Responses to Information Requests

Research Directorate, Immigration and Refugee Board of Canada, Ottawa

1. Services

The Mental Health Unit webpage of the Ministry of Health's website states that there are four regional health offices in Jamaica, namely the Southern, Southeast, Northeast and Western Regional Health Authorities (Jamaica n.d.a).

A May 2016 report prepared by the Auditor General's Department of Jamaica for presentation to the House of Representatives explains that mental health patients receive treatments "mainly … in out-patient primary care facilities (health centres) and Type B classified general hospitals" (Jamaica May 2016, 15). According to the website of the Jamaican Ministry of Health's Southern Regional Health Authority, type B hospitals are hospitals situated in "larger" urban centres and they provide "inpatient and outpatient services in at least the five basic specialities - general surgery, general medicine, obstetrics and gynaecology, paediatrics and anaesthetics" (Jamaica n.d.b). A 2016 dataset on hospitals across Jamaica, available on the Jamaica Open Data Portal of the Government of Jamaica, indicates that the University Hospital of the West Indies, which falls under the Southeast Regional Health Authority, is a "[q]uasi[-p]ublic" institution and is a "[t]ype A" hospital (Jamaica 9 June 2016). The Southern Regional Health Authority website explains that type A hospitals are "multi-disciplinary institutions which provide both secondary and tertiary care and are the final referral points for such services" (Jamaica n.d.b). According to the Auditor General's report, the psychiatric units of the University Hospital of the West Indies and of the Cornwall Regional Hospital offer in-patient care, but "comprehensive psychiatric services are predominantly offered at the Bellevue Hospital" (Jamaica May 2016, 15).

The information in the following paragraph is provided by the World Health Organization (WHO)'s Mental Health Atlas 2014:

Jamaica's law for mental health was adopted in 1997 and, as of 2014, was "partially implemented." Jamaica has one "mental hospital" with 28.6 beds per 100,000 individuals, two psychiatric units in general hospitals with 1.8 beds per 100,000 individuals and four residential care facilities. There were, in 2014, 133 mental health out-patient facilities in Jamaica with an admission rate of 5,547 individuals per 100,000. In 2014, there were 1.11 psychiatrists, 0.43 psychologists and 15.26 "[o]ther mental health workers" per 100,000 individuals in the population (WHO 2014).

In comparison, according to WHO's 2011 Mental Health Atlas, the most recent version that provides data on Canada, there were, in 2011, 12.61 psychiatrists and 46.56 psychologists per 100,000 individuals in Canada (WHO 2011).

2. Cost

The 2014 WHO Mental Health Atlas for Jamaica indicates that the government is the main source of funding for the delivery of care for "severe mental disorders" (WHO 2014). The website of the National Health Fund (NHF) of the Government of Jamaica lists "[m]ajor [d]epression" among the illnesses covered by the NHF (Jamaica n.d.c). The "Major Depression" webpage of the same website provides a list of "[t]ypes of depression" which includes bipolar disorder (Jamaica n.d.d).

Article 20 of Jamaica's 1999 Mental Health Act, on the cost of treatments, provides the following:

20.—

1. The managers of any public psychiatric facility may, at any time during the treatment or detention of a patient, require that the patient or any relative under a legal obligation to maintain him shall pay the cost and charges for the treatment or maintenance of the patient at such rate as may be prescribed from time to time.
2. The cost and charges referred to in subsection (1) shall be specified in a notice which shall be-
   
   1. in writing signed, in the case of a public psychiatric hospital, by the Administrator or, in the case of any public psychiatric facility, by a duly authorized officer; and
   2. served either personally or by post on the person legally bound to maintain the mentally disordered person.
3. Where, on appropriate enquiry it is established that the person on whom a notice is served under subsection (2) is able, by work or other means, to maintain himself and his dependants (including the mentally disordered person) then if that person fails to pay the cost and charges specified in the notice, within the period specified therein or such further period as may be allowed by the Administrator or duly authorized officer, as the case may be, the amount owed is recoverable as a civil debt in a Resident Magistrate's Court without limit of amount. (Jamaica 1999)

Further information on the cost incurred by mental care services could not be found among the sources consulted by the Research Directorate within the time constraints of this Response.

3. Complaint Mechanisms

Article 26 of the 1999 Mental Health Act provides for the "[e]stablishment of Mental Health Review Board" for each health region (Jamaica 1999). Article 27 of the 1999 Mental Health Act, on the function of the "Mental Health Review Board," provides the following:

27.—

1. Subject to subsection (2), the functions of a Review Board are-
   
   1. to receive and investigate complaints from patients, relatives or next friends of patients on any matter connected with their care or treatment or their discharge from, or detention in, a psychiatric facility within the health region;
   2. to undertake a periodic review at least once in every six months of all patients who have been undergoing treatment in a psychiatric facility within the health region.
2. Subsection (1) does not apply to a person who is admitted to a psychiatric facility pursuant to an order of the Court or a warrant under section 9.
3. A patient who is admitted to a psychiatric facility pursuant to an application for admission for treatment may apply to the Mental Health Review Board within a period of six months beginning with the day on which he is so admitted or, in the case of a patient who is under the age of sixteen years, with the day on which he attains that age.
4. Where a Review Board undertakes a periodic review under subsection (1) (b), the Review Board shall, within sixty days thereafter, forward a written report of its findings to the Senior Medical Officer of the psychiatric facility and a copy thereof to the patient and, if the patient is not able to understand the report, to the nearest relative or next friend of the patient.
5. The Review Board shall cause to be made and transmit to the Minister a yearly report dealing generally with the activities of the Review Board during the preceding year.
6. For the purpose of performing its functions under this Act a Review Board shall have power to-
   
   1. Summon the attendance of persons, including any member of staff of a psychiatric facility;
   2. Take evidence under oath;
   3. Require any person to produce such books, records or documents as it thinks appropriate;
   4. Make such order as it thinks appropriate in any case, including an order for the discharge of the patient concerned. (Jamaica 1999)

Article 31 of Jamaica's 1999 Mental Health Act, on the "Appeal Tribunal," provides the following:

31.—

1. There is hereby established a Mental Health Appeal Tribunal for the purpose of hearing appeals from the decisions of the Review Board.
2. The Appeal Tribunal may at the hearing of an appeal-
   
   1. dismiss the appeal and confirm the decision of the Review Board;
   2. allow the appeal and direct that the matter be re-examined by the Review Board;
   3. set aside the decision and substitute therefor such other decision as it thinks fit.

… (Jamaica 1999)

The May 2016 Auditor General report states that, in the case of Jamaica's Ministry of Health, "[t]he mechanism, established under the Mental Health Act, to allow for independent monitoring of patients in mental health care facilities; and the investigation of complaints from patients and their relatives was not functioning as intended" (Jamaica May 2016, 11). According to the same source,

no documentary evidence [was found] that the regional review boards were carrying out their functions to receive and investigate complaints from patients and their relatives, and conduct periodic reviews at least once in every six months of patients in mental health facilities. For example, during our review of patient records at [the Bellevue Hospital] we found allegations made by five patients, about issues relating to poor service delivery and inappropriate conduct of staff towards patients. However, we saw no documentary evidence that these complaints were received and investigated by the South East Regional Health Authority (SERHA) Review Board, which is responsible for [the Bellevue Hospital]. (Jamaica May 2016, 11)

Information on complaint mechanisms specific to Ward 21 of the University Hospital of the West Indies could not be found among the sources consulted by the Research Directorate within the time constraints of this Response. The "Contact Us" webpage of the University Hospital of the West Indies's website indicates that individuals can fill out a "[c]ontact [f]orm" to file a "[c]omplaint" to the hospital (University Hospital n.d.).

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim for refugee protection. Please find below the list of sources consulted in researching this Information Request.

References

Jamaica. 9 June 2016. Jamaica Open Data Portal. "Hospitals." [Accessed 9 Mar. 2018]

Jamaica. May 2016. Auditor General of Jamaica. Management of Mental Health Services: Rehabilitation and Reintegration of the Mentally Ill. Performance Audit Report. [Accessed 7 Mar. 2018]

Jamaica. 1999 (amended 2009). Mental Health Act. [Accessed 6 Mar. 2018]

Jamaica. N.d.a. Ministry of Health. "Mental Health Unit." [Accessed 8 Mar. 2018]

Jamaica. N.d.b. Ministry of Health, Southern Regional Health Authority. "SRHA Hospitals." [Accessed 12 Mar. 2018]

Jamaica. N.d.c. National Health Fund (NHF). "NHF Card." [Accessed 27 Mar. 2018]

Jamaica. N.d.d. National Health Fund (NHF). "Major Depression." [Accessed 8 Mar. 2018]

University Hospital of the West Indies. N.d. "Contact Us." [Accessed 12 Mar. 2018]

World Health Organization (WHO). 2014. "Jamaica." Mental Health Atlas Country Profile 2014. [Accessed 7 Mar. 2018]

World Health Organization (WHO). 2011. "Canada." Mental Health Atlas 2011. [Accesssed 28 Mar. 2018]

Additional Sources Consulted

Oral sources: Committee for the Upliftment of the Mentally Ill; Jamaica Mental Health Advocacy Network; Pan American Health Organization/World Health Organization – Representative in Jamaica; University Hospital of the West Indies – Administration, 2 Psychiatrists.

Internet sites, including: Committee for the Upliftment of the Mentally Ill; Commonwealth Health Online; ecoi.net; Jamaica – Jamaica Information Service; UN – Refworld.