Formed three years ago, St. Brendan's Hospital's Community Rehabilitation Service can be proud of its success. This is partly due to the fact that Bermuda has learned from mistakes made by mental health institutions in the US and UK, says Christopher Tuckett, programme manager for the scheme.

"Back in 1994, it was felt that we needed a more comprehensive care service for people with mental illness who were being released back into the community,'' he explains. "We have instituted a case management system so that clients don't fall through the cracks. This involves training before they are released, backed up by a daily monitoring programme. I think there needs to be a better understanding of mental illness, a realisation that people with mental illness -- if given the chance -- can function and even return to the workplace. Our programme helps them to do this.'' As a former charge nurse for an inpatient rehabilitation ward, Mr. Tuckett says that when it was closed down, "it was felt we needed to have more support on an ongoing basis. It made sense for me to become part of that team.'' Noting that the programme now has around 700 clients, Mr. Tuckett reveals that "the rehab section alone has 304 clients. But overall, the numbers have dropped because some have been discharged from our care and are well enough to be taken care of by their G.P.'' Mr. Tuckett's team of 24 people includes a consultant psychiatrist, psychologist, resident doctor, recreational and occupational therapists, welfare officers, community nurses, a rehabilitation therapist, support workers and a secretary. Meeting as a team once a week to discuss clients, the monitoring is maintained through a case management system. "Each case manager monitors a client based on need,'' he explains. "Services include vocational rehabilitation, developing work skills -- or redeveloping, because some people, through illness, have lost the skills to function in a working environment. We also have an outpatients' clinic for follow-up care with a psychiatrist and support therapy.'' Mr. Tuckett notes that, at St. Brendan's, there is also an extensive counselling service for such problems as anxiety management, coping with unemployment, developing social skills or arranging financial assistance.

There are also a number of group homes in the community, two of which are owned by the Bermuda Mental Health Foundation (formed in 1994) where people live in shared accommodation. "Before the Foundation came along,'' says Mr.

Tuckett, "we had about three homes but the problem was that, at any point, they could be moved out -- there was no security of tenure. So the Foundation has provided that security for our clients. They -- and their families -- are very happy about this because it has been very instrumental in helping clients to get back to a productive way of life.'' He emphasises that clients are supported in carrying out their daily living skills and medication supervision.

"They are well prepared for living in a group home. We assess each client's ability to cook, clean, and budget for groceries and utilities. We have a training cottage, so if they fit the criteria, they will spend six months or a year there, gaining the skills for independent living.'' Some clients are reluctant to leave the security of institutionalised life but there are various departments within the Service that cater to their needs.

One of these is the work therapy department, where clients are involved in vocational rehabilitation, training for future employment, pursuing sheltered employment or on day release programmes.

Occupational therapist Angelow Mocklow explains that people's potential and work habits are assessed within a structured work environment. These may range to catering, packing leaflets and forms and mailings. "Even dishwashers need to be able to keep up with the work and keep themselves safe,'' says Mrs.

Mocklow. "Failures can happen here, but that's good because they don't lose face --we're here to help rebuild confidence.'' Some clients are employed in bottling Bermuda's famed pink sand for souvenir stores. There is also a carpenter's shop, and rooms for training in sewing and ironing and, if skilled, office work.

"If someone is on the list for home living,'' says Mr. Tuckett, "we have a kitchen to see how they get on with cooking a simple meal -- and clearing up afterwards!'' There is also a small hairdressing salon, where a volunteer comes in to do clients' hair.

"The average case load is between 30 and 40. I have my own case load and make home visits to see how everyone is getting on. I have a dual role, as I am also a mental welfare officer which gives me, together with a doctor, the power to admit a patient to hospital''. With the Mental Health Act, 1968 under review Mr. Tuckett hopes that the present six months compulsory treatment order will be increased to one year.

Mr. Tuckett, who trained in Northampton, England, says there is a relatively new problem facing those involved in mental health care. "The majority of our clients have schizophrenia and a number of them are also abusing drugs. So a relapse is compounded by the use of illicit drugs to the point that the normal 21-day programme often has to be much longer. This is something that urgently needs to be looked at.'' Even so, Christopher Tuckett and his team are pleased with the new approach.

"It's still early days, but we have seen significant benefits for clients and families who now contact our services regularly and there's been a big opening-up process. In fact,'' he adds, "we now have to treat a significant number of family members who become part of the cure -- and that's a very good thing!'' CHRISTOPHER TUCKETT -- "We have instituted a case management system so that clients don't fall through the cracks.''