A hospital chief has responded to claims that Bermuda needs a secure unit for schizophrenics who are unable to take care of themselves after parents spoke out following the death of Earl Smith.

His mother Donna Mae Smith said last week that doctors knew her schizophrenic son was incapable of taking treatment for his diabetes, and so should have ensured that he was kept in St. Brendan's hospital for his own safety.

He was found dead last Monday of heart failure after slipping into a diabetic coma. His mother said he had regularly forgotten to take his diabetes injection treatment.

And she said a tribunal five weeks ago had decided that her son was a danger to himself, and questioned why then he had been allowed to just leave.

Another mother echoed her calls, and said her son had HIV and suffered from mental illness following a number of strokes, and he, too, was left to fend for himself.

They questioned why more people with mental conditions were not kept in secure, locked units.

But yesterday, chief operating officer at St. Brendan's Patrice Dill said although she was unable to talk about specific cases due to confidentiality, the hospital did its best, under the Mental Health Act 1968, to meet the needs of the patient and the community.

And Ms Dill said while some people met the criteria in the Act to be committed to the hospital, others were allowed into the community.

But she said the patient's human rights always had to be protected.

She said: "To begin, our condolences are given to the family of the late Earl Smith. It is always a tragedy when a life is lost under any circumstances, however, even more so, under the circumstances as recorded in The Royal Gazette.

"St. Brendan's Hospital has come a long way in fighting the negative stigma surrounding mental illness, however, we have yet to totally overcome this problem. One's mental health must be viewed as just as important as one's physical health."

She said in the early 1900s, any person deemed to have mental health problems would have been ostracised from their families and communities.

However, with the introduction of education in the area of psychiatry, the development of medications and the variety of therapies, Ms Dill said doctors were now able to offer treatments that enabled the vast majority of clients a high quality lifestyle.

And that included operating freely in the community.

She said one to two percent of the Bermuda community suffered with schizophrenia, and a third of the hospital's outpatients had been diagnosed with it.

In response to the questions raised about the secure unit, she said the hospital's aim was to support its clients and their families to achieve their optimum level of functioning to live in the community - and not to be institutionalised.

She said schizophrenia was an illness that could not be cured, but the symptoms could be controlled.

She said: "Most of the clients with a diagnosis of schizophrenia live in the community. Out of the 243 in-patient admissions in the year, 92 had a diagnosis of schizophrenia. Clients with schizophrenia are prone to relapses of their acute symptoms and need readmission.

"Therefore, once the client is re-stabilised, they are discharged home and followed up in the community."

Ms Dill said once a patient had been stabilised on a treatment regime, he or she may lead a relatively normal life with regular follow up.

However, she said if a client had both mental and physical illnesses, as in Mr. Smith's case, monitoring, compliance and cooperation were even more critical factors for maintaining their well-being.

She added: "A key element to every client's evaluation and in-patient admission is the risk assessment.

"This will take into account the client's age, habits, diagnosis, history and physical state. With this information, a treatment plan, including the most suitable placement, is developed.

"In order for someone to be compulsorily detained at St. Brendan's, they have to meet the criteria of the Mental Health Act, which is dependent on their mental health status at the time of assessment."

And she said, after assessment, if deemed appropriate, the client will be placed on a section order of the Mental Health Act.

Mr. Smith, in this case, had been placed on a section 13, which was an emergency order lasting 72 hours.

But Ms Dill said most patients arrived at the hospital voluntarily, and could leave the hospital if they chose or if clinicians believed their mental state at the time did not fit the Mental Health Act.

She added: "Currently, in our outpatient services, there are just under 800 open files. It should be noted that most of these clients have never had an inpatient stay in St. Brendan's Hospital.

"These services are comprised of the Acute Service and Rehabilitation Service and the Child and Adolescent Community Services.

"These services provide assessment, treatment and follow up to clients who live in the community. The client may live at home, in a residential facility, a group home, prison, Salvation Army shelter, or choose to be homeless. We also offer a 24-hour crisis hotline for those that need it."

She said discussions had taken place with stakeholders about establishing a psychiatric forensic unit for people with mental conditions who have committed criminal offences.

She said a facility where the client and community could be protected, and treatment given was a long-term goal and was necessary, but did not say how, if or when such a facility could become a reality.