August 4, 2020

OPINION: Cause for concern – Turks and Caicos Islands

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Mental illness and prison

(An analysis in three parts: – historical – international – domestic – on the ’s approach to mental illness)

Part 1 – Historical: The Turks and Caicos Islands is subject to the customs and practices of the United Kingdom.

In practice, be that practice in the United Kingdom ( UK) or the TCI, as this series of articles shall go on to explain, the realities are not rosy for mentally ill persons, and in actuality, quite harsh for a number of mental patients.

Historically, mental illness was never understood by the medical profession at the same rate as were physical illnesses, and in fact, oftentimes that lack of understanding meant stigma, distance, and oftentimes mistreatment of mentally ill persons. This Lack of understanding, absence of empathy, lead to such persons being all simply termed ‘lunatics’.

This classification adumbrates the historical attitude towards persons experiencing mental problems. They were ‘lunatics’ – ‘mad’ – ‘out of their minds’ and removal was the most common response. Removal or at the very least a safe degree of marginalisation.

So, considered as widely as possible, those persons so defined as ‘lunatics’ were in familial, social, cultural, political, medical and other institutional contexts treated in manners which sought to remove, confine and to be rid of them and the attendant stigma. It was acceptable to ostracise them from the collective social world of the ‘normal’ persons.

Why start here? Simple, to trace the evolutionary treatment of the mentally ill by the medical profession and society from removal, then a drift towards understanding and integration into the ‘normal’ world; acceptance of and appropriate treatment for the mentally ill considered then as a backdrop for how the mentally ill are defined and dealt with in the context of my profession, the law.

In England, South London, Bethlem Hospital, or Bedlam, founded in 1247, is probably the oldest, if not most infamous mental asylum built in Europe.
“Madness” in England began being seriously focused on in the nineteenth-century. In 1863, Broadmoor as a criminal ‘lunatic asylum’ was established.

Treatment relied upon in the mid-1800s was applied and administered to persons so defined when convicted and committed. This becomes the medico-legal historical reference point for changing attitudes in a waltz, as it were, between medicine and the law. Both professions had to address the challenge of medical issues from different starting points.

The law is focused on definitions, classifications, restraints and controls all in theory aimed at the protection of the ‘normal’ members of society.

Medicine’s response marches along from classification and confinement over the centuries to person-centred care, primary patient well-being focus, recovery as the target objective, the involvement of health care service providers with users in ways which afford increased access to the best available psychological therapies and so on.

Medical science makes new discoveries over time. The level of understanding increases. Psychiatric drugs are discovered/developed and feature significantly in the care and treatment of mental disorders. These findings further feed into the general society, influencing attitudes and treatments evolved further to the levels we find today.

At every step, legislators are themselves defining and continually re-defining to address responses to new developments so that areas of resource allocation, human rights considerations and serious ethical considerations related to medicinal applications for the mentally ill persons’ treatment and care and provisions for their suitable confinement, when determined to be necessary, are all written down, codified and suitably legislated for. Sounds well-intentioned, good and reasonable? Yes, but that is the refined theory .

Colonial context

There are parallels to be drawn between the TCI and other countries within the Caribbean, previously under British rule. In 1865, post- emancipation of slavery in , the people had had enough and simply rose up in what started out as peaceful protest.

Colonialism believes it is right and should not be questioned, so peace became war in what historically is known as the ‘Morant Bay Rebellion’. Out of this arose the establishment of a regular police force, the building of the first prison, and the construction of ‘Bellevue’, Jamaica’s first mental asylum.

As this series of articles advances, I shall with specificity explain and factually confirm what I mean by the ‘colonial context’ in the TCI and indicate the actual double-standards applied to the treatment of the mentally ill in the TCI by Her Majesty’s Government. Stated succinctly, the TCI laws have evolved from:-

• Lunatics Ordinance 1902
of the UK in the 1950s – applied in part to the TCI
• Prisons Ordinance 1990
• Mental Health Ordinance 2016

It is in the way that these laws work and are applied in practice in the TCI, which sheds light on some hidden truths about the ‘colonial context’ of governing this British colony.

Next week: – the international aspects of ‘MENTAL ILLNESS AND PRISON’

Biographical note: Courtenay Barnett is a graduate of London University. His areas of study were economics, political science and international law. He has been a practising lawyer in the TCI for over thirty years, has had his life threatened, been arrested for defending his views, and has argued public interest and human rights cases.

IMAGE: (supplied)

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