Wednesday, 5 June 2013

The Madness of It All: Jamaica’s Mental Health Challenges and Violent Crime

By Mario Boothe

“May Madness Jolts’ the Nation” was the title of “The Jamaica Gleaner’s” first Editorial for June; incidentally the start of the Atlantic hurricane season. Possibly a cautionary indication of the nation’s mental tempest caused by harsh economic times; maybe the unyielding cyclone of public opinion or the political storm to follow on the matter of National Security and our relentless struggle with crime and violence.

Unfortunately, not even a slight breathe of a whisper will be said of Mental Health in its truest form as a contributor to our crime rate. Although In Jamaica, neuropsychiatric disorders are estimated to contribute to 20.3% of the global burden of disease (WHO, 2008).

While the word “Madness” in the Editorial title may have suggested the topic of Mental Health, it read to the effect of repeated commentary with mentions of Jamaica’s high murder rate; the conventional public condemnation by Government officials; the ineffectiveness of our Law Enforcers; and our broken communities.

Notably missing was the criticisms of the church’s institutional role as the ‘moral compass’ (as it were) but they hinted to our pseudo Christian Nation claim it is scandalous that our small, supposedly God-fearing country ranks among the top 10 in the world for murder.” said the Editors.

“the dismembering of a four-year-old girl in Trelawny; the murder of an eight-year-old left to rot in a latrine in St Catherine; the dumping of a new-born’s body in a pit latrine in Trelawny; and the beheading of an octogenarian in Kingston, all within days”.  

The editorial recalls the gruesome acts of human violence (or Madness) but this sort of human behaviour is hardly human (at best) yet the church and other conservative/traditionalist stakeholders continue to push the issue of ‘Who is to Blame’ - Society or the Individual, when both are inseparable and link through many channels; the most fragile being “Mentally”. 

Tampered Thoughts

“Murder is so commonplace in Jamaica that the country appears to have become inured to the grisly litany of death and mayhem that stalks the land. There seems to be no more outrage left for another wave of brutal murders.”  

The opening lines read with truth ringing in every word. Jamaican sentiments concerning violent crimes have shifted over the years from absolute sensationalism characterized by the symbolic wearing of black and the now trending “Jungle Justice” rational, characterized by the mobbing of the ‘suspects”.

Have our minds been so littered with violence we have become immune to its emotional sting and still be susceptible to its virus-like effects ourselves?

It’s been argued for decades whether violent media (i.e. Video Games) can leave an impression on the thinking of adolescence, most research papers reject the claim of ‘virtual’ imprinting; However “actual” exposure to continuous violence does impact our mental status, from the extremities of war to the secrecy of domestic violence.

In a 2002 World Health Organization’s (WHO) fact report on “Youth Violence” stated that “In 2000, an estimated 199 000 youth murders took place globally – equivalent to 565 children and young people aged 10-29 years dying on average each day as a result of interpersonal violence”, the main risk factors and influences included:
  • ·         “history of early aggressive behaviour”

  • ·         “parental conflict in early childhood”

  • ·         “Gangs and a local supply of guns and drugs area potent mixture, increasing the likelihood of youth violence”

Jamaican youths are three for three on the ‘main risk factors and influences’ listed.
The late detection or refusal to acknowledge the existence of mental illness in its many forms (depression, stress, bi-polar disorder, etc.) caused by the ‘factors and influences’ is indicative of a Black society as studies show that Blacks have tabooed mental illness treatment due to the “crazy, coke-head or madman” stigma attached to the issue – the religiosity of the race places even more pressure on the individual relating mental illness to a sin or demonic possession, although many churches provide train therapist.

In a 2007 Study conducted by the Department of Psychology and Neuroscience, Baylor University, USA; involving self-identified Christians on an online mental illness discussion group. 

Interestingly though, when the participant were asked “As a result of the church’s involvement, the problem seemed” the results showed (Unchanged, 39.9%; Worse, 25.9%, Better, 34.1%), meaning more than half the participant had ‘no change or got worst’ after their churches involvement. 

Then do we really need “Divine Intervention”?

Lacking Leadership

Also under the “main risk factors and influences” in the WHO’s “Youth Violence” report was “The quality of a country’s governance – its laws and the extent to which they are enforced, as well as policies for social protection – has an important effect on violence” .

Our Politicians must begin to personally take serious the ‘Culture of Thinking and Behaviour’ among the population not just hold hands with the nearest priest - singing “Holy Mary” - as though the human component is expendable. In respond to the high levels of misfits within our society, who only see themselves as other and replaceable; bitter about their economic situation and lifestyle; seeking leaders to rap with them on their level and not just be a jacket and tie aristocrat.

An officially approved mental health policy exists and was approved or most recently revised in 2004. Mental health is specifically mentioned in the general health policy.
While our laws maybe up-to-date, there needs to be systematic changes for mental health in Jamaica, to fix the legal provisions concerning mental health that are not covered in other laws (e.g., welfare, disability and general health legislation); education about mental disorders and the treatment process is a critical part in reducing barriers to treatment including public education campaigns (e.g., social media), and educational presentations at community venues and mental health sessions at local health clinics.

The cost of treatment may be prohibitive for many, especially among those without insurance coverage. Many low-income individuals can find help in the community health system, but such systems may suffer from a lack of clinicians able to treat complex and less common conditions.

Inability to Access care has been noted by a WHO report on the website stated “Persons with mental illnesses in Jamaica are also affected by the lack of appropriate and timely care. Most of the patients are sent for treatment to the capital city, Kingston, due to lack of facilities in other areas.  The World Health Organization has indicated that this situation violates its regulation regarding treatment of patients as near to their homes or communities as possible, and called on the Jamaican State to address this issue in the revision of its mental health policies.”

Where is the public private partnership on Mental Healthcare? It would make sense to keep your workforce in ‘working order’ to keep your labour force effective and efficient to pump revenue in the government.

Going Forward

According to the Mental Health Atlas 2011 - Department of Mental Health and Substance
Abuse, World Health Organization: Jamaica

“Jamaica’s mental health expenditures by the government health department/ministry are 6.04% of the total health budget. Precise mental hospital expenditures are not available. However, data from 2006/2007 estimate mental hospital expenditures to be approximately 80% of the mental health budget.”

The budget allocation is up from 5% in 2005 to 6.04 in 2011, a jump of 1.04% which is a good direction for our Government to continue on as the society begins to adjust into the new reality of relating mental illness to violent crime, and it can no longer be a stigma or something to be ashamed of. The economic, physical, political, social, spiritual pressures all contribute to the well being of your mental health therefore the welfare of society itself because as an individual you are a part of humanity.
When we engage in these conversations we use of the term “society” as a way to deflect responsibility. We do this because, well, it’s the easy thing to do. To accept one’s membership within to society is to accept responsibility for the injustices.
The truth of the matter is this; we do not have the option, or the privilege, of opting out of our membership to society whenever we feel that it’s convenient to us.  We should not embrace our membership to society whenever we make strides of wealth; only to distance ourselves from, and blame, society whenever we feel it is convenient to us.  Collectively, we all participate in this thing we call “society”.

Rather than focusing so much on how society impacts the individual; we need to place an equal (or greater) amount of emphasis on how the individual can impact society. It is only then that we can begin to engage in a discourse than can foster real change and limit the “Madness”.