overview of psychiatry in jamaica

PSYCHIAT

RY

OVERVIEW OF

IN JAMAICA

BROUGHT TO YOU BY:

*Samuel Martin

INTRODUCTIONPsychiatry is the study and treatment of mental illnesses. There are many mental illnesses. These are conditions which cause severe alterations in a person’s thinking and abnormal behaviors.Today, mentally ill people are probably the most rapidly growing set of social outcasts. In Jamaica, “Mad” people can be seen loitering and living on the streets of our towns and cities. In many cases, those removed from the streets end up in hospitals and lock-ups for health or security reasons.In this presentation we will look at how psychiatry has been developing in Jamaica over the years and some of the persons presently actively involved in the provision of mental health care services.

OBJECTIVESBy the end of this presentation, participants should be able to:*Identify the origin of psychiatry in Jamaica*Identify significant changes in the approach to

psychiatry as society changed*Identify the major infrastructure for psychiatric

management.*List 5 duties of the Psychiatric Aide*List 3 members of the Medical Team*List 3 members of the Mental Health Team*List 2 roles of the Mental Health and Medical Teams

CHAPTER 1

HISTORY OF PSYCHIATRY

IN JAMAICA

*Started prior to colonization, by Arawaks. 'Lunatics' were treated in the community with healing herbs, which were blended with food, and by the administration of ointments and baths while singing. Records indicate that the mentally ill were treated by the indigenous Indians without restraints, and with primitive attempts at pharmacology and cultural therapies.

HISTORY OF PSYCHIATRY IN JAMAICA

*The Spanish introduced European methods of treatment. Introduced violence and physical restraints.

During the period of Spanish occupation (1500-1650) the practice of institutionalization was introduced with dedicated buildings being erected in major towns. Namely, in Santiago de la Vega now known as Spanish Town, a series of buildings were erected next to the monastery to house the mentally ill on a long-term basis. These institutions treated their residents to harsh beatings and physical restraints of various forms.The Arawak methods of treatment died with them as Spanish diseases and wars destroyed their population.


Britain’s contributionThe British arrived in the 17th century carrying thousands of slaves. They constructed buildings on plantations to specifically house mentally ill slaves. Many slaves detested the conditions of these facilities and in turn committed suicide. Patients who were violent were punished by either being hung or being burnt alive.


*Doctors for white, Obeah for BlacksAlthough, there were many distinguished doctors on the island, they only treated the colonials who were mentally ill. Slaves had to seek treatment from black preachers, imported village doctors and the Obeah Man.


*Emancipation brings hopeEmancipation in 1834 was followed by the construction of eight hospitals in Jamaica, each offering treatment of the mentally ill. This usually meant confinement for all and severe punishment for the unruly.By 1844, things had got worse and insane persons charged with offences were being confined in prison.Restraint remained the main therapeutic tool and the mental health system remained largely unchanged until the mid-20th century.


*Bellevue is born.In 1862 the mental health wing of the Kingston Public Hospital was enlarged and relocated to a separate premises, being officially designated “The Jamaica Lunatic Asylum”.In the 1930s the lunatic asylums were all re-designated as mental hospitals with names suggesting tranquility; the Lunatic Asylum was rebranded “Jamaica Mental Hospital”.The name was changed to Bellevue in 1946. It has over 1000 beds and occupies over 40 acres of land.This facility was designed to offer long-term inpatient care for patients who were too sick to function without continued supervision and medication.


*The Service growsIn 1963, it was recommended that Community Mental Health Services be developed and the role and size of the mental hospital be reduced.In 1964, the first batch of community mental health nurses was trained and deployed to work in health centers and parish hospitals. They were however working as extension officers of the mental hospital.Since then, continuous policy revisions have been made to further the scope of community mental health services to include its decentralization and its integration into the primary healthcare system’s core structure.


*Continuing GrowthIn 1992, the Ministry of Health created the Mental Health Unit. Its function include policy formation, mental health promotion and coordination, research and programme development, standards and monitoring, and integration of service.The Ministry of Health also appointed a Mental Health Director to oversee the development of the mental health service and ensure its continued growth and sustainability.In 2006, all mental health services and staff were adopted by respective regional health authorities as part of the Ministry of Health’s continued decentralization programme and putting mental health services into the mainstream of healthcare.


*Jamaica todayOver the years the focus of Mental Health care has moved away from institutionalization to rehabilitation with Bellevue, the largest mental health hospital, continuing its reach reduction; now offering just around 700 bed spaces, down from thousands in the 1960s.Through the work of community mental health teams across the island, efforts have been made to provide patient-centered interventions. They help patients to maintain a better state of mental health through medication compliance and social reintegration.Today, mental health services are offered in most health centers and public hospitals with a minimum basic sensitization of all staff being implemented to raise awareness of the importance of maintaining good mental health.


CHAPTER 2

THE ROLE OF THE

PSYCHIATRIC AIDE

*Who is a Psychiatric Aide? A Psychiatric Aide provides care for mentally impaired or emotionally disturbed individuals. They work in a team that may include psychiatrists, psychologists, psychiatric nurses, social workers and therapists. Psychiatric aides spend a lot of time with their patients, and are in close contact with them. Because of this, psychiatric aides can have a great amount of influence on their outlook and treatment.

THE ROLE OF THE PSYCHIATRIC AIDE

* What does the Psychiatric Aide do?A Psychiatric Aide has many varying responsibilities, to include:1. Provide care to emotionally disturbed or mentally ill patients in a healthcare setting.2. Perform routine tasks under the supervision of registered nurses.3. Take patient's temperature, pulse, respiration rate, and blood pressure and determine if

range is abnormal.4. Serve meals, feed patient and mash up food if necessary.5. Bathe and dress patient.6. Make beds and perform light housekeeping duties in patient's room.7. Take patient on walks.8. Deliver them to operating rooms.9. Provide skin care.10. Set up equipment.11. Store and move supplies.12. Observe patients' physical, mental, and emotional conditions.13. Observe fluid intake and output.14. Report abnormal changes or patterns to nursing staff.15. Develop nurturing relationships with patient.16. Empty bedpans and change dirty linens.17. Report violent behavior.18. Follow proper procedures for lifting and moving patients.19. Insert catheters and administer bladder irrigations.20. Socialize with and educate patients.


*How does the Psychiatric Aide work?Psychiatric Aides may be employed in hospitals or community based clinics. Their core function is to interact with the mentally ill patient.They are the most integral link between the patient and the mental health team. Their influence can improve or delay a patient’s recovery.


*Important Qualities

Compassion. Because psychiatric aides spend much of their time interacting with patients, they should be caring and want to help people.Interpersonal skills. Psychiatric aides often provide ongoing care for patients, so they should be able to develop a rapport with patients, making them better able to treat their patients and evaluate their condition.Observational skills. Psychiatric aides must watch patients closely and be sensitive to any changes in behavior. For their safety and that of their patients, they must recognize signs of discomfort or trouble among patients.Patience. Working with the mentally ill can be emotionally challenging. Psychiatric aides must be able to stay calm in stressful situations.Physical stamina. Psychiatric aides must be able to lift, move, and sometimes restrain patients. They must also be able to spend much of their time on their feet.


CHAPTER 3

THE ROLE OF THE MENTAL HEALTH

AND MEDICAL TEAMS

*What is the Mental Health Team?The mental health team is the group responsible for providing mental health care services to persons living with mental illnesses.They operate both in hospital and community health center settings. They are required to provide equitable service to all in need.

THE ROLE OF THE MENTAL HEALTH AND MEDICAL TEAMS

*Who is on the Mental Health Team?The mental health team consists of:1. Psychiatrist2. Psychologist3. Social Worker4. Community Mental Health Officer/Psychiatric

Nurse5. Psychiatric Aide6. Occupational Therapist7. Others


*Who is on the Medical Team?The medical team consists of:1. Doctor2. Registered Nurse3. Patient-Care Assistants4. Hospital/Clinic Attendants5. Porters6. Social Worker7. Admission/Records Clerk8. Others


*What is the function of the Medical Team?The medical team is responsible to perform a complete assessment of each client with the goal of coming to an accurate diagnosis in a timely manner then initiate appropriate treatment plans. They must provide equitable service in a comfortable environment and promote client’s physical and psychological well-being through education, medication and rehabilitation.


*What is the relationship and responsibility of both teams?

In order to achieve their common goal of providing high quality health care, both teams must work together. The medical team, during its assessment of a patient will identify certain discrepancies with a person’s psychological profile as per prescribed criteria. They then refer this client to the mental health team for further assessment and treatment as is necessary. Likewise, the mental health team must refer its clients who are comorbid (meaning, suffering from other medical conditions) for medical assessment and management.Together, the teams monitor the clients and assist them to maintain their physical and mental health through timely reminders and assistance with setting appointments and so on. In so doing, they aim to reduce the number of deaths among mental health patients and increase their level of rehabilitation.


*SUMMAR

Y

SUMMARYPsychiatric services have been offered in Jamaica for over 200 years now. Through the years it has grown and changed to fit the needs of society.Today, it has become a central part of healthcare and is poised for future growth. As we move forward, collaborations between the psychiatry and medical departments will continue to improve patient outcomes. This is the foremost goal of healthcare.All that is left is for us to remember, “There is no good health without good mental health”.

Thank you for your time!

*ANY QUESTIONS?

overview of psychiatry in jamaica

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