Brief History of Bellevue
Bellevue Hospital, as it is known today is situated on 123 acres of land on Windward Road, Kingston, Jamaica, West Indies. It came into existence as a separate institution for the care and treatment of Mental Disease in 1861. Prior to this, it was connected to the Kingston Public Hospital and was known as the Jamaica Lunatic Asylum. About this time reforms were taking place throughout Europe. This might have influenced the hospital Administration then, because conditions to which patients were subjected previously were improved. By 1868 there was the introduction of newer concepts of therapy, chiefly occupation and amusement, which abolition of unnecessary seclusion and the complete removal of mechanical restraints.
The community was becoming more appreciated of the hospital facilities provided and consequently more patients were being admitted with the increase admissions came overcrowding and new wards were built to accommodate the population. The recognition of the role of the hospital came into being in 1938 when the name was changed from Jamaica Lunatic Asylum to Jamaica Mental Hospital. By 1945 the resident population had reached 2,350 patients and overcrowding was more evident. Maximum accommodation available was for 1,819 patients. This caused some retardation to recoverable cases and deterioration in chronic cases. At the same time patients were having less nursing medical cases, as there was no corresponding increase in quality or quantity of nursing or medical staff.
‘Staff unrest’, a general atmosphere of frustration, complaints
of inadequate salaries and unsatisfactory working conditions led to a
strike of the nursing and sub-ordinate staff in 1945. This brought
some change in the hospital and progress as a direct result with ultimate
benefits to the patients. Steady progress continued in the following
year 1947 with the introduction of Electro Convulsive therapy and Insulin
Coma Therapy. Provisions were made for more organizing training
for medical and nursing staff. Tranquilizers were introduced shortly
after and this proved very effective in the control of patients. Custodial
care was largely the recognized pattern of nursing care. The main
emphasis was attending to the patient’s physical needs, maintaining
discipline and controlling the patient’s behaviour. The main
function of the nurse was keeping the wards clean and neat. Little
thought was given to the emotional needs of the patients. In 1949
School of Nursing was established.
The day hospital built in 1960 provided care for outpatients. There was an out-patient follow up care but this was insufficient to cope with the demand within the Kingston area as well as other outlaying areas.
Although there was an increase rate of discharges, admission rate was relatively high due to lack of adequate care for psychiatric patients outside of Bellevue. There was also the problem of long stay patients who only needed custodial care. At this time the Government became aware of the need to review the existing Mental Health Law, and that a change therefore requested help from the World Health Organization (W.H.O) with the view of appraising the existing services and families and preparing a long range programme. A W.H.O specialist assigned to prepare a National Mental Health Programme in March 1965 and after a survey made certain recommendations.
A second assignment was done in December 1965 to view the National Mental Health activities from basic information available and to determine the implementation of the first phase of the plan and to make recommendations for the initiation of the 2nd phase of the National Health Plan.
A demonstration unit was established in order to enhance the attitude towards Psychiatry as well as towards Bellevue.
1. To attract and retain suitable personnel and to
It is essential to have a demonstration unit specifically allocated to the function of new admission.
Furthermore, this unit can be used as a pilot unit for working through the problems and processes which ensure with the establishment of the first General Hospital Psychiatric Unit at the Montego Bay Hospital. In addition to the above functions this unit would provide:
1. In-service training for currently employed
2. Provide training in Psychiatric Nursing for student Registered Nurses.
3. Be a demonstrative unit for various
Some of the essential features of this unit are that it should have a health service atmosphere rather than that of welfare of forensic institution. This would be conveyed by the manner in which the building is maintained, the personnel are dressed and how the patients are being cared for.
1. Be directly accessible to the community.
2. There should be sufficient grounds for
3. Be able to accommodate both men and women.
The number of in-patients should be 40-60 with one psychiatrist, one Social Worker and an increase concentration of nurses.
Regular team collaboration should be established between the Psychiatrist, Occupational Therapists, Social Worker and Nurses. Nursing Service should be on a team basis, with individual nurses being responsible for the total nursing care of a specific number of patients, shift rotation would be minimized to enhance continuity of care.
On the 12th July 1965, an agreement was signed by the Ministry of Health and the Assistant Director of World Health Organization in which the recommendations made by Dr. Richman was accepted. In 1966 Kingston Public Hospital students started at Bellevue.Integration of male and female patients began at Bellevue on the 27th November 1967. The demonstration unit began functional in January 1978.