The State, the individual, the person with mental health issues, the homeless and free choice

Mental Health Week, Mental Health Day 10.10.08

Many years ago, 1989 or 1990 to be a little more precise, I was privileged to attend a meeting of heads of departments in the Mental Health Unit of the Lothians Health Board in Edinburgh. At the time I was head of the Speech and Language Therapy Department providing a service to those with learning disabilities – mental health and learning disability all came under one umbrella at that time. It was the beginning of the movement for the dismantling of all the residential hospitals, regardless of whether their residents were labelled ‘mad’ or ‘stupid’. I never have forgotten that meeting because there were senior members of the psychiatric service, probably about 65 years, a bit older than me now, who remembered the days before residential hospitals existed as they did at the end of the 1980s. One or two of them made an impassioned plea: “Please, some of our population need constant care, and we are in danger of returning to the conditions of earlier in the 20th century in the UK, with many of those with more chronic conditions living as paupers in the streets. The goal of achieving ‘independence’ does not apply to everyone. What will happen to those who are dependent upon our constant care?”

These men’s concern was palpable, and moving. They were reassured that transferring into a small residential unit did not necessarily mean that an individual’s care needs would be jettisoned. And now, twenty odd years on in the UK, by and large it has been a wonderful improvement in many people’s life experience. Levels of care have been identified, and funds have also been made available to individuals to determine how best to budget for their care package.

In Belize, I have often remembered those psychiatrists’ impassioned pleas. Here on Albert St., where I both live and work, I see the ‘simple’ and the ‘insane’ in a state of slow decay. I see the scene the UK psychiatrists had already witnessed, and that they were anxious to avoid going back to. One man often catches my attention: he almost invariably wears a green velour top (hot!) and a pair of grey flannel trousers. He is occasionally seen scrounging a light for a fag, but more often he lies listlessly on the steps outside one of the shoe shops, with an expression on his face that tells me he is very far away and probably depressed. I asked Byron about this man, the taxi driver we phone when we need an escort somewhere because it is dark. He knew exactly who I was talking about. He told me that he was ex-US army “who threw him out when he was burnt up and no more use to them”. (Same as the UK, I hasten to add!) I talked to the Women’s Development Officer, the name of social workers in the Women’s Department, hard working, dedicated and ever-available women, about homes and refuges for these people. She replied that a couple of refuges were there, but many homeless people did not wish to comply with the regulations about no smoking, no booze, curfews, etc.

Maybe I should list what I have witnessed. In Edinburgh, I have seen many folk on the streets. Most recently they look as if they have originated in Eastern Europe, not speaking much English and attired in a more traditional dress.  But even these folk are usually more or less clean and clothed. A decade or so ago the travellers and drug-addicts would decorate street corners. One or two over the years stand out for their appearance and indomitable spirit. One more elderly man with African blood in him would walk around with a portly belly covered by scraps of jackets and trousers. As the top one became too worn, he would don a new (old) one, only for that to fall apart and be covered up by yet another. Thus a patchwork of flesh and cloth would emerge, topped by grey dreadlocks and grey beard, accompanied by a determined walk as he strode through the vennels and alleys of Edinburgh Old Town. He was familiar, and somehow belonged to the landscape.

Here in Albert St., we have our fair share. I have mentioned the woman with Tourettes Syndrome who entertains the queues waiting for their $5 on a Thursday and/or Friday. Conor has his chap that he feeds every Monday with a loaf of bread and a tin of luncheon meat. He looks as if in a different environment, he could do quite well for himself thank you very much. Ernesto disappears and reappears from time to time. Where does he go, what does he do, I wonder? There is a skinny man outside of Brodies, the supermarket, that I think cannot speak, who shakes a plastic cup for a few cents, and twice a week when the papers are published has a few copies to sell. There are various men who are adorn corners and steps, wizened and crushed by years on the streets. One man has hair that is so matted with mud all you could do is shave him and start again. There are some who live in a parallel universe, chatting away to their ghosts and memories with scant regard for those of us who take the time to notice. Some stand, statue like, and some resemble Old Father Time himself. One very tall man has some old trainers bound with twine to stop the soles from flapping too badly. He can be seen on various corners. One of the Ancient Mariners sits outside of the fishermen’s congregating place, and holds up a finger saying ‘1’ in a simple manner that usually makes Conor succumb. (Conor gets a lot more hassle than I do.) Some men are more assertive, more demanding, almost intimidating, but not many. We noticed that on Sundays, there is invariably a line of dusty grey men seated in a row on the long steps outside some of the shops, echoing the row of grey pigeons lined along the roof top above them, each row as still and as impassive as the other. Conor’s Monday man explained that a man hands out a dollar to each of the homeless waiting there each Sunday. Trying to be resourceful, a few folk come round selling anything – palm trees carved out of coconut husks, or an old ceramic cream pot found in some midden or other, that we are reassured is ‘very old’. We frequently see the chap who told us about the origins of the word Belize on our first day here, always with an eye out for the new tourists, and he greets us like old friends. One day he asked straight – “Been a bad day – can you spare a dollar or two?” But he is neither homeless, mad or with learning difficulties. There are very few women that I have witnessed either begging or living rough. Maybe another expression of sexism? And where are they?

So it was with not a little curiosity that I received an invitation a few weeks ago to be one of the judges in a school’s debate on whether or not there should be mandatory removal of the homeless and those with mental health issues from the streets. Last week was World Mental Health Week, and last Friday 10 October was Mental Health Day. The Mental Health Association wanted to involve young people in thinking about the issues, and so cooked up the creative idea for there to be a debating competition, the subject of which would be homelessness and mental health. As one of the women who is central to the MHA said to me, young people listen to each other before they listen to those older than them! By having the whole topic of mental health and homelessness being discussed by young people for young people, there would be an inevitable raising of awareness of the issues involved. Two of the local schools had applied for the debate, St John’s College and St Catherine’s Academy, which was to be held in the Bliss Centre. (And as I found out almost at the end of the debate itself, it was also broadcast live on the local radio!)

I ran it past the head of the Women’s Department, who said that if I was being asked as me, then it was OK, but as a volunteer I could not represent the Women’s Department. It was me they wanted, given the topic, and I was only too happy to oblige!

Conor came with me to the Bliss Centre for the Cultural Arts, which is a good looking modern theatre situated on the sea front near the swing bridge, behind the Courts. It is one of the few modern buildings which stands out as you approach the city from the cayes, and is 6 minutes walk from both our apartment and the Women’s Department. We arrived at about 12.50, and I was taken to meet the Moderator, currently the CO of the Ministry of Education, and a fellow judge, one of the key people in the running of University of West Indies. (There are 2 universities here, the other being the University of Belize.) We had each been emailed a sheet describing the protocol of the debate, plus some guidelines as to what we were supposed to be assessing them on. The three of us got into a huddle, each professing to be uncertain as to exactly what we should be doing, and none of us ever having done such a thing before. One of the organisers turned up, and reassured us that the points system that was suggested was probably too complex and not that relevant…Feeling a little more confident, my fellow judge, the moderator and I sat at a table in front of the stage as pupils, teachers and parents, plus other members of the MHA gathered behind us. The tension was palpable, as much from the teachers and parents as the four brave debaters!

The charming newsreader from TV Channel 5 News, Marleni Cuellar, was the MC, and first of all she welcomed the head of the MHA.  Jennifer Lovell introduced the debate, the moderator and the judges, and of course the two teams. One of the three psychiatrists in Belize gave a great introductory speech, identifying some of the issues in mental health disorders, people’s care, and homelessness. She said that there had been great strides forward with drugs, but there was still a need for more individual interventions in the form of counselling.

We judges had to decide both which team should win, and which individual debater should receive a prize. The individual debater may not necessarily be from the winning team. We were asked to consider:
– The Argument – convincing, with materials presented. (Our own knowledge and views had to be put aside; judged on their performance not whether they said what we thought to be right!)
– Resources – scientific, varied, recent.
– Format – was it followed? Could they argue well? Did they produce new arguments in the rebuttal? Keep to time?
– Personal presentation skills – eye contact, good speaking voice, etc. (I had been a little concerned beforehand that if they broke into broad Creole I may not be able to follow it all, but I needn’t have worried!)

The form they had to follow was very precise:
– First affirmative construction – 7 minutes
– Cross-examination by the negative – 3 minutes
– First negative construction – 8 minutes
 -Cross-examination by the affirmative – 3 minutes
– First Affirmative rebuttal – 4 minutes
– Negative rebuttal – 7 minutes
– Second affirmative rebuttal – 4 minutes

My fellow judge and I were almost as nervous as the contestants!

Marleni invited the two lassies from St. Catherine’s and the two lads from St. John’s onto the stage. Both teams had had to prepare an argument both for and against the debate, and then whoever won the toss could choose which side to take. St John’s won, and they chose to speak against the motion:
There should be mandatory removal of the homeless and mentally ill from the streets.

They were off to a flying start. The initial speaker came in strong and clear, with excellent engagement with her audience. Her argument was sound but there were few statistics to back it up. One of the boys parried with good questions, though he was a little hesitant at first. Then it was their turn to deliver the negative construction. Their case was very well prepared, with excellent use of statistics from a political, sociological and personal perspective. The delivery at this point was poor, though, with the lads’ arguments being more read than discussed. The girls’ cross-examination let them down…there was just not enough of it, and they had been unable to note down points to raise with the degree of precision shown by the boys.

In the rebuttal stages, the girls were again unable to really support their case, whereas the boys were going from strength to strength, both revealing their capacity to argue their points and to develop their position. Then the floor was open to questions, and after each answer, the schools would cheer loudly. It was good fun!

During a short film presentation on mental health issues, we judges slipped out to make our decisions. Fortunately we were in total agreement about both the winning team, and the individual speaker – whew! We were asked to go up on the stage, and before announcing who had won, we gave feedback to each team.

St John’s College:
– Argument excellent
– Format good
– Presentation – started weak but got stronger
– Resources – statistics good, scientific and varied

St. Catherine’s Academy:
– Great start, with a substantial argument but no statistics to support it.
– Format was good.
– Presentation started very well indeed but weakened under argument
– Resources were weak but improved.

Winning team: St John’s College.

Based on our observations of each stage of the debate, and the enthusiastic and engaging way he warmed to his subject, we declared Chris Hulse from St. John’s College the overall winner. No doubt a politician, diplomat or lawyer in the making!

Oh, and the negative argument got my vote for content too! Developing personal individual interventions for the relatively small number of folk here in Belize is preferable to mandatory removal from the streets. The argument the kids liked the best went along the lines of:
How can you justify removing the homeless and mentally ill from the streets when most young people stay on them till three in the morning!

And a little aside – those of you who have followed this blog will know my view that to make secondary education free here would be a swift way to radically change the poverty trap that so many are in. I double-checked with my fellow judge that the Moderator was the CO for Education, and would this be a good time to venture my opinion: “Never miss an opportunity” was her rely – so I didn’t! Judging from his body language, I think he agreed with me, but is unable to implement it because of the financial restraints of the country. Apparently education is currently subsidised to 45%, but the government is looking at the cost of raising it to 60%. Here’s hoping…