In May 2010, Honourable Minister for Health, Mark Scotland established a National Mental Health Taskforce Committee. Its immediate responsibility was to revise and update the current Mental Health Law.

For almost a year and a half the taskforce worked on changes to the law. It reviewed and amended four drafts, teaming with the Ministry and the Legislative Drafting Department.

Currently, the taskforce is working on the development of the Mental Health Regulations. These consist of the procedures for the various detention orders, the role of the responsible medical officer, the appeals process, the detention forms for each order and the statistical reporting form.

In the revised Mental Health Law, some of the proposed changes and new sections introduced in the legislation are:

• Request for Review – this allows a guardian or nearest relative who is of the opinion that a person is suffering from a mental impairment to report the matter to a medical officer.
• Emergency Detention Order – this allows a medical officer who is of the opinion that a person is suffering from a mental impairment or serious mental illness, to have this person detained for up to 72 hours.
• Observation Order – at any time during an emergency detention order, this order, which lasts up to 14 days, may be invoked to determine whether a patient needs to undergo treatment.
• Treatment Order – this order can last up to six months and is invoked if a patient requires further detention under an Observation Order.
• Assisted Outpatient Treatment Order – this has been introduced for patients who, after a period of hospitalisation, are released but are unlikely to participate in treatment voluntarily or do not comply with recommended treatment.
• Other orders such as “temporary holding power” and “emergency medical treatment order” are for persons who appear to be suffering from a mental illness and are likely to leave the hospital when unfit to do so, or for persons undergoing treatment for a mental illness and requiring urgent treatment for a medical condition but are unable or unwilling to give consent.
• Establishment of a Mental Health Commission – this body will have several roles/functions, including:

Review of treatment orders

Review all cases for persons detained longer than six months

Periodic review of remand prisoners unfit to plead

Maintain a list of approved overseas mental health facilities

Review of overseas patients

Compile statistics on mental illness and submit an annual report to the Ministry of Health

The Mental Health Commission can also designate a “Place of Safety”, which should not be confused with a “safe facility”.

The provisions for “Place of Safety” designation in the Law are there to deal with a situation where patients are so ill that they are likely to become a danger to themselves or others, and they cannot be safely managed in the standard accommodation provisions.

Consideration of the safety of the patient, the other patients on the ward, and the staff members are all factors that must be taken into account when determining whether to invoke the “Place of Safety” provisions of the law.

The Cayman Islands has a safe facility — the inpatient mental health ward at the Cayman Islands Hospital. Unfortunately the Islands don’t have a local long-term care facility for chronic patients; most have been placed at facilities off-island.

A private group is currently investigating the feasibility of constructing a long-term care facility here. This would enhance treatment and stability for patients requiring long term hospitalisation, keep Caymanians close to family and friends, reduce costs to government for overseas care and avoid potential human rights conflicts.