A brief overview if Psychiatry as it has been developed and practiced in Jamaica.

2. *Samuel Martin

3. Psychiatry 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.

4. By 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

5. CHAPTER 1

6. *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.

7. *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.

8. Britain’s contribution
The 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.

9. *Doctors for white, Obeah for Blacks
Although, 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.

10. *Emancipation brings hope
Emancipation 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.

11. *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.

12. *The Service grows
In 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.

13. *Continuing Growth
In 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.

14. *Jamaica today
Over 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.

15. CHAPTER 2

16. *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.

17. * 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.

18. *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.

19. *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.

20. CHAPTER 3

21. *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.

22. *Who is on the Mental Health Team?
The mental health team consists of:
1. Psychiatrist
2. Psychologist
3. Social Worker
4. Community Mental Health Officer/Psychiatric Nurse
5. Psychiatric Aide
6. Occupational Therapist
7. Others

23. *Who is on the Medical Team?
The medical team consists of:
1. Doctor
2. Registered Nurse
3. Patient-Care Assistants
4. Hospital/Clinic Attendants
5. Porters
6. Social Worker
7. Admission/Records Clerk
8. Others

24. *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.

25. *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.

27. Psychiatric 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”.

28. *ANY QUESTIONS?