There, but for the grace of God

by Anita Botti Tue, Oct 11. 2011

There, but for the grace of God, go I. This thought would go through my head whenever a new patient was admitted to the Mental Health Centre. As a 22-year-old Peace Corps Volunteer living in Calliaqua and assigned to the Mental Health Centre in 1968, I became all too aware of this condition called “mental illness.” It does not discriminate, affecting anyone regardless of age, race or class.{{more}} For families, I found the fear of those who became ill often became the issue rather than trying to understand the person suffering with the illness. This initial reaction was not very different from what I experienced in the United States, working with families of young adults with mental illness.

I was fortunate to work with three incredible, albeit very different, individuals during my two-year assignment. The first was Dr. Gideon Cordice, who had responsibility for the patient population at the Centre. He was a brilliant doctor and despite his brief training (according to him) in psychiatry, he was always on the mark with his diagnoses. He had a wonderful way with people and often provided the best course of treatment. Unfortunately, he came only once a week, so everyone did not benefit from his brilliance. The second person was Nurse Allen, who basically ran the Centre and the staff. She was omnipresent and provided a professional tone to the Centre. She was a gracious woman who took her responsibilities seriously and expected all of the staff to follow suit. Last, but definitely not least, was Sheila Clouden. She was one of the Centre’s brightest stars. She was a mentor and good friend. She taught me that not all knowledge comes from books and that I should trust my God-given instincts, a particularly noteworthy recommendation that would be repeated to me ten years later by my advisor in graduate school, a professor at Johns Hopkins University. Ms. Clouden did not spend a lot of time fretting over things that she could not change, but focused on rehabilitating the patients she knew were ready to be healed. She insisted that patients would recover faster if they had purposeful activities to perform. So she set about creating an environment in which that could happen. With the help of a Peace Corps Volunteer architect, we were able to take the old TB building, which was sitting vacant and turn it into a recreational therapy unit for the patients. Ms. Clouden got her wish and patients thrived under her direction. What I remember most was the complete dedication of the staff to the patients, about one hundred and fifty in number. Clearly the goal was to discharge patients as soon as they were ready and prepare their families for their return. Each patient had an on-going evaluation plan, even if the plan was to have the patient remain at the Centre for the duration of his/her life.

In June of this year, I visited the Mental Health Centre again and met some of the staff. While the patient population has swelled, partly due to the increase in drug-induced mental illness, what has not changed is the dedication of the staff. The Centre has a full time physician and a Psychiatrist. It is blessed with three dynamic senior staff, who relentlessly advocate on behalf of the patients – Dr. Morris-Patterson, Dr. Providence, and Nurse Smart. In discussion with them, I learned that while they have as their ultimate goal the establishment of a national mental health policy, they are also working with available resources to integrate mental health services into Primary Health Care, which will allow individuals to be seen in their local primary care clinic and treated there. The hope is that discharged patients could also receive follow-up treatment by the District clinic staff. Keeping the patient in the community is far preferable to having them admitted to the Mental Health Centre. With the help of the government of St. Vincent & the Grenadines and Mt. Sinai Medical School in New York, the Centre staff has started this process, but much more is needed if this objective is to be achieved across the island. In-service training for all staff is also underway. The staff continues to supervise nursing students at the Centre and is working with government to procure additional training off-island in psychiatric nursing. Ultimately, the staff would like to develop a specific curriculum for psychiatric nursing, so that it can be built into the Division of Nursing Education Programme. They are also working toward revitalizing the Mental Health Association and promoting many issues affecting the patients in the community. I wish them well, as I found that a robust mental health association was critical in my time in gaining support from the island community.

Despite all of the good progress being made, the elephant in the room continues to be the increase in the patient population, due to the devastating effects of drug abuse. I know this issue continues to be of great concern to the mental health professionals at the Centre.

I am honored to be given this opportunity, after so many years, to express my appreciation for the work done by the mental health professionals in Saint Vincent, and hope that the staff will continue to involve me in some small way in the continuing progress made by the Centre in the future.

Anita Botti is currently the Deputy and Chief of Staff of the Secretary’s Office of Global Women’s Issues at the U.S. Department of State. The views expressed are the employee’s own views and not necessarily those of the State Department or U.S. Government.