Mental health journey

RadioScope: Journalists writing about the health service here frequently make comparisons with health services in other countries. So readers have some impression how service users in the rest of Europe or in the US fare.

But that's usually how far it goes - a look at the provision of care, particularly mental healthcare, further afield and particularly in developing countries, rarely features. That's why Dr Raj Persaud's return to the BBC for another series of Travels of the Mind is always welcome.

In this new four-part series, Persaud, consultant psychiatrist at Maudsley Hospital in South London, is examining how different cultures deal with mental illness and talking to doctors, healthcare workers, patients and their families in Sri Lanka, Jamaica, India and Iceland. For last Monday's programme, the second in the series, he travelled to Jamaica, a country whose approach to the care for the mentally ill was put in the spotlight in 1999 during the so called "street people scandal". In advance of a major civic event in Montego Bay, around 30 street people, all experiencing degrees of mental illness, were rounded up in a truck by a parish council with the help of the police. They were driven far away from the tourist resort and abandoned in the hills.

Some made it back onto the roadway, where they were able to tell their story. It's a defining incident that still hangs over all the health workers Persaud spoke to, and he found that the historic lack of availability of good mental healthcare and deepseated prejudice had forced a range of different responses.

Persaud spoke to two women whose sons suffer from schizophrenia and who have set up an NGO 'Mensana'. Their new and impressive facility in Montego Bay got off to a rocky start, says Elizabeth Hall. They managed to secure three months of start-up funding from the local Rotary Club but relations soon soured when their sponsor announced it was unhappy with the speed and methodology of the centre. "They seemed to think we were going to be herding the homeless mentally ill off the streets," said one of the women. "So I said if that's the way you want it done, you can take your money back." The Rotary Club is still the sponsor.

The largest facility, Bellevue Psychiatric Hospital, is falling apart and due for closure as Jamaica tries to move away from institutional models to more community-based care. The further Persaud moved away from the popular tourist parts of the island, care for the mentally ill decreased in quality to the point that in one rural area a residential facility resembled a grim underfunded jail with one nurse looking after 17 acutely ill residents.

However, Prof Frederick Hickling, head of community health and psychiatry at University of West Indies, said: "We are moving away from the legacy of a colonial system so that more than half of all people with mental health issues are treated in general hospitals."

It was a small glimmer of hope at the end of a rather grim picture.