FREE Health Clinic For Men

Mental Illness Woes: Lack of Respite & Discrimination

Ann Greaves
Executive Member - Friends of the Mentally Ill

By:    Roslyn A. Douglas
          Founder of Central Health - Grenada

Individuals who make the decision to care for a loved one who suffers from an illness, because of genuine love and concern or obligation, at times need a break from the day to day responsibilities. This is called respite.  Carers/caregivers of loved ones suffering from mental illnesses are no different. In fact according to Ann Greaves, Executive Member of Friends of the Mentally Ill, respite services for carers in Grenada is not seen as a priority. Additionally, patients who are released after the completion of their in-house treatment are faced with abandonment from family members and discrimination from members of society.

Friends of the Mentally Ill began in 1999 and is a registered organization in Grenada, birthed out of a need to provide support for out-patients. It was created by staff of Mt. Gay Psychiatric Hospital, the only mental hospital in Grenada.  Its humble beginnings focused on delivering food parcels and now has morphed into a group that advocates on behalf of those suffering from various mental illnesses.

“The group meets every Tuesday at Mt Gava Community Center. It caters for carers as well. So that’s one of our successes.  Friends of the Mentally Ill have also started a husbandry project, right here at Mount Gay [Hospital] to actually help the patients in terms of their therapeutic needs,” says Ann Greaves.

When asked what type of services would assist the mentally ill in Grenada, Greaves said support from the police, day center(s), and a half-way house would helpful. Police being available and willing to assist  when a patient enters psychosis at home and the carer or family members are unable to restrain them by themselves is still a need.  Having Day Centers would provide a safe place for outpatients to stay during the day and get involved in constructive activities while the carer goes to work, or runs an errand.  Additionally, Halfway houses will be helpful in transitioning outpatients from their time in hospital - into society so as to become independent.  According to Greaves, if these mechanisms are put in place, it may help free up some beds at the hospital for those who need to stay at Mt. Gay hospital for an extended period of time.

“What happens is patients are admitted and families don’t visit them. They don’t come back and receive them, so they have nowhere to go. A lot of the patients can live outside [the hospital] in the community,” said Greaves.  She added, “As you know [when] you’ve been in a [mental] institution for so long, you become institutionalized but it doesn’t mean you have to be locked up for the rest of your life. You can actually go out and live safely in the community.  And I believe that can happen and can free up beds for the most acute patients that needs to be hospitalized. The ones that need to be cared for and the public need to be protected from – because there are times when people do become psychotic and need that service. But when you are no longer acutely ill and you have plateaued, I believe that community services should be in place to enable you to manage and to live a full life and to contribute.”

One of the members of the group, Avaline Mc Clean expressed frustration over the levels of discrimination experienced by fellow out-patients, “Stop the discriminating. Discrimination is not a choice. It’s not an option. Don’t do it.  There are a lot of patients that when they come out of [Mt Gay] they are [afraid] to come out into society. They are going to be cursed at. They are going to be beaten, belittled and it is not nice and it doesn’t feel nice. And I don’t think anybody would like that done to them. I just want to appeal to the public do not discriminate, especially when someone has come to the mental hospital and they come out – and the reason why they come out is because they are better than when they went in.  And when they come out and the public does not welcome them, they feel closed up. They feel left out. They feel like they are not wanted and a lot of the times they end up right back in the hospital.  So I am just appealing to the public to try and avoid that and try to welcome them back.  And when somebody come out of the hospital, the families don’t take them back. And they have nowhere to go, because some of these families, they don’t come back.”

Central Health - Grenada is a faith based initiative that seeks to bring awareness of chronic non - communicable diseases, treatment options and health care services. 

Eating Just Isn’t The Same With Dentures - Avoid This Silent Disease

Dr. Tara Baksh (BDS, BSC) General Dental Practitioner of Island Dental Care

The reason dentists encourage us to brush our teeth at least twice a day and ideally after each meal is to remove the buildup of plaque from our teeth. According to the National Institute of Dental and Craniofacial Research, “Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean.” The organization’s site went on to say that, “The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily.”  Gingivitis is reversible, however the second stage of gum disease – periodontitis is not.

In periodontitis the gum starts to pull away from the teeth and form small pockets around the tooth. Bacteria in those pockets around the tooth get infected and increasingly new forms of bacteria form that over time cause erosion to the jaw and ligaments that help to hold the teeth in your mouth naturally. Dr. Tara Baksh a practicing dentist in Grenada is concerned about the number of patients that come to her office with periodontal disease.  This silent disease of the gums can lead to destruction of the bone of the jaw and ultimately tooth loss.  It is called silent because the destruction can go on for years, without causing pain until the very end when it is too little, too late. She is concerned that some dentist in Grenada are not recognizing its signs so by the time the patient come to her office the condition is already chronic.

“Periodontitis is something that I am seeing a lot of here [in Grenada] and what does upset me a little bit is that I find it is going undiagnosed for many years.  The problem with periodontitis is it is called a silent disease. It’s not one where, you know, you are going to get pain.  Yes there are versions of it that happen very, very quickly but most commonly periodontal disease happens over years. You’re talking 5 to 10 years in the making and a lot of people don’t understand that. When they [patients] come to me they have pain and it’s caused by the periodontal disease.  By that time it is well advanced and I am talking tooth mobile [shaky/loose] that if I could take out if I wanted to or they have an abscess because the bacteria load is so much - they now have an abscess. And in cases like that there is nothing you can do but extract the tooth; because you can’t keep a tooth in there, that’s not supported by bone or anything. So unfortunately in many of the cases that I see, by the time I see them they are advanced and they have to end up losing two, three teeth.”

Cancer, HIV/AIDS and diabetic patients are particularly at high risk for developing periodontitis because their slightly lowered immune system, the body a longer time to fight off infections in the mouth and so the disease festers quickly. However the root cause of gum disease is poor dental hygiene. The lack of brushing and flossing often puts a person at great risk for developing gum disease.  Although hereditary genetics does play a factor, meaning if an immediate family member has this particular disease it can make you more susceptible to it, however with diligent care you may be able to prevent it.  

When periodontitis sets in the patient will have to get their affected tooth or teeth removed and according to Dr. Baksh, dentures are not always comfortable, “We don’t like to do extractions, because when you do extractions, you lose your teeth.  What are you going to eat on? Okay yes, you have a denture. Everyone is like, “Oh yes, pull out your teeth and get a denture,” but that’s not what you want to do. Not everybody understands how difficult it is to adapt to this cumbersome denture in your mouth, and you don’t want to have to do that if you don’t have to. You want to keep your natural teeth. And then your quality of life goes down as well.  There are certain foods that you are not going to enjoy eating anymore. Depending on the type of denture you have, the roof of your mouth is covered. You can’t feel the texture of the food, you can’t taste the texture of the food. Food gets stuck under the dentures. It’s just not nice. You don’t want to [get] dentures if you don’t have to. So therefore you would want to look after your teeth.”

Dr. Baksh who is part of a group that is developing an Oral Health Policy for Grenada says there are additional benefits for going to the dentist twice a year.  She said dentists can often notice underlying health issues based on the conditions of inner walls of the mouth, tongue and gums.  For certain vitamin deficiencies for example the tongue may appear discolored. Regarding periodontitis, if a dentist notices rapid bone loss they may suspect the patient has an underline health issue and is unaware, “We as dentist want patients to understand the importance of coming to the dentist, as recommended, which is twice a year – every six months. There is a lot of things that we can detect in the mouth before it actually manifests itself on the body. A lot of patients are pretty surprised when I say to them, “Do you have this [condition]?” and they haven’t mentioned it to me. And they would be like, “How do you know that?”” The general dental practitioner says she can notice if a patient is anemic, has diabetes, Crohn's disease or even AIDS or HIV. When she notices these early warning signs she would say to the patient, “I think you should go to your doctor and get a blood test and make sure all your levels are good,” and just educate them in that way.  They usually quite surprised that I can tell these things.”

Men: Uncontrolled Diabetes May Lead To Erection Difficulties

Robert Yearwood, MD, MBBS, FRCS, DM-Surgery, FCCOS

Urologist and Surgeon - Ocean House Medical Services

Erectile Dysfunction (ED) - the inability to sustain an erection when sexually aroused, is a complication of diabetes that affects some men.  This condition is caused by neuropathy (nerve damage). 

A practicing urologist and surgeon in Grenada Dr. Robert J. Yearwood, says that there is a direct correlation between uncontrolled diabetes and ED, “Erectile Dysfunction in males is a lot more common than people think because it is certainly not something that people talk about - but a major or leading cause of erectile dysfunction is diabetes.”  Dr. Yearwood went on to say that diabetic patients taking their medications as prescribed, following a healthy diet plan and exercising daily can lower men’s risk of developing this particular complication of diabetes, “Some people are still able to get an erection but the quality might be diminished and another thing too -  just to just sort of stick a pin here - diabetes is not the only cause of erectile dysfunction; and because you have diabetes it does not mean you will get erectile dysfunction. So everyone who is a diabetic don’t think, that they have erectile dysfunction but if you are diabetic and you don’t look after yourself; take your medication as prescribed [or] stick to the diet plan, the chance of you getting erectile dysfunction is very high.”

The United States’ National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) and National Institutes of Health (NIH) states that nerve damage is likely due to a combination of factors, these include:

• high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin
• damage to the blood vessels that carry oxygen and nutrients to nerves
• inflammation in nerves
• inherited traits that increase susceptibility to nerve disease
• lifestyle factors, such as smoking or alcohol use

Neuropathy is one of several complications associated with diabetes when the blood glucose levels are not controlled.  Other complications that can develop are eye disease, kidney failure, dental disease, heart disease, stroke and amputations - due to poor circulation in the extremities, in the legs, feet and fingers. Additionally, neuropathy is not limited to just ED. It depends on which nerves of the body have become damaged due to the long periods of high glucose (sugar) levels.  NIDDK/NIH list other symptoms caused by nerve damage that both men as well as women can experience, these are:

• numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
• wasting of the muscles of the feet or hands
• indigestion, nausea, or vomiting
• diarrhea or constipation
• dizziness or faintness due to a drop in blood pressure after standing or sitting up
• problems with urination
• erectile dysfunction in men or vaginal dryness in women
• weakness

Patients who notice any of these symptoms are encouraged to tell their doctor immediately.

This article was written by Central Health - Grenada in recognition of November being diabetes awareness month.