Expert: Drew Wilmoth - 11/12/2009

Question
QUESTION: For someone moving to the islands how would someone go about accessing mental health services?  Not through private insuracne.  Is there an agency that works with the SMI seriously mentally ill population?

ANSWER: Matt,

There are very limited services available for the mentally ill in the Cayman Islands. Only a very limited subset of those services are suitable for the care and treatment of the seriously mentally ill.

There are counseling services to address more common, and generally less serious, mental health issues. There are social workers, ministers of religion, psychologists and psychiatrists who offer counseling for issues such as grief management, depression, family and marital counseling, and substance abuse issues.

There is a scheme of mandatory medical insurance in Cayman. You may be able to make arrangement for private payment of mental health services should you not wish to engage the available coverage under any relevant medical insurance.

There is little suitable care for those with more serious mental health issues. Persons with schizophrenia, bi-polar disorder, or any person displaying violent tendencies due to mental health issues can be brought to the George Town Hospital for intake and stabilization. There is a Mental Health Law which permits police to arrest and detain those who present an imminent danger to themselves or others.

The Cayman Islands does not have any facilities for long term inpatient treatment of the seriously mentally ill. There is a mental health unit of the George Town Hospital but it is not equipped for long term care. Persons detained under the Mental Health Law who require long term inpatient treatment will be sent to another country for that care.

Finally, there is a medical screening requirement for all persons moving to the Cayman Islands to take up employment under a Work Permit. The same standards apply to the dependents of Work Permit holders. Generally a serious mental illness would be grounds for refusal of a work permit. A person with such medical history is ineligible for entry to the Cayman Islands under the Immigration Law.

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for the prompt reply.  The information is very useful.  I am a Clinical Liaison/Case Manager in Phoenix, Arizona and have a patient that is wanting to move back to the Cayman Islands to be with his Father.  The last time he did this he became very symtomatic while there and had to return due to not taking his medications.  This individual has been determined to be SMI (seriously mentally ill) but by no means prohibits him from being a productive member of society.  It sounds like the best option would be for him to go to the George Town Hospital to be evaluated and receive medication.  Again Thank you very much for your help.

Matt

Answer
Matt,

As you are aware, some seriously mentally ill persons make a choice to remain unmedicated. Should your client choose to seek care in Cayman, Doctor Marc Lockhart is the psychiatrist in charge of the Mental Health Unit at the George Town Hospital. I would encourage that your staff discuss with your client to arrange a referral with a copy of relevant medical records to Doctor Lockhart regardless of whether your client now believes he would seek care while in Cayman.

I would further impress on him that since Cayman has far fewer resources to handle problems arising from actions of the seriously mentally ill, the police are much more likely to become involved in matters of concern here. Those persons with mental issues who present to the police repeatedly become well known to emergency service providers.

Assuming your client is a Caymanian passport holder he would be eligible for entry to Cayman despite his history of mental illness.