OVERCOMING THE BARRIERS TO CARE
OF THE HOMELESS MENTALLY ILL
IN PORT ANTONIO, JAMAICA
A Research Project of the Rotary Club of Port Antonio by
Navdeep Mathur, MD, MPH and Paul Shalom Rhodes, M.D.
In Association with the Street Persons Committee of Port Antonio, September 2005
THE AUTHORS WOULD GREATLY APPRECIATE YOUR COMMENTS AND SUGGESTIONS FOR REVISIONS OF
THIS PAPER OR FOR IDEAS IN OPERATING THE PORT ANTONIO PROGRAM. (DrPaulShalom@yahoo.com)
Revised, and questions for discussion added, November 2006. Addenda, March 2007, October
2007, Dec 2007
Above the administrator’s desk at the “CUMI”, The Committee for the Upliftment of the
Mentally Ill in Montego Bay, rests a painting in folk style of a dump truck full of persons driven
down a narrow winding country road. The image is of an actual event in the year 1999 when
scores of homeless persons were involuntarily transported from downtown Montego Bay to a
remote swamp in St Elizabeth Parish. The artist has titled the painting “Dumping of Street
People at Mudlake”. This involuntary transportation was in fact authorized by the City officials
and the Police, was not a novel phenomenon, but was the first such transport to be so publicly
decried by a story hungry and angry media, an outranged public and a reactive Amnesty
International. Unconfirmed reports by many health professionals in Montego Bay tell of similar
forced transportations of the homeless especially before tourism events. As well, for many years,
up until the destruction of the Jamaican Rail Road by Hurricane Allen in 1988, discharged
mentally ill persons were routinely placed on trains from Bellevue Public Hospital in Kingston with little more than the clothes on their back- and with instructions to “get off the train at the
last stop,” Montego Bay. This raw “discharge procedure” begs the question, what are we to do
with homeless, mentally ill persons? Sadly, the expose of the dumping of the street people in
July, 1999 galvanized communities across Jamaica to stop transporting mentally ill homeless
persons anywhere, including to a hospital or mental health center, very few of which existed, lest
those doing the transporting, such as the police, might be charged with violating human rights.
Such was the case in Port Antonio where -even though there a homeless shelter was recently
constructed- the mentally ill homeless were “left alone” and the new homeless shelter left vacant.
Port Antonio, the very hub of Jamaican tourism in the early 20th century and a city investing
millions of US dollars to rehabilitate itself both as a city and tourism destination, had only the
most meager services for its homeless persons, many of whom were severely mentally ill. They
continued to harass and annoy citizens and often appeared filthy and sometimes naked in the
town square and on the steps of banks and near food markets. This article attempts to tell the
story about Port Antonio’s problem of homelessness, the barriers to caring for such person,
examples of what other communities have done and the beginnings of a plan to provide
necessary and humane help to this needy population.
This report draws on the research efforts of a graduate of the Ben Gurion Medical School in
Israel and a resident in internal medicine of George Washington University Medical Center
(NM) who -while enrolled in an elective study program of community health established by the
Rotary Club of Port Antonio- helped organize community meetings, interviewed many homeless
persons and, with another physician volunteer (PSR) visited a number of sites where housing
and/or rehabilitation services were already being provided. The reader will recognize that the
term “homeless” is an imprecise one, and greater effort is needed to differentiate between the
different type of homeless people (those who are mentally or physically ill and those who are
relatively well) and to distinguish true homeless people from those who just appear homeless,
including persons who have homes and families but congregate with homeless people and loiter.
The problem of homeless persons in Port Antonio, Jamaica has remained an obstacle despite
multiple attempts to rectify the situation. Jamaica has a population of 2.6 million people and is
composed of 14 parishes (Similar to US states). Port Antonio, located in Portland parish, in the
NE coast of the island, has a population of about 14,000. Surveys in the recent years have shown
that there are about 30-35 homeless individuals living in Port Antonio (Monroe). About 1/3 of
these individuals have been diagnosed with some form of mental illness, most commonly
schizophrenia or bipolar disease (Monroe). A rehabilitation facility, constructed in 2000, for the
purposes of providing psychiatric treatment, meals, clothing and temporary shelter has not been
used as of yet. This report will investigate the barriers to starting the rehabilitation program and
will provide solutions for its implementation. Why are several organizations and citizens of Port
Antonio resolved to house and rehabilitate its street people? This section of the paper will focus
on three aspects to answer this question: 1. Public health. 2. Economics and, above all, 3.Ethics
and responsibility.
To treat and rehabilitate the homeless mentally ill is certainly of public health interest. Paranoid
schizophrenia is the most prevalent diagnosis in this population and their propensity for violence
can be high. Acts of violence by the mentally ill homeless against citizens and tourists is an area
of concern because they are preventable. Although it is unclear how many of these episodes have
actually been documented in Port Antonio, numerous accounts of these incidents have been
reported (Street People Committee Meeting, July 2005). Dissemination of infectious disease is
also of concern. Many times the homeless are sifting through garbage bins or dump sites for
food or water and then eventually they are in contact with the public. This can increase the risk
of transmission of microbes that can lead to potential public health hazards. Jamaica’s most
important industry is tourism and its economy relies heavily on it. Although currently other areas
of the country are more lucrative for visitors than Port Antonio, the potential for development of
tourism is immense in this town. Consequently, the city tourist board has invested money, time
and personnel to try to solve the homeless problem. In fact, it was the Ministry of Tourism that
provided the money to make the rehabilitation facility. The way that tourism is adversely
affected by the homeless is simple: the tourists are bothered by the homeless approaching them
for money, creating a level of discomfort in the tourists causing them spend less time in
commercial areas. Some tourists, as do local townspeople, feel uncomfortable just by seeing the
homeless in their near vicinity. Because of Port Antonio’s great potential for recruiting visitors,
the local tourist board has invested a variety of resources in trying to solve the homeless
situation. Indeed the sight of filthy and sometimes naked or exposed street people is an
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understandable annoyance to townspeople and visitors alike. One banker has recently joined the
Port Antonio Homeless Committee in part because street people congregate, eat and litter on the
very steps of her establishment. Few would question that the basic human instinct to help another
in distress is right. Yet, quite certainly all of us have been in situations where we should have
helped and did not. An above all reason for helping the homeless of Port Antonio is the fact that
it is ethically the right action to take. Because ethics are personal and therefore subjective care
must be taken not to impose one’s values on others. It should be emphasized, however, that
Jamaica is an openly and deeply religious Christian country. Blessings and prayers initiate
meetings in government, business and health care alike. With frequent expressions and
admonitions to “love thy neighbor as oneself” and “bear the burdens of the afflicted,” few people
would argue against sheltering, protecting and treating these “afflicted” persons, provided basic
human rights of the street people are respected.
HOMELESS POPULATION DEMOGRAPHICS
The homeless population of Port Antonio can be divided in four main groups (SPCM, July
2005): 1. The mentally ill who have committed a crime, 2. The mentally ill who have not
committed a crime 3.The competent (not mentally ill) homeless people. 4. Loitering people.
Although the rehabilitation facility was built primarily with the homeless mentally ill in mind, it
can also serve to help the competent homeless. Mr. William Monroe, a mental health nurse
working with the Portland Health Department, has conducted several surveys in the past
collecting data on the homeless mentally ill. The most recent one, done in 1999, concluded that
there were 10 homeless persons who suffered from mental illness. Eight were men and two were
women. Ages ranged from late 20’s to 60’s. Other homeless persons include those who have
poor social coping skills, have little education, little family support, and poor job skills. While
data from surveys is valuable in determining the needs of this population, they offer little insight
as who these people really are and how they came to be in their current situation. An attempt was
made by the author to try and fill this gap. The personal interview was the method of choice to
gather information from the population in question. A total of 16 homeless persons were
approached during the morning and afternoon hours for a period of 3 weeks in downtown Port
Antonio. It must be said, however, that some days there were no interviews and other days there
were several. Not all of the people who were approached were able to give an interview. Of the
16 that were approached only 10 were willing to answer questions. Of those who did not want to
answer questions the most common reason for not participating was their state of acute
psychosis. The help of a local health aide was beneficial in translating the often use Patois
vernacular. This report will not focus on all the 10 interviews that were conducted. However, the
hope is that one particular interview will bring forth the much-needed inspiration to resolve the
long-standing issue of homelessness in Port Antonio.
Mr. R is a 40-year-old homeless person originally from Port Antonio. At the time of the
interview he had been homeless for greater than 4 months. He stated that he was “taking a break”
from his family. He is not married and has no children. He lived for at least 10 years in Texas; in
fact, his mother still resides there. Around the age of 11 he suffered from depression (reasons not
stated) and tried to commit suicide by jumping out the window of his house. He was evaluated
by physicians in the US and was informed by them that he was mentally retarded. Interestingly
one of the first impressions one notices when speaking to Mr. R is that he is articulate with good
vocabulary. This is quite the opposite of a person who is described as mentally retarded. His
physical appearance can be described as disheveled and unclean. While observing the public
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around him, it was obvious that they treated him with a sense of disgust, inferiority, and
rudeness. He states that he worked in construction while he was in the US. He graduated high
school from the city of Beaumont, Texas. His aspiration: “Wanted to become the best doctor
there was.” He has been addicted to cocaine since the age of 21 and in further questioning we
find out how this started. His elder brother, whom he was very close to, was killed by gang
violence in a case of mistaken identity in Florida. This event led him on spiral downward with
recurrent bouts of depression. With the depression came the addiction to cocaine. He sleeps on
the street at night and his day usually consists of trying to find food and beg for money to
support his addiction (Note: Mr. R never asked the author for money). During follow up
interviews he expressed anger and disappointment at Jamaican society for not giving him a
chance and for passing judgment on him without knowing him. When asked what would be the
first step to help him change his situation he replied with an emphatic “opportunity”. When
asked about his thoughts on the rehab facility he was optimistic. He added, “If people cannot
make decisions for themselves, everything should be done to help them.” The benefit of
describing individual stories is that they provide us with knowledge about the persons and also
inspire us to help because they show a dimension that charts and numbers cannot provide. Other
interviews included 89-year-old Mr. S, who was previously a farmer and had been homeless for
3 years for unclear reasons. On examination he was suffering from a severe infection of his legs
and was severely dehydrated. He was taken to the Port Antonio Hospital and after hospitalization
discharged again to the street. Ms. M, in her mid thirties, an ex-farmer, who was most likely in
a state of acute psychosis during the time of the interview, proceeded to disrobe herself on the
sidewalk in an attempt to show a lesion on her breast. Another street person was extremely
agitated, actively hallucinating, looking at imaginary objects and was shouting obscenities at
actual people. Several of the homeless were walking about with their pants down and were soiled
with feces.
PREVIOUS PROPOSALS
In the past, numerous attempts have been made to help the homeless of Port Antonio (Bernard
and McGill). This section will describe the history behind the previous programs. In the 1970’1990’s health workers from the mental health department, Red Cross and the local police
department coordinated their resources to provide psychiatric care, food and clothing for the
homeless (Monroe). This would happen three times per week at the police department
headquarters in downtown. Mental health workers would provide necessary medications and the
Red Cross would provide food and clothing. In 1999 the disturbing Montego Bay “street people
scandal” occurred. The scandal surrounded the loading of numerous homeless persons from
Montego Bay in a truck and driving them to another parish and unloading them there. Some
officials state that this happens every year as a result of a festival that occurs in Montego Bay
annually and 1999 was the first year that it was actually noticed by the media. Implicated in this
scandal was the local police department of Montego Bay (Amnesty International, 2001), which
led to the withdrawal of police support for the homeless program in Port Antonio. Another
unfortunate consequence of this event was that many citizens started to consider that by taking
an actively psychotic homeless individual to the hospital or other facility would be violating their
human rights and was unlawful. Opponents of this viewpoint argued that the acutely mentally ill
are not able to make competent decisions and therefore a physician, the police, or a concerned
citizen can make decisions regarding their welfare for them. The 1997 Mental Health Act
provides the legal framework and allows concerned parties to take acute mentally ill homeless
persons to a hospital or other such facility for evaluation and treatment. In particular it states,
“where a constable finds any person in a public place, or wandering at large, in such a manner or
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under such circumstances as to indicate that he (she) is mentally disordered, the constable may,
without a warrant, take such person in charge and forthwith accompany him to a psychiatric
facility <such as the public hospital> for treatment or forthwith arrange for him to be conveyed
with all reasonable care and dispatched to that facility; and the constable shall, within 30 days…
make a report to the Mental Health Review Board.” Furthermore, regarding an offence
committed by a mentally ill person, the constable may, “charge that person for the offence and
bring him before a Resident Magistrate at the earliest opportunity…” and if necessary, “detain
him in a lock-up, remand center or place suitable for the detention of mentally disordered
persons.”
Although the Red Cross and mental health department workers tried to keep the program running
in Port Antonio, it was difficult to do because there was not a designated area that they could use
to meet the homeless. Currently the Red Cross uses an outreach program that provides food to
the homeless three times a week. This program requires a volunteer to cook and actually hand
deliver the food packages to the individuals in the downtown area. As a result of these events
the idea surfaced that a day rehabilitation facility should be constructed to serve as the grounds
for psychiatric and social services. The building was constructed next to the Portland infirmary, a
dilapidated government run institution that caters to need of those who cannot take care of
themselves, similar, in some ways, to the idea of a nursing home in the US. The cost of making
the rehab facility was about US$ 22,000, which was paid by the ministry of tourism. Its
construction was finished in 2000 and till this date it has not been used for its intended purpose.
There was, in fact, a detailed proposal made Drs. Bernard and McGill (parish psychiatrists) in
2004 to facilitate the opening of the rehab facility (Bernard and McGill). Although the proposal
was thorough and proposed the implementation of services in different phases within an allotted
time period, it assumed that the new facility could be an expansion of the Portland infirmary.
This, unfortunately, is far from reality. It is certainly logical to think that use of a pre-existing
health facility and its workers can be expanded and used for another health related project.
However, because the infirmary is in such poor condition and funding from the federal
government is minimal, it is financially and logistically impossible to add another facility under
its auspices.
BARRIERS
The first barrier in starting the rehab program has been political will. If the local and federal
governments do not have the will to resolve the issue then it certainly will not be resolved. One
of the parish councilors stated in a poignant tone “we are careless about the street people.”
Fortunately, a number of agencies and persons have for years expressed a strong desire to
provide better care to the homeless of Port Antonio. Currently, the following entities are
involved in the homeless initiative: the parish council (similar to US state government), mental
health department (MHD), city tourist board, the Red Cross, Food for the Poor (NGO), the city’s
chamber of commerce, Port Antonio’s Rotary Club, and many individuals in the local
community. In meetings with the city mayor and other officials it was clear to the authors that
currently there is a commitment and will to tackle the issues. A debate regarding which of the
above-mentioned parties will actually manage the rehab facility has caused much delay. The
parish council wants the MHD to run the facility. The MHD states that it does not have the
personnel and other required resources to manage the facility. Both sides make valid points. It
does make logical sense that the MHD should have control of the facility, however, having
limited resources the MHD cannot make this commitment.
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The Montego Bay “street people” scandal has also contributed to the delay in opening the facility
by influencing societal attitudes towards the homeless. As mentioned earlier, debates regarding
human rights violations ensued throughout the country after this incident. In general people
became apprehensive in committing the mentally ill homeless to a facility because this would be
considered going against their will and therefore unlawful. However, we know that this is not
against the law and that other parishes are actually doing it with success (further described
below). It is interesting to note what the facility has been used for while it is not operating in its
intended capacity. It is has been used to store food for the Portland Jerk Festival, an annual event
in Port Antonio, used to house Haitian refugees temporarily and currently it is being used to
house a problem resident from the infirmary. The monthly cost of currently running the facility is
about US$130. This may not seem like much, but when funding is limited and the facility is not
being used for its purpose then it makes one wonder how this has happened.
The goals are clearly defined: to help the homeless and the homeless mentally ill become a
productive part of society to the best of their potential. The next section will focus on some of
the ways that this can be achieved.
SOLUTIONS
According to the mayor of Port Antonio, the major obstacle in starting the rehab facility was
overcoming the argument that people cannot be forced to enter a rehab facility. This may be true
for those who are competent of making decisions, however, it may not apply to those who are
mentally incompetent. The town of May Pen, in Clarendon parish, started a facility strictly for
the homeless mentally ill in 1995. CLASP, The Clarendon Association for Street People, is a
non-profit organization composed of two permanent buildings and three temporary ones that
occupy ½ acre of land next to the Clarendon infirmary. This locked facility with bars resembling
those of a prison, is home to 17 paranoid schizophrenics who have a history of violence. It has a
maximum capacity of 30 residents. All the current residents are males. They are provided with
food twice a day by the NGO, Food for the Poor. Psychotropic medications are administered by
injection once monthly by the regional psychiatrist (Personal interview, Wilson). Asking how
this compared to their previous living conditions, one of the residents replied, “its better than
living on the streets.” What has particularly interested the Portland parish council is that a
committee of 15 volunteers which helps reduce cost runs the Clarendon facility. At least one
volunteer is present at the facility 24 hours per day, seven days per week. One of the volunteers
has formal training in mental health and has trained others in basic aspects of caring for the
mentally ill. The cost of running the facility is approximately US$60,000 per year (Wilson). The
federal or parish governments provide none of the money. Most of the money is obtained from
private donations and churches (Wilson).
Although CLASP has been a successful model for caring for the mentally ill homeless, there are
aspects that can be improved. For example, job skills training has been difficult to implement
because the stigma that surrounds the mentally ill. Employers are hesitant to train or hire people
with mental illness. Nonetheless, it is a starting point and can be used as a potential model in Port
Antonio. As well, despite security measures, visitors of the inmates, sometimes distribute illicit
drugs sometime by attaching them to broom sticks passed through the bars of the window or
doors. There have been no serious violent acts and no suicides of CLASP patients since its
inception.
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The Committee for the Upliftment of the Mentally Ill (CUMI) is an NGO organization, which
operates from a home (provided by the Parish Council), located about 1/2 mile from downtown
Montego Bay and ½ mile from the overnight shelter adjacent to the Infirmary. Established in
1991, by businesswoman Elizabeth Hall, it serves as a rehab center and an outreach center
mostly for the homeless mentally ill. Eighty percent of the clients are homeless mentally ill,
while the other 20% are economically destitute/HIV positive/drug addicted individuals. About 25
clients are serviced by CUMI each day, two-thirds of who are male. At the time of our
inspection, 7 women and 17 men were being treated. Its hours of operation are limited: From 8
AM to 4 PM only, after which the clients return to their own home or to a separate night shelter
adjacent to the St James (Montego Bay) Infirmary. Only 7 of CUMI’s clients were resided at the
Shelter. Daytime treatment at CUMI consists of receiving prepared meals, medication,
socialization, and engaging in recreational activities including woodworking and gardening.
Group therapy is given once weekly. The psychiatrist visits once monthly for diagnostic and
medication review. Since its inception in 1991, CUMI accumulated 700 clients and has
rehabilitated 300 of them by making them productive members of society (CUMI). Of the
approximately 60,000 US dollars annual CUMI budget, 2/3 is donated by the family business of
CUMI’s founder, Jamaica Money Market Brokers. Of note, a grant from the Rotary Club of
Montego Bay funded the first three months of CUMI’s operation.
Unrelated to CUMI and working in parallel is the City Spirit of Montego Bay, another daytime,
rehabilitation centre for the homeless. Located in downtown MoBay, just 2 blocks from the town
square, the Parish Council founded City Spirit in the aftermath of the homeless scandal of 2000.
Financed by the Parish Council, services of City Spirit include prepared meals, social work and a
work therapy program. Clients of City Spirit include not only the mentally ill, but drug addicts,
non-ill homeless people, persons unable to afford meals, and sometime even, stranded tourists.
About 18 clients of City Spirit sleep at the homeless shelter adjacent to the Infirmary. The shelter
is constructed inexpensively of two 40-foot containers at right angles and a concrete building
joining them together. Female and male wards and bathrooms are separate.
The women spoken with at the shelter seemed to feel content and safe and in good spirits.
These examples of outpatient rehabilitation centers working in tandem with a nighttime shelter
for 25 persons provide a framework that the community of Port Antonio may emulate, modify
and adapt. Additionally there is reassurance that the transfer of a mentally ill person by a police
officer to a designated mental health center is not a violation of human rights but is specifically
allowed under the Mental Health Act. Namely, it is not unlawful or unethical to take mentally ill,
incompetent patients, to a facility where they can receive proper care. Several issues were raised
in the Street People Committee meeting in July of 2005. First, the services to be offered by the
rehab facility needed to be clearly defined. It was concluded that the following were the most
important services that should be provided initially and on a continuous basis:
1. Basics---food, clothing, temporary shelter
2. Psychiatric evaluations and medications
3. Social support—through a social worker
4. Skills training--- including skills that homeless persons can teach others (i.e.
arts/crafts, carpentry, making clothes, etc.)
As previously proposed by Drs. Bernard and McGill, it is logistically more attainable to provide
different services gradually and this can be divided in the short, medium and long- term phases.
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As an example, the short- term phase can include the following (the responsible parties are in
brackets):
1. Cleaning of the facility and renovation of bathrooms/showers (Parish council and
community volunteers)
2. Arrange for meals three times per day (Red Cross and Food for the Poor)
3. Provide clothing (Red Cross and Salvation Army)
4. Medical assessments provided by volunteer physicians and
regional psychiatrist three times per week.
5. Transportation (Poor Relief and volunteers)
Phase two of the proposal can focus on such issues as program development for rehabilitation
(i.e. job skill training, education). Phase three can incorporate issues such as expansion of the
facility to provide night shelter. It is important to remember the concept of sustainability in each
phase. It is not worth time and resources for certain services if they will not be sustainable in the
future.
CONCLUSION
It is clear that helping the homeless is valuable economically, ethically, and is consistent with
good public health. Barriers such as political will and societal attitudes towards homeless are
changing and this will lead to progress in opening the rehabilitation facility for its intended use.
Work concerning the homeless mentally ill in other regions of the country has provided legal and
logistical precedents that can be applied in Port Antonio. Recent official meetings have clearly
defined the role of the rehabilitation facility regarding services offered. Complete proposals
should focus on delivering services in three phases keeping sustainability in mind. Remembering
that it is not numbers and charts that need help, but human beings, like Mr. R. who have fallen
on hard times, and have become homeless and sometimes nameless. Like CUMI, may we create
and fulfill a mission, “to reach out to the street people and mentally ill homeless (of Port Antonio
and Portland) and within the limits of resources available, attempt to improve their level of
physical and mental health as well as to improve their basic quality of life.”
REFERENCES
1. Amnesty International. “Killings and Violence by Police: How many more victims?”
2001.
2. Bernard and McGill. “Proposal for the Rehabilitation of the Chronic Mentally Ill and
Homeless Population for the Parishes of St. Ann, St. Mary and Portland.” 2004.
4. Committee for the Upliftment of Mentally Ill (CUMI) web site, http://montego-bayjamaica.com/cumi/
5. Pan American Health Organization (PAHO). “Jamaica” Country Health Profile, 2001.
6. Personal interview with Mr. William Munroe, Public Health Nurse, Portland Health
Department. July 2005.
7. Personal interview with Mayor Kelly, Mayor of Port Antonio, July 2005.
8. Personal Interview, Ray Wilson, Mental Health Volunteer, CLASP project, July 2005.
9. Street People Committee Meeting (SPCM), July 2005.
10. Personal Interview of staff members and clients at City Spirit, Montego Bay, Sept. 2005
11. Personal interviews of staff members and clients at CUMI, Montego Bay, Aug-Sept, 2005
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BASIC QUESTIONS ON CARING FOR THE HOMELESS:
The authors hope that these and other questions can help guide the establishment and ongoing
administration and policy of a structured program for housing and rehabilitation for mentally ill
and not-mentally ill homeless persons. While many of these questions are emotionally charged
and controversial, we raise them in order to confront barriers to care of the homeless and to
decrease future problems. We do not seek to offend any party or person.
1. How can we best benefit from the experiences and trials and errors of the established programs such as
CUMI (Committee for the Upliftment of the Mentally Ill) and City Spirit, and the homeless shelters of
Montego Bay and May Pen?
2. Are there large businesses or health care grants and foundations, which from the outset can fund a
substantial portion of these projects?
3. How can we collaborate with the Port Antonio Constabulary and to explore and hopefully resolve the
resistances born of past experience?
4. Is this homeless person psychotic or otherwise seriously mentally ill as judged by the mental health
nurse, voluntary doctor, or police officer? Is this person a risk to herself or others?
5. Will the police officer bring this person for treatment to the Port Antonio Hospital?
Will the person need to be restrained? If so, by what means?
6. Will the hospital doctor admit or release to the community this person?
Will the person be treated only briefly in the emergency room? If admitted, for how long?
7. If not treated in ER or admitted, what follow-up care can be provided to this evaluated and released
person? 8. What systems are in place to protect the admitted person from harming himself of others?
9. What follow-up care will be provided to this person after the period of inpatient care?
10. Will the rehabilitation center and the shelter be separate facilities (distinct buildings)?
What services will be provided at the rehab center and the shelter. What will be their hours of operation?
11. Should the homeless shelter be used for residential care of the seriously mentally ill (propensity to
violence or suicide)? Might these mentally ill persons (especially if paranoid schizophrenic) reside in an
already established residential care facility such as the CLASP center in May Pen? If so, who will
transport the patient and accompany the patient?
12. In addition to providing a bed for overnight sleep, what services would be provided to residents of the
homeless shelter of Port Antonio? What are its hours of operation, 7AM-7PM? How do we enforce these
hours? If someone is sick but not sick enough to warrant hospitalization, must they get out of bed during
the closing hours and if so where will they lie?
13. Is it ethical to offer alcoholics alcohol if they come to the shelter or rehab center, if the intent is to
help wean them from their addiction? Is it ethical to continue to offer them small amounts of alcohol as an
alternative to begging, drinking and lying in the streets? Must our facilities be “dry”?
14. How much will it actually cost to operate a shelter and how will these funds be raised?
15. Who will staff the Port Antonio Shelter?
16. Is it possible to staff this shelter with volunteers alone?
How might we attract such volunteers? Can we collaborate with the US Peace Corps, UWI, nursing and
social work schools, overseas institutions, and thus staff the shelter and or rehab center with
nursing/social work and mental health professionals full or part time?
17. Can local persons (not trained in nursing) be schooled in the 13- week psychiatric nursing aide
program available through Bellevue and Cornwall Regional Hospitals and thus be better qualified for
working in the Port Antonio rehab center or shelter? Or might local certified nursing assistants, LPN’s or
RN’s receive additional brief training from the Portland Health Department, such as is currently available
through Mr. Monroe, to further prepare them for work in our rehab program and shelter?
18. What changes and additions need to be made to the shelter to both accommodate men and women and
be safe and private for women? Should not a men’s and women’s shelter be separate?
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19. Where will these residents receive medical (non-psychiatric) care, especially to insure freedom from
infectious diseases like Scabies, Lice, TB, syphilis and HIV?
20. What medicines can be safely used to treat pain in persons with history of substance abuse?
21. How will the shelter be kept free of illicit drugs and potential weapons (knives)?
22. How do we manage the belligerent, hostile and otherwise resistant client?
23. Will the professional (paid or voluntary) caregiver for the homeless be able to receive emotional and
information support from well trained, highly experienced support personnel? How can we avoid burnout
of our caregivers?
24. Who will contact friends or relatives to investigate the possibilities of alternative living arrangements?
At what point can a resident be discharged into the community and how may avoid “relapse” into
homelessness? Will every homeless person need a social worker? Are there sufficient social workers for
this purpose?
25. Can rehabilitated homeless persons, assume responsibilities in running the shelter?
26. To what extent can the residents take care of themselves and the home and thus minimize the need for
voluntary or paid staff?
28. Might the residents be able to volunteer in the infirmary?
If so what types of service might they provide and how will safety be assured to the residents of the
infirmary?
29. How can we obtain good media coverage of what we are doing to establish good community relations
and moral and financial support?
30. How can we learn from the mistakes and the best practices of other homeless programs?
31. How can we guide legislator and government entitlement program to streamline delivery of services
to homeless while enhancing quality and accountability of these services? For example recently Virginia
USA enacted strict requirements for food preparation for the homeless, shutting down Church and and
good will “soup kitchens” which indirectly encouraging homeless to rummage through thrash cans for
their meals. (Washington Post)
32. How can we avoid wasting resources on those who cannot be helped while balancing hope and
compassion? In New York State, for example, the profitability of in hospital drug rehab programs have
allowed some homeless mentally ill to reside in hospitals most of the year costing tax payers as much as
300,000 USD! (New York Times)
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The following questions deal with psychological issues we face in reckoning with homelessness as providers
and as human beings. I do not want to offend anyone but openly ask these questions with hope of confronting
and overcoming barriers to establishing our program. (PSR)
1. How do we really feel about particular homeless people and homeless people generally?
2. Do we believe that a person’s status in life, including homelessness, is determined by God? Do
we believe that if only the person would have worked harder, they would not have become
homeless?
3. To the extent that we are aware of and admit negative feeling of anger, blame, disgust,
condescension, indifference, hopelessness, frustration, excessive pity, loss of personal
boundaries, anxiety and other negative feelings, how can we best verbalize these feelings, to
whom may we verbalize them, how can we better understand their origin, and how might we
learn from these feelings and use them in a positive way.
4. To what extent are we resistant to sharing economic and other resources with the homeless and
what are the real reasons for our resistance?
5. To what extent are we concerned that the provision of services will aggravate the dependency of
the homeless, i.e. only perpetuate their neediness and reliance on others? Are we concerned that
providing services will attract more homeless to our area and further deplete resources?
What dangers are we concerned with such as violence, drug use, inappropriate sexual behavior, infectious
disease (HIV/AIDS/TB, skin infections, bugs) and others? How may we decrease the risk of such
problems through policy, surveillance, punishment and reinforcement/ reward of positive behavior of our
homeless clients?
6. Do we believe that homeless persons are better off on the street than in confined quarters in which
fighting, physical injury and infectious diseases might be more likely? If so, what steps shall we take to
avoid such complications of close quarters? Are we averse to using inexpensive options such as tents and
converted containers for housing? If so, are there successful models of such use which will inform our
plans and construction? How may we best seek friends and family with whom some of these homeless
persons may live and thus leave the shelter and return to the community, after of course stabilizing
medically psychosis of those homeless who are so affected? In other words, how may we make the shelter
a temporary or transitional one?
7. What are our feelings about the prospects of personal exhaustion and burnout as providers of care
to the homeless and how may we minimize these possibilities?
8. To what extent does our use of volunteers compromise employment opportunities for workers?
In other words if we take on a volunteer or subsidize a volunteer, does this rob a prospective
employee of a gainful job? How do we feel about this possible compromise? Would be rather have a
Jamaican volunteer or a foreigner? Are we embarrassed by asking for outside help?
How do persons of color really feel about receiving help from white people? Do the international relations
and politics of America the nation, impact negatively on the perception of American people- to- people
volunteers? How does colonial history impact on these dynamics? How does Peace Corps approach this?
9. If we are to begin with a day program first and add a shelter component later, how do we feel
about sending the homeless people back to sleep on the streets? Or if our shelter operates from
7PM to 7 AM only, how do we feel about making the homeless leave their shelter?
10. How do government officials and government employees really feel about the work of private
organizations which make a homeless program possible? Do we feel embarrassment, shame,
resentment, jealousy? How can such feelings be worked through. How can the public and private
sectors best work together? 11. Might partners seek to sabotage a project and what might be the
source of feelings which drives sabotage? 12. How do issues of control, authority and power
influence our feelings towards each other, and the elements of this homeless project? Will
struggle for power sabotage the efforts to establish a rehab center and homeless shelter? How can
power struggles be minimized? If a project or idea is not ours (the one that we or I came up with)
will we or I support it on its merits or undo and sabotage it? If someone in the team ‘should’ be
doing something and another team member ‘picks up the slack’ and does it herself, will someone
be hurt, offended or feel that their toes are stepped on? How can such interactions be minimized?
To what extent does our insecurity and false pride derail the effort of others and the team? 13. To
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15.
16.
17.
18.
19.
what extent does one’s belief in God influence one’s feelings towards and service to the
homeless? What would Jesus, Allah, Adonai, do and want us to do? 14. How may I actualize the
spiritual dimensions of my work for the needy while maintaining humility and avoiding self
righteousness?
What is the source of my compassion to the very needy? True mercy? Recognition, self healing,
condescension, power and control, financial gain, other reasons? Multiple factors?
What are the possibilities for graft and corruption? How can these possibilities including kick
backs be prevented? How can we avoid even the appearance of conflict of interest?
Do we volunteers in the private sector feel that members of local government laugh at us for our
interest in the homeless? Do they understand? Do they really care? Do we think that they ask,
what’s in it for them? Do members of local government fear that we want to embarrass or shame
them? How can the public and private sectors best establish trust and support of one another?
If I cannot build support for this project and inspire others to take action, take pride and ,take
credit for the program, at what point do I take action myself and I am prepared for the resistance
this will engender because “they” didn’t take action because “they” didn’t want to and that they
will therefore become angry at me for acting? How do we and other leaders process this ‘damned
if you do’, ‘damned if you don’t’ dilemma?
We wish to work with local government but at what point is non-violent aggression and powerful
activism called for and what forms might this creative non-violence take? Are we prepared for the
emotional and legal consequences of such activism?
SIMPLIFIED SCHEME
(1) Police or Samaritan transports mentally ill homeless person to hospital for evaluation
(2) Patient is hospitalized, treated and discharged to the home of a family member
or to the homeless shelter
(3) Patient is assisted with hygiene and meals, is engaged in recreation, receives medications as
needed at the rehabilitation center (day care center). Family/ friend contacts are reestablished.
(4) Some rehabilitated patients gain employment and obtain apartments or live with family members
(5) Others continue to reside at the shelter
(6) Non-mentally ill homeless people receive daytime care at the rehab center and sleep at the shelter
(7) Some of these people are rehabilitated and gain employment or live with family members
(8) Others continue to reside at the shelter
(9) Virtually all homeless people are able to shower, toilet and eat at the rehab center
(10)Fewer homeless people remain on the streets
(11) Storefronts tidier, business people are pleased, tourists more comfortable, measure of humanity
provided to homeless people and every now and then a formerly homeless person is fully rehabilitated
and perhaps a “miracle” is made possible.
*Addendum: As of November, 2006 the following elements are available for the rehab center:
1. Car and driver to transport homeless to hospital and rehab center
2. Rehab center building (since 1998). 3. Furnishings for rehab center
4.Physician and psychiatric nurse for monthly visit from Health Department
5. Medications from health department. 6. Peace Corps volunteers for recreational therapy
7. Weekly visit by retired psychiatric nurse for group discussion and supportive psychotherapy.
8. One year grant for rehab center program manager from Mennonite Committee (suspended)
9. Registered NGO, 8 member board of directors 10. Pledged funds
As of December 2007, The Portland Rehabilitation Building built in 1998 by the
Ministry of Tourism with tax payer dollars to provide a day program of
rehabilitative activities for Portland’s street people has not been opened nor its
intended program begun.
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