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Transition to Scale

The pathway to scale for the DAW CT project has been designed to progressively morph from 1 to 4 schools, then into a DAW CR program in 35 schools, then to 350 schools and finally to 1000 schools over a three-year period. Although funding for this process has not yet been established, the interest being shown by the Jamaican Government and a number of international agencies generates a degree of optimism. The CARIMENSA collaboration with public and private sector organizations has been instrumental in

Jamaican Life-cycle Developmental Map overcoming challenges such as funding, political resistance and community acceptance of the innovation

Fig. 29.2 Jamaican Life-cycle Developmental Map overcoming challenges such as funding, political resistance and community acceptance of the innovation.

Cultural Engagement—The Adult Arm of the Psychohistoriographic Cultural Therapy Program

The pernicious psychological sequelae of slavery and colonialism on the Jamaican people have engendered the need for a systematic social reengineering program for the country to overcome the damaging outcomes.

Post-independence creative public policy has established an island-wide community mental health service (Hickling 1995; McKenzie 2008) and PCT (Hickling 2007) intervention as social reengineering tools that have impacted the Jamaican mental health landscape. The development of a Cultural Therapy Team and Garden Theatre Center in Bellevue Hospital in 1977 had a powerful influence on the hospital, the surrounding inner-city communities and the entire country (Hickling 1989, 2004).

The adult arm of the GCC-funded intervention aims to reestablish the efficacy of the PCT intervention in decreasing violence in an inner-city community in Jamaica. Using a case-control study design, PCT will be evaluated in Seaview Gardens Health Center (SGHC) in inner-city Kingston. This community has high unemployment, very low income, high levels of interpersonal violence and escalating crime rates. At SGHC, a primary care clinic offering services to the community in all specialties of public health and a team of mental health professionals led by a psychiatrist have been responsible for implementing the Community Engagement Cultural Therapy (CECT) program. During 30 months, patients from all of the public health specialties and other members of the Seaview Gardens community will create a Cultural Centre located in the existing community health center. Also, the Community Engagement Mental Health Team (CEMH) will engage in weekly PCT meetings and activities conducted by the mental health team. Focusing on wellness, the CEMH is engaging all persons at the clinic, those with physical and mental ill health, as well as those who are not employed, creating facilities for them to develop productive skills in a social rehabilitation program. The project is following the outcome of the CECT intervention for the period. A range of measurable mental health outcomes, including assessment of domestic and interpersonal violence, job creation and poverty reduction, as well as degree of community engagement and participation will be assessed and reported. The potential for sustainability and scale up through the sharing of techniques learned has been insightful.

Many variants of PCT including DAW CT, DAW CR and CECT are discussed in this chapter. The current work is enabling the writing and publication of the qualitative and quantitative data characterizing these processes so that the models can be replicated and practiced not only in Jamaica but also in other areas of the world. The creation of manuals will also assist in the design of policy recommendations for the incorporation of the variant models of Cultural Therapy in the school curriculum and mental health services in Jamaica and worldwide. The DAW CT project has had success and gained attention in both international and local circles. Internationally, the pilot DAW CT project won the ‘Turning The World Upside Down’ competition in London in November 2013 established by Lord Nigel Crisp to recognize mental health innovations in low-income settings (Centre for Global Mental Health, 2013). The success of the DAW CT and the scale up internationally has led to a Global Mental Health (GMH) discourse about DAW CT via social media and local programming (Centre for Global Mental Health 2013, McGrath 2014). The GMH conversation aimed at achieving equity in mental health for all people worldwide (Patel and Prince 2010) has generated questions about its current goals and consequences (Kirmayer and Pedersen 2014) and has been critically challenged by Summerfield (2013) and White and Sashidharan (2014) as being synonymous with medical imperialism. The suggestion that this Jamaican initiative is an example of ‘counterflows’ of mental health knowledge originating in low- and middle-income countries that could influence practice in high-income countries has been advanced by White et al. (2014) to encourage reciprocity in the current discourse on GMH.

The ‘Dream-A-World’ project has successfully taken the psychiatrist and the mental health team out of the office and the clinic, and it has placed mental health squarely in the schools. This metamorphosis has taken psychotherapy out of the hands of the psychiatrists and psychologists and placed it in the hands of teachers and school guidance counselors. This devolution of power suggests that cultural therapy may help reduce mental health stigma and be an agent of liberation psychology in oppressed and impoverished communities.

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