Formed only one year ago, the Bermuda Mental Health Foundation's first major project is already nearing completion Today's trend in North America and Europe of encouraging the mentally ill, whenever possible, to live within the community, takes a step forward in Bermuda with the Foundation's recent purchase of shared residential accommodation.

Establishment of the Foundation arose out of recommendations made in 1993 by the rehabilitation division of St. Brendan's Hospital. It was felt that a non-profit group, independent of public institutions and government ministries would provide the most effective method of advancing the `community' approach in caring for the mentally ill. The Endowment Fund of the Bermuda Hospitals Board also gave a $200,000 commitment.

Under the scheme, which has the blessing of Government and Bermuda's health officials regular supervision, clinical support and assistance with such day to day issues as medication and budgeting, will be provided. Where necessary, Social Services assist with payment of rent.

Now, the the Foundation is appealing for financial help in furnishing and equipping the recently purchased residence which, it is hoped, will be up and running by the autumn.

One of the main aims of the Foundation is to develop awareness and educate the general public, so that integration of the mentally ill into society will be more readily accepted.

Speaking on behalf of the Foundation, Lady Waddington says: "This is a problem that has to be addressed in Bermuda. In a civilised society, we have to look at every area of need -- and deal with it! I may have been named `Honorary Chairman' but this is definitely a hands-on job -- up to the elbows, actually!'' Well known, and tireless for her work on behalf of the mentally ill in Britain, Lady Waddington says that mental health is still the `Cinderella' of the most health services.

"People can find money for everything else but they have to be firmly `encouraged' to help with this -- yet it is so very important. Once you have stabilised someone who is mentally ill, most can go back into the community, lead useful lives and give something back to the community. If we don't help them to do this, they can become utterly wasted people.'' Both Lady Waddington and St. Brendan's psychiatrist Dr. Gavin Tennent feel there is a need for greater education on the nature of mental illness.

Lady Waddington recalls that when she first became involved with various medical charities in Bermuda, someone remarked that schizophrenia "can't kill you'', but she points out that the suicide rate for this illness and clinical depression, is extremely high.

Emphasising that modern medication combined with therapy has made long-term hospitalisation largely obsolete, Dr. Tennent makes the analogy between schizophrenia patients and those who suffer strokes. In both cases, there can be residual disability, but the majority continue to work and function within the community.

"The mentally ill have something wrong with their brains, rather than their pancreas!'' exclaims Lady Waddington. "There is this lingering myth of `mad axe' syndrome, but there is no evidence that their violence is any higher than in the rest of the population. The trouble is, it tends to hit the headlines if it does happen.'' It is estimated that there are between 600 to 800 people in Bermuda at any given time who are suffering from schizophrenia, one of the commonest forms of mental illness. Percentages here, says Dr. Tennent are in line with other places around the world.

A perhaps surprising 90 percent rate of Bermuda's mentally ill who require continuing therapies are already residing in the general community. With an improved network of support, most can be gainfully employed on a full or part-time basis, so long as some of their fundamental special needs are met.

"What people may not realise,'' Dr. Tennent points out, "is that mental illness is the biggest cause of permanent disability payments in health insurance. So anything we, as a society, can do to make these people productive citizens, makes sense. Long-term hospitalisation or institutionalisation is not only often unnecessary and regressive in terms of the patient, but also extremely expensive.'' Under the Foundation's scheme, it is hoped that, eventually, most of the people who are living in institutions simply because they have nowhere else to go, will be able to take advantage of this more enlightened approach. "We were lucky with our funding in the beginning to get $200,000 from the mother of an ex-patient. Her great wish was that her child should have suitable, safe accommodation. This person has since died but she was concerned that provision be made,'' explains Lady Waddington. "The law of averages would suggest that there must be other people who will want to feel that their children will also be taken care of,'' agrees Dr. Gavin Tennent. "The formation of the Foundation will provide a vehicle for people to make donations on a `peppercorn' rent or very long lease. We would certainly like to hear from anyone who may be worried about the future of their loved ones and would be interested in making property available to help with their continued care and well-being.'' Dr. Tennent notes that this practice has become commonplace in other countries, where people have bequeathed property to charities such as the Foundation on condition that offspring will be provided for, for the rest of their lives.

"What better way to relieve the anxiety of what will happen to your child after you are gone?'' he asks. "Even if two or three people in Bermuda were thus moved, it would be of enormous help and value to us!'' Emphasising that the first three people who will live in the house have already been living within the community for the past 10 years, Dr. Tennent says: "Unfortunately, even those who are stable enough to live in the community, usually have to live in accommodation that's at the bottom end of the market, or we find that rentals are on a comparatively short lease.

This,'' he emphasises, "is the real problem, as the individuals we are talking about fear change. A feeling of permanence is important to their recovery.'' Future plans for the Foundation include the establishment of a day-care centre. "We hope to pay the debt off on the house soon,'' explains Lady Waddington. "Then we would like to find somewhere in Hamilton where people can go for coffee, lunch and to make social contacts. This would be a place that would cater to our street people -- those with mental illness and those without -- to help those who want a way out of the flotsam and jetsam of life on to a level where they can begin to help themselves.'' This scheme has been operating in a limited way, with some success, for the past two years but, again, the urgent need is for permanent accommodation.

"We may do this in conjunction with Government whose homeless committee has been looking at it, but it probably needs a combined Government/private effort,'' says Dr. Tennent.

Lady Waddington refuses to accept possible criticism that this programme will benefit `down and out' alcoholics and addicts: "We could say that lung cancer or diabetes is your own fault! We have to remember also, that many people have had injuries that have damaged their brains. In any case, there is a need in society -- if only to remove them from Front Street -- so even it's done simply from compassion, it's still worth it, and a good thing to do.'' In the long term, it is hoped to also provide permanent premises for a sheltered commercial workshop operation.

Committee member Ms Christine Barritt says that the Foundation was surprised to find a suitable house for the first stage of their shared accommodation plan so quickly.

"Now, we need urgent help from service organisations and individuals to donate some money so that we can buy furnishings. We do have other projects but we decided the residence was the most desperately needed priority,'' she says.

Also serving on the executive committee of the Bermuda Mental Health Foundation is Sen. Norma Astwood, Warren Cabral, Stanley Chetkowski, Jeremy Lodge, Dr. E.S.D. Ratteray and Louie Grant.

In its 1994 Background Report, the Foundation notes that, even today, treatment of the mentally ill raises `troubling and perhaps unanswerable questions about our moral obligations to strangers'. It quotes Samuel Johnson who, in the 17th century, wrote: "The quality of a civilisation is measured by the way it cares for its most unfortunate members.''