Prime Real Estate

The following story has been circulating the local internet and it came to my in-box today

I trust that each and every one of you had a Happy and Holy Easter. I would just like to share an incident that occurred on Wrightson Road on Saturday 7th April, 2012 between 4 to 5pm.

A 4-door pickup heading west in the vicinity of SWWTU Hall saw a man kneeling on the road and in his lane so he had to slam brakes to avoid hitting the man. Of course a station wagon hit the back of his van since the stop was so sudden. But what transpired next is what is so amazing because it was almost a scene out of a movie.

The guy kneeling on the road was an outpatient of St Ann's Medical Institution. He is from Farm Road Rich Plain Diego Martin. His mother is Mrs King and he was released about 2 weeks ago. He was opening people's car doors and snatching their bags when someone chopped him across his face so he knelt on the road bleeding forcing the van to stop.

He immediately got up ran to the station wagon to try opening the door but the doors were locked so he tried the 4- door pick up (the doors weren't locked) opened the door and sitting in the back seat was a mother with her 2 infant children probably  a 6 year old boy and a 2 year old girl who lay asleep.

He grabbed the girl by her feet and dragged her out of the vehicle holding her upside down. The mother fought back in an attempt to get back the child, rolling and falling onto the roadway bruising her arms etc but getting back her baby. Fortunately, 2 cars behind were 2 plain clothes officers who stopped to investigate and this is the man saying
to them that the van had hit him and that they wanted to beat him. The police soon got the right story and held him but he was too much for them so he escaped again running and dodging the traffic he threw his bloodied t-shirt into a moving car hitting the driver in his face and blocking his vision also causing his face to be covered in blood. He
continued running, flipped over the median and onto the east bound lane, rolled onto the bonnet of a moving vehicle, dodged a few cars before diving head first through the back window and onto the backseat of a moving Matrix sitting between the backseat passengers causing more chaos and panic because the car stopped abruptly and everyone ran out of the vehicle.

By this time the police caught up with him but the more they tried to subdue him the harder it became. Even getting him into the ambulance was a task and the policemen collected some very hard cuffs to their faces. Although the little girl was covered in blood no physical harm was done but both mother and children were traumatised and the little girl
kept asking to go home. I guess because home to her is where she's safe. Further details of this incident can be obtained from the Central Police Station since those officers were on the scene.

The lesson learnt though: Please lock your doors and keep your windows up especially when in traffic.

Councillor Cleveland Garcia
Woodbrook

I found this story interesting because a few days ago I read in the Express Newspaper that the Minister of Health is planning to sell St. Ann’s Mental Hospital because, according to him, it is prime real estate and the government can get a lot of money for it.

He says that the proceeds from the sale will be used to implement community-based mental health care.  He says.  But we all know that is a statement to be taken with a grain of salt.  But seasoning aside, what his explanation logically means is that the government needs the money from the sale of the hospital to establish the alternative to the hospital.  So, St. Ann’s will be sold, the patients disbursed to the four winds, and then a community based mental health system will be put in place. 

Do these people ever think of what they are saying?

He also said that roughly 65% of the people at St. Ann’s should not be there.  I am not sure if that means they are not mentally ill, or if their illness is not so critical that they need hospitalization.  Even if that was true, which I very much doubt, what does he plan to do about the other 35%? 

My brother has been schizophrenic for most of his adult life – more than 35 years – so I have a little knowledge of how the system works, and I am here to tell you that this is, please pardon the pun, insanity at its highest level.

In the first place, does Dr. Faud Khan have any idea how difficult it is for a member of the public to get a mentally ill person admitted to the hospital in the first place?  I have a friend whose daughter is mentally ill.  The girl paces the house at night, talking loudly to voices only she can hear and sometimes smashing things and cursing.  She leaves the house during the day and nobody knows where she is or what has happened to her, sometimes for hours and hours.  She quarrels incessantly with everyone, accusing them of doing her bad things and sometimes becoming incoherent and often violent.  Although she takes medication, attends clinic (or more precisely, her mother drags her to clinic) and is under the care of a public health psychiatrist, her doctors refuse to have her admitted to a hospital.  They say her family just has to understand that she is ill and can not help her behaviour.  Her mother and siblings are nervous wrecks themselves, never knowing what she will do next, or if she will hurt somebody or somebody will hurt her. 

Years ago my brother had a violent episode and when we called his psychiatrist he advised to call the police as they could get him admitted to hospital.  When the police arrived, another family member who had just returned home and did not know what was taking place, told them that they must have received a prank call and they left.  When we called them and explained the misunderstanding they told us they did not have time to waste and they would not come back.  We had to get four men to help us to jump on my poor brother, tie his hands, force him into a car and take him to the psychiatric unit which was then still open in the Port of Spain General Hospital.  Fortunately they agreed to admit him as he was already a member of that clinic. I will never forget that horrifying day as long as I live.  Incidentally, that unit was closed a few years later.

So I don’t know how all of these not-so-mentally-ill patients got into St. Ann’s, but surely that is an indication of a poor system of evaluation and administration that needs to be corrected immediately – and not by the closure of the entire hospital.

My brother now lives in England.  When he first went there he was institutionalized.  A few years later, just like Trinidad, the country decided they could not afford to run a full time psychiatric hospital and would scale down to community based care.  By that time my brother had been released, so this decisioni did not affect him.  But this is the important difference between what happened in the UK and what Minister Khan is proposing for this country – the out-patient/community-based system was already in place when the decision was taken!  This means that there was a system in place for continuing evaluation and follow up of the released patients.  My brother has a team consisting of a doctor, psychiatric nurse and social worker assigned to him.  My mother is his official care-giver and she can call any member of this team at any time if she is having difficulty with him.  If needs be, he will be admitted to the psychiatric unit in the local general hospital, but for that to happen the members of the psychiatric team have to agree that it needs to be done and the police (who have been trained to deal with mentally ill people) have a role to play as well.

But it does not end there.  As his care-giver, recognition is given that my mother also needs help.  They system does not leave her to sink or swim.  If she needs a break, provision is made for the care of my brother and she is given the financial support necessary to go on a vacation.  The case worker will also take my brother out – to the cinema, shopping, to museums, or just for a walk – on a regular basis both to make his life interesting and to allow my mother to have a breather.  If he does not want to go out, the case worker will just visit with him, chat or play cards, watch television – whatever he wants to do. 

My friend has a very difficult time getting her daughter to go to clinic.  My mother used to have the same problem when she lived in Trinidad with my brother.  Now she does not have that problem – if my brother won’t go to clinic, they will do a home visit.  If she is having problems with transportation (hardly likely due to the excellent public transport system), they will send a car for her.

Community based health care systems do not work unless they take every aspect of the problem into consideration.  Total support is essential.  In Trinidad the needs of the care-givers and other family members are not considered at all.  But it is like when you are in an aircraft and they tell you that in an emergency you should put on your own oxygen mask before trying to help anyone else.  If the person helping is not strong and healthy – how can they help anyone else?

Years ago they started to “phase out” the inmates at the St. James Geriatric Hospital.  As a child I remember going to visit these elderly people with my grandmother – just to chat with them, sing some hymns and hopefully brighten their lives a little bit.  In those days, if a family could not take care of their older members, or if there was no family, that person would live at the “St. James Infirmary” as it was called.  As an adult, I used to visit maybe once a year and that is how I found out that the Government had decided not to accept any more admissions.  When the people already there died, they would not be replaced and the Infirmary would be closed once it was empty. 

Not everybody knows this, but the hospital cared for other types of people too.  I think that the reason d’etre behind the hospital was wider than just the elderly. It cared for those who could not care for themselves and who did not have anyone else to care for them. Some people in that hospital had lived their whole lives there.  There was an elderly man who had come in when he was six years old with his elderly granny and just stayed on after she died.  There were wards for people who were severely handicapped, sometimes brain damaged – for instance there was a lady who had been born without legs and was brain damaged as well.  Poor people can not always afford to stay at home to care for a handicapped person, so the only solution was to institutionalize them.  Sometimes family visited these people, more often they forgot about them.  There were wards for the insane – not all the people in these wards were elderly and not all of these wards were clean or well and humanely run either.  Sometimes terrible abuses took place.  I remember going into one and seeing a half naked woman locked into a small room with mattresses pushed up against the walls, screaming and screaming to be let out.  The ward that day was being run by another patient who said the woman had to be punished because she had tried to run away.

I have not been back to the St. James Infirmary since December 2008.  I don’t know what has happened to the people in the handicapped wards or the psychiatric wards or the geriatric wards.  But I agree with the nurse who said that if their families could not take care of them for all years, she did not see how they could suddenly do it now or how the patients would be better off living with strangers.

Which brings us full circle to the patients at St. Ann’s Hospital.  Is this country so cash-strapped that it has to sell “prime real estate” to find money to care for its mentally ill?  Is it really a lack of money that is causing the under-staffing at St. Ann’s?  Is it because we have no money that so many of the attendants are callous and cruel?  Is poor maintenance due to lack of money, so that a ward has to practically fall to pieces before it is refurbished? Are we really such a poor country that we can not afford modern exercise, recreational or entertainment facilities, except those little entertainments organized by the staff themselves? 

I have visited St. Ann’s on many, many occasions. It is a lovely location.  There are many caring, committed, knowledgeable nurses and doctors there.  But that is about it.  With few exceptions (the “Villa” being one), the buildings more nearly resemble some institution called “Bedlam” out of a Charles Dickens book and the care is generally mechanical and indifferent.  There is little friendliness, cheerfulness or happiness in that place – I don’t suppose those characteristics exist in most psychiatric hospitals, but it seems like they are deliberately sucked out of the fabric of people working in St. Ann’s. And no amount of money is going to put them back in.

The Ministry of Health has identified several priority health concerns of Trinidad and Tobago (chronic diseases like hypertension and diabetes, non-communicable diseases like cancer being two of them) but nothing is ever said in all the policy documents about mental illness and drug addiction – one sometimes caused by the other – which contribute to more crime, stress and lost productivity in this country than anything else.  So it is no surprise that the Minister of Health can so cavalierly talk about selling prime real estate to fund a system to take care of people that need to be taken care of now and not after escrow.