Editorial | Whither the ‘unfit to plead’ report?

If, as Jesse James Clarke claims, Jamaica’s police are increasingly being required to respond to incidents involving people with mental problems, they, as he says, need training in this kind of intervention.

But, despite any training police officers may receive, this newspaper’s preference would be that they have support from mental health specialists when they attend such matters. These specialists, at least, should be on call. For, notwithstanding any skills they may have in de-escalating situations and their readiness to treat all citizens with decency and compassion, cops are not mental health professionals. They may not often identify a seeming obstreperous person as being in the midst of a mental health episode.

In that regard, The Gleaner’s Editorial Board recommends that the issues raised by Mr Clarke, a People’s National Party (PNP) councillor at the Kingston and St Andrew Municipal Corporation (KSAMC), be given serious consideration. Further, Police Commissioner Kevin Blake and the national security minister, Dr Horace Chang, institute ‘mental health and policing’ as a standard component in the curriculum for the training of members of the Jamaica Constabulary Force (HCF). Beat and mobile patrol officers, who are more likely to more frequently come into direct contact with citizens, should have to undergo periodic re-training in de-escalation and mental health encounter skills.

While the specific issues highlighted by Mr James have to be seen in the context of the state of mental health in Jamaica. They also remind of the seemingly forgotten, or stalled, proposals for modern institutionalised mechanisms for dealing with people with mental health conditions who come into conflict with the law.

Globally, it is estimated that up to 14 per cent of populations live with some kind of mental health condition. In Jamaica, the authorities estimate that the figure is 20 per cent, putting the island up to six percentage points higher than the global average.

However, the late Professor Fred Hickling, a Jamaican psychiatrist and mental health researcher - who, in the 1970s and ’80s, pioneered the use of theatre in the treatment at Kingston’s Bellevue Hospital and advocated community-based mental health treatment - argued in published articles that the incidence of mental health conditions was much higher that the official estimates: at least double.

GROWING REALISATION

Whatever may be the real number, there is a growing realisation of mental health issues in Jamaica. There have also been some policy initiatives by the government to deal with the problem. Mental health is being spoken about more openly.

But, by Mr Clarke’s assessment, what is being done is not keeping pace with demand, even as Bellevue, the island’s only mental health hospital, is overcrowded.

“The reality is that Bellevue is at capacity,” he said at a KSAMC meeting. “We have to invest in expanding the hospital and strengthening mental health services, if we are serious about protecting vulnerable Jamaicans.”

However, the hospital’s CEO, Suzette Buchanan, has in the past said that part of Bellevue’s problem is its forced provision of “social care”. That is, patients become long-term residents at Bellevue not because they need hospital care; their families don’t collect them. There are about 400 such ‘patients’.

Judging from these figures, despite the gains made in recent years in fighting discrimination and stigma associated with mental illness, there is still much to be done. However, it is not only families and communities that have things to do. The State, too, has matters to address, including how people with mental health issues fare in prisons and lock-ups.

In a 2020 analysis, the Independent Commission of Investigations (INDECOM), the agency that investigates abuses by the security forces (including correctional officers) found hundreds of such persons in prisons. One was 81-year-old Noel Chambers, who died before he was released. Mr Chambers had spent half his life in prison (40 years) without trial. He was ‘unfit to plead’.

When INDECOM found Mr Chambers “his clothing was filthy, and his body showed evidence of chronic emaciation”. He was full of sores. Another man, George Williams, had spent half a century - his entire adult life - in lock-up, without trial. The INDECOM report led to his release.

Two years ago, Justice Leighton Pusey ordered the supervised release of a schizophrenic who had been in prison for 42 years without trial. He, too, was unfit to plead.

TASK FORCE

In the aftermath of the INDECOM report, Chief Justice Bryan Sykes established a task force to review the regime covering “unfit to plead” inmates and to make broader recommendations for the treatment of mentally ill people who come into conflict with the law and fall within the judicial system.

The task force pointed out, prisons are not good places to keep, and care for, people with mental health illnesses. Among its major recommendations is that one be established, with specialist mental health and other staff, including some who might be recruited via the courts and correctional institutions.

Although forensic mental health services and the secure psychiatric unit suggested by the task force were discontinued at Bellevue over four decades ago, there has been no public follow-up of the recommendations by either the health, national security or justice ministers. After nearly six years, it is time they say something about it.