to a public which is only too willing to automatically assign "pariah status" to someone suffering from a mental illness. Myths. Secrecy. Shame. This is the language in which the experience of the mentally ill in Jamaica is draped. The malaise runs deep in civil society. The stigma attached to mental illnesses is a ghost that haunts lives forever. The stigma fractures families, destroys careers, and murders dreams. It is a barrier to the overall development of the afflicted individual. And because this disease carries such a profound stigma, those who do recover often live secretive lives, revealing their psychiatric histories only to their closest intimates. So the public seldom hears about the thousands of success stories. Famous sayings such as "whom the gods wish to destroy, they first make mad" only add credence to the belief that a mentally ill person is experiencing divine retribution of some kind. The occult also has its role to play, as in some deep rural areas, mental illness is sometimes attributed to demon possession, a belief which is a major obstacle to psychiatrists treating their patients. Ugly On occasion, ignorance and fear turn ugly. The case of Michael Gayle, who was of unsound mind, died in hospital after being beaten by police and soldiers during a curfew in Olympic Gardens on August 23, 1999 generated a lot of public debate. The Director of Public Prosecutions chose not to bring charges against members of the security forces in connection with his killing, even though a coroner's inquest had recommended that those on duty be charged with manslaughter. In the wake of the July 1999 Montego Bay street people scandal, the nation wrestled with feelings of disgust, anger, shame evoked by a crime of symbolic weight - the kidnapping and forced removal of street people to St. Elizabeth. Nothing much came of that glaring human rights violation except a $4 million bill for expenses to conduct the inquiry. The sexual abuse of mentally ill females also remains a serious problem. It is not unusual to see a "mad woman with a belly". Even seemingly sane men are known to sometimes take advantage of mentally ill women. "We had a case some time ago with a woman called 'Claudette' who was taken in by a lady in Falmouth who cleaned her up, only to find out that she had been impregnated by a man of some repute in the community. "She had a lovely baby girl who was adopted by a family. Claudette has now migrated to Kingston," Mylie McCallum, co-ordinator of the Community Mental Health Services in the Ministry of Health, said. A lot of Jamaicans equate mental illness with the raving, half-naked schizophrenic roaming the dirty streets of the big city. But schizophrenia is the exception, not the norm. With the right treatment, more than 75 per cent of diagnosed schizophrenics have a complete or at least functional recovery, experts say. Schizophrenia is perhaps the most visible form of mental illness, and according to statistics from the Ministry of Health, the dominant mental illness in Jamaica. In 1999, there were 28,812 schizophrenic cases treated, but in the year 2000, that number jumped to 31,887. In Kingston and St. Andrew alone, there was an almost 2000 per cent increase from 439 cases in 1999 to 4,654 cases in the year 2000! Schizophrenia usually emerges between the ages of 13 and 25 and often appears earlier in males than females. Symptoms include disordered thinking, paranoid delusions, hallucinations, and extreme apathy and social withdrawal. Yet many experts say that our mental health system is ill-equipped to treat people with schizophrenia and that the psychiatric profession clings to outdated notions so that patients deteriorate, not improve. It's no wonder, they say, that one of every 10 schizophrenics commits suicide within 10 years of diagnosis. Mood disorders run a distant second, numbering some 10,961 cases in the year 2000, and there were 6,069 cases in 1999. But, health officials say, the numbers may be deceptive because of undiagnosed cases of depressives in the island. Even with a growing demand for services, the 105 mental health centres in Jamaica, are manned by only 32 mental health officers islandwide, of which only 26 are clinical officers. The mental health division's case load reached 10,939 in the year 2000, when compared to 8,134 in 1999. And the case load is increasing all the time. "We ought to see our patients every two weeks but because of the shortage of staff, we sometimes can only see them once every two months. We are trying to step that up now, but the caseload is very heavy," she said. Crisis According to Ms. McCallum, schizophrenics are administered a standard dosage of two ccs of Moderate, a long-lasting but expensive drug, through a needle at each visit. A 10cc vial of Moderate costs $1,500 and can be used on five patients. Health experts concur that there may be a "mental health crisis" brewing. According to figures from the Community Mental Health Services division of the Ministry of Health, the total number of visits to mental health clinics by mental health patients reached 45,945 in the year 2000, a leap of almost 37 per cent. In 1999, the total number of visits (interactions) was only 33,937. At a recent Pan American Health Organisation (PAHO) meeting Dr. Peter Figueroa, chief medical officer, said that mental health issues account for only two per cent of the total public health centre visits, a figure which he said was "grossly under-represented". He may be right. Indications of the state of the country's mental health are seen daily in terms of the sheer numbers of homicides, suicides, and the myriad of difficulties faced by adolescents and children. People with mental disorders are discriminated against in workplaces, in the community, the health services and even by insurance companies. A number of factors continue to mitigate against the prompt treatment and return of people with mental illnesses to their communities. No fairy tale The prisons are no fairy tale story. According to statistics, more than one in 10 of the total persons incarcerated are known to suffer from a severe mental illness, a rate approximately four times that of the general population. The present deplorable conditions of our jails and prisons are known to precipitate psychosis in otherwise sane inmates. At times, correctional officers have had to be treated for psychiatric disorders associated with depression, demotivation and fear. More than 400 persons deemed mentally ill have been languishing in the island's prisons, detained because they had been found unfit to plead in court. In the meantime, decision makers in the field of mental health are already looking at several issues, to address the fall-out in mental health in the general population. General practitioners and nurse practitioners, who are often the first contacts for patients in the formal health care system, are now being trained to diagnose and treat depression, anxiety, stress-related disorders and other common problems which often co-exist with medical problems. Fortunately, the Occupational Therapy Unit at the University Hospital of the West Indies has been refurbished and re-established by the Rotary Club of St. Andrew. Established in 1967, it aimed to provide this needed care for the entire hospital and particularly for the psychiatric patients, but the Unit stopped functioning in 1995. Nevertheless, many mentally ill persons continue to fall through the cracks of civil society. According to the Ministry of Health, at least 25 per cent of patients are classified as "poor in terms of finance, employment, family support and cognitive functioning" and "10 per cent of these are on the streets". "The biggest challenge is the psycho-social rehabilitation," Ms. McCallum said. "We need vocational training areas, areas of employment, and some sort of industrial units so they can find something to occupy their time and integrate themselves into society. Employment is a serious problem as people don't want to employ them but a lot of them can function well, doing simple to moderate tasks. "Funding and staff is a big problem as well. We need more hostels, trained occupational therapists, social workers and nurses. A lot of mentally ill patients can contribute to society, our records show that at least 75 per cent of our patients out there have good family support and can function in society, but no one wants to hire them," she added. It sometimes takes years for mentally ill persons to begin to climb out of the depths of madness. In Jamaica, that climb has all the charm of a neophyte climber tackling the sheer, rocky cliffs of a Mount Everest: almost impossible, and deadly.
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