#BTEditorial – Our national shame: how we deal with mental illness

The law of unintended consequences is a law of innate cruelty. It may not be found on the pages of our statute books and cannot be tested with scientific certainty in a test tube. But in the crucible of human life, this law’s unerring quality is in its potential to be wildly errant.

First popularized by the American sociologist Robert Merton, the law of unintended consequences refers to those outcomes of purposeful action that are neither foreseen nor intended. There may be an unintended benefit or drawback that is perhaps even more significant than the planned effects.

Sadly, more often than not, the law of unintended consequences is invoked to explain the perverse result of a seemingly well-intentioned but less-well-considered policy or programme.

In 1985, in the waning months of the Bernard St John administration of the Labour Party, the authorities began to trumpet “deinstitutionalisation” as the new watchword of health care policy. Their presumably benign intention was to release some inmates of the state psychiatric hospital from the bondage of dependence on an institution for food, clothing and shelter.

The then Minister of Health and Social Security Senator O’Brien Trotman sought to persuade the nation of the beneficent wisdom of the new policy, which appeared to follow developments that were begun two decades before when local government authorities in the UK sought to develop community mental health teams and an increased outpatient role.

It was not intended that mental health patients who had become fixtures as chronic inmates of the Psychiatric Hospital would find themselves taking up alternative residence on the streets of the national capital by 1987.

But that indeed is what happened.

It would be easy – all too easy – to ground the alleged horrific acts of a homeless man with mental health issues solely on a 35-year-old shift in public policy. For indeed, there was no promised decentralisation of mental health care although Tamarind House, an outpatients clinic, intended primarily for the newly rising phenomenon of crack cocaine addiction, was hastily stuck onto the southeast corner of the Psychiatric Hospital.

What, however, is evinced by our shameful ignorance of, and prejudice against, the mentally ill is the stereotype of the growing numbers of people, mostly but not exclusively men, sleeping rough in Independence Square, Heroes Square and other nooks and crannies of our capital city, or pushing their earthly belongings in shopping carts, or yelling obscenities or scripture at passersby, or relieving themselves wherever they can find relief or begging for alms.

Paradoxically, just as white people around the world have been spurred to the cause against racism after seeing its blunt force trauma on a black body in the US, it has taken the horror of Bishop’s Court to bring attention to the sharp end of our national collective shame of disregard and disdain for the mentally ill.

Just as with the newly energized Black Lives Matter movement, it has taken extreme events to capture our attention while letting us off the hook for continuing to ignore systemic iniquity.

The Prime Minister, joined by the nation’s leading advocate for the homeless, has been spurred to focus, and rightly so, on the state of mental health care in our nation – not on whether journalists should attend crime scenes with police officers as minders and censors according to the rants of some reactionary callers and talk show hosts, clueless until this minute about the practice of journalism.

But two people died on Monday, senselessly and needlessly.

Perhaps, had photojournalist Christoff Griffith lived to tell the story, we might have begun to question our medieval attitudes and policies that relegate the severely ill to a life of marginalisation and penury. Had contractor Glenroy James lived to survive an encounter with the alleged machete-wielding assailant, he too might have called national attention to this yawning chasm in our national psyche.

But we are left with the inadequacy of a social care system in which repeated neighbourhood reports of a machete-wielding homeless man attracted police attention as a law enforcement matter but nothing further.

For in Barbados, proverbial horses must first bolt from stable doors, trampling innocents underfoot, to be followed a loud national wail of “cuddear!” Then on come the backseat drivers of policy more often seeking to crack whips or heads to maintain “law and order” than try to understand the definite roots and unintended routes of the original trauma. We say enough of that.

We are heartened somewhat by the Prime Minister’s framing of yesterday’s atrocity in the context of mental wellness.

On the floor of the House, she declared: “Even as we come to grips with the horrific murders yesterday, we have to understand that this country cannot continue to bear the weight of mental health problems anymore, and there is no disgrace in treating people for mental illness.

“We have seen nine people in the last 15 months lose their lives at the hands of three people whose mental capacity was at the very least questionable.

“There is more to mental health than not being diagnosed as bipolar, or not being diagnosed as schizophrenic. It is all about wellness, and this starts with knowing who you are and loving who you are, warts and all, strengths and all.”

We agree entirely. But beyond the bully pulpit rhetoric must come the hard work of reversing the trajectory of the law of unintended consequences. Just as a previous Labour Party administration decentralised health care through the development of the polyclinics, it is past time to create a more mature community mental health care system.

And as we have advocated before and during this pandemic, it is also time to educate public and policymakers alike on the full spectrum of mental health. We need a cohesive, coherent social policy that bolsters mental health and fights inequality – the unintended consequence of which must surely have been a mentally disturbed man taking up residence on an abandoned property in a world that caved in on itself.