THE ADVENT of newer, more effective medication together with advances in neuro and behavioural sciences have facilitated a shift, internationally, in the treatment of persons with mental illness.
Dr. Earl Wright, director, mental health services, says that this shift away from 'warehousing' mentally-ill patients in large prison-type asylums to treating them in the setting of the general hospital, has been taking place in Jamaica since 1970s.
Since then, following that policy decision, the patient load at Bellevue Hospital has been drastically cut from more than 3,000 in 1968 to 1,600 in 1978 and currently stands at about 800 patients. About 300 of them are geriatric citizens who don't need hospital care.
Dr. Wright said that closing down Bellevue Hospital is the final phase of the strategy that will bring the parishes of Kingston, St. Andrew and St. Catherine, in line with the other parishes in the country in terms of treating acute mentally-ill patients in the general hospital.
"Cornwall Regional Hospital for instance has been running a 30-bed discrete unit for the acute services in the western end of the island. So for many years few patients from the western end of the island were being sent to Bellevue Hospital for care," he said.
Other major hospitals, in other regions, such as the Mandeville, St. Ann's Bay and Savanna-la-Mar hospitals have been functioning in the same way for some time. The University Hospital of the West Indies (UHWI), though not a part of the government hospital system, has also been successfully running a discrete acute care service, supported by community outreach services for many years.
The decision has not yet been taken about which general hospital in Kingston and St. Andrew will function as the acute care hospital once Bellevue is closed down it could be the already burdened Kingston Public Hospital (KPH) or it could be the National Chest Hospital.
Supporting the system of treating acute mentally-ill patients in general hospitals will be other levels of service in the community such as infirmary-type care, rehabilitation and outpatient services. There will also be emergency crisis assertive teams, which Dr. Wright said are already working in some health regions. This service, consisting of mental health officers and aids, the police, a psychiatrist (on call), evaluates and treats street people.
"Currently, the situation is that more mentally-ill patients are being treated in other areas of the island than at Bellevue. That hospital mainly serves patients from Kingston and St. Andrew. I know that for a lot of people the closing down of Bellevue will be a loss and they have to think about it and internalise it but afterwards they will understand," Dr. Wright said.
