In March this year government published the Mental Health Law 2013 that gave the Grand Court of the Cayman Islands power to remand prisoners who are unfit to stand trial and also provided many additional provisions.

Legislators repealed the old law and replaced it with the new one that took eight years of hard work, especially on the part of local psychiatrist Dr. Marc Lockhart.

However, there has been no action so far because of the election and the new government has not had time to approve the regulations.

Dr Lockhart is very enthusiastic about the new law as he says it is one of the most modern health laws in the world.

“We have now jumped from being on the bottom of the list in the world in a sense, to moving towards one of the most modern and current mental health laws,” he said on CITN/Cayman27.

The facility he manages near the Chrissie Tomlinson Hospital is Cayman’s only mental health clinic that has eight wards.

The new law provides more detailed powers for the Grand Court, in relation to the property of patients under guardianship during the period when they are incapacitated and empowers a person defined as a “nearest relative” to report an individual to a medical officer.

This law defines “nearest relative” as a person of at least 18 years of age, whether or not living in the Islands, who is a spouse or common law partner; son or daughter; parent or legal guardian; brother or sister; grandparent; grandchild; uncle or aunt; nephew or niece; a social worker or probation officer employed in that capacity in government or a statutory body; attorney at law of the person concerned; the mental health professional treating the person concerned; or a close friend.

If such a person is of the opinion that a person may be suffering from a mental impairment or serious mental illness, or is not compliant with treatment related to his mental illness, he/she may report the matter to a medical officer.

However, the law has made a provision to make it a criminal offense to get someone detained under the law following a false statement.

A patient who is detained under this section but who is of the opinion that there were no reasonable grounds for making the emergency detention order may, at any time after the making of the order and up to 14 days from the expiration of the order, personally or through a nearest relative, file an appeal with the Mental Health Commission and the Commission may affirm or expunge the order.

The law has defined a mental health illness as, “mental impairment”, meaning a state of arrested or incomplete development of mind, which may or may not be due to a trauma or injury and includes significant impairment of intelligence and social functioning and which may or may not manifest itself in abnormally aggressive or seriously irresponsible conduct.

It has further been defined as a developmental disability”, which means a disability attributable to (a) brain injury, cerebral palsy, epilepsy, autism, Prader Willi syndrome, intellectual disability; or (b) other neurological condition closely related to intellectual disability; or (c) requiring treatment similar to that required for individuals with intellectual disability, which has continued or can be expected to continue indefinitely and constitutes a substantial handicap to the afflicted individual, but does not include dementia.

The law also allows for emergency medical detention. Where a medical officer if of the opinion that a person is or may be suffering from mental impairment or serious mental illness, he may order the detention of that person for up to 72 hours. In the new bill, the law now allows a constable to apprehend and place in custody a mentally impaired or mentally ill patient who is an immediate danger, or is likely to become a danger to himself or others. A medical officer has to examine the person concerned and may direct that the person be detained in a hospital or place of safety.

Also related to this bill is the establishment of the Mental Health Commission that will among other things advise the health practice commission and the councils established under the Health Practice Law.

The commission will include one medical doctor who has the specialisation in psychiatry and another who has training or experience in mental health; this will also include three members of the public who are not registered under the Health Practice Law.

The commission will submit an annual report to the minister responsible for health on the needs and performance of the islands mental health system including complaints, which report shall be tabled in the legislative assembly.

This commission will obtain and compile statistics of mental illness and deliver mental health training and sensitisation sessions for prison officer, constables and any other persons who may in the performance of their duties be expected to deal with mental health patients.

Beyond dealing with specialists and stakeholders who come into contact with these patients, the commission will maintain a programme, which provides information to the general public concerning mental illness and co-occuring disorders and related conditions.

With 1,490 patients diagnosed, with mental disorders in 2010 and only hypertension (3,273 patients) and diabetes (1,691) above them in the list of top diagnoses, not only does government need to cross the t’s and dot the i’s as soon as the necessary forms are completed, but take a look at the size of the only facility we have.

One can have the finest legislation in the world but with only eight wards to look after the mental health patients I fear we are still a long way off from solving the problem.

With no money in our coffers even to upgrade our appalling prisons I fear even when the new legislation does come into affect Cayman’s most vulnerable are not going to see much change.