Dr Fred Hickling, Contributor
The outrageously high murder rate, hypercriminiality, enforced idleness, low productivity and increasing poverty are only some of the features of the madness rampant in this society. With prevalence rates in this society of psychosis at nearly five per cent, anxiety and depression at nearly 20 per cent, and personality disorder of over 30 per cent, mean that every other person in Jamaica today suffers from some form of mental illness.
Present day Jamaica can be likened unto a traditional lunatic asylum. It is clear that the nation has not taken the crisis of mental illness in our society seriously. Many people think that psychosis is the totality of mental illness, and are locked into a 19th-century conception of the treatment of mental illness by custody in a mental institution. This is an obsolete paradigm of the past. The reality is that in Jamaica today, 75 per cent (more than 2,000 people annually) of all severely mentally ill people are admitted for treatment to general hospitals islandwide, and usually spend less than two weeks in hospital before returning to their communities. There are more than 40,000 clinic appointments annually for mentally ill patients in clinics around the country. Mental illness is the predominant diagnosis of most general medical practices today.
Lack of rehabilitation a problem
The short-term incarceration of more than a thousand persons following the recent state of emergency is a tragedy. These people have all been returned to the transgressive communities from whence they came with minimal mental-health diagnostic or therapeutic intervention. Without rehabilitation, we can only predict a ramping up of their transgressive behaviour in the future. Thorough investigation of the man who was recently killed in Buckfield might no doubt reveal that he was a severe psychopath with psychotic features, recently discharged from prison. The appropriate mental-health provisions to protect the community from his vicious transgressions did not exist. The tragic outcome at all levels should have been anticipated.
Jamaica needs to wake up to the reality that a paradigm shift at the level of mental-health care has to take place in this country to solve the high crime and murder rate, and to catapult the productivity to levels required for growth in this society.
Transformation can only take place with the development of a national psychological agenda to be instituted at the community level by an army of trained mental-health practitioners (psychiatrists, psycho-logists, social workers, mental-health nurses, guidance counsellors, cultural therapists, teachers, educators), skilled in diagnosis and treatment of the most severe conditions, and confidently practising therapeutic group conflict solving and group social unification as a primary prevention programme for the majority of the society.
Cultural therapy programme
Jamaica has not had full employment of its people since slavery. A vocational programme has to be developed and implemented across the nation to put the 900,000 unemployed or unemployable into productive work and creative employment. This needs to be synergistically linked to a programme of training Jamaicans to provide skilled workers to the world: nurses, doctors, entertainers, artisans, engineers, teachers and other categories of workers for export. Jamaica has the training infrastructure to achieve this goal. Finally, a cultural therapy programme needs to be established at every level of the society to harness the creative energy of the Jamaican people in art, craft, music, drama, sports and all aspects of creative cultural expression.
The key to this transformatory development programme is finding the psychological mechanisms to rid our people of the personality disorders and psychoses that currently cripple the leadership of many of our institutions. In the 1970s, Jamaica demonstrated our ability to successfully transform its single lunatic asylum, Bellevue Hospital, by the implementation of the concepts of the 'therapeutic community', 'work as therapy' and 'cultural therapy'. During that time, the Bellevue Hospital grew its own food, produced top-class theatre and entertainment and successfully rehabilitated and treated those who were mentally ill.
This transformation model can be used again to quickly and successfully rehabilitate and treat the insane society that this country has become.
Frederick W. Hickling, professor of psychiatry, University of the West Indies, Mona.