Community psychiatry and deinstitutionalization in Jamaica.

Between 1960 and 1990, the population of Jamaica's single mental hospital was reduced by 58 percent, from more than 3,000 to less than 1,300. Services were reoriented from mental-hospital-based custodial care to rehabilitative, community-based care with no appreciable increase in the mental health budget. Despite several changes in government over the past 30 years, continuity of public policy and fiscal support has allowed ongoing development of the island's community mental health services. The national community mental health service, which had a case-load of about 14,000 patients in 1990, relies on specially trained psychiatric nurse practitioners who provide crisis management, medication management, and supportive psychotherapy; make home visits; and carry out treatment plans developed by the community psychiatrist. Community acceptance of mentally ill persons has been enhanced by public education programs and media coverage of advances in treatment.