Changes in management structure and style aimed at boosting morale among staff and upgrading patient care are imminent with the appointment of a new Chief of Psychiatry at St. Brendan's Hospital.

Management decentralisation, better communication with staff and increased community involvement in the care of the mentally ill are some of the short and long term goals Sri Lankan-born Dr. Hameen Markar expects to see over the next three years.

Dr. Markar, 44, who took up his post last week, said he spent many months following his appointment studying a Hospital Board review which cited low staff morale as a significant problem at the hospital.

Dr. Markar replaces former Chief of Psychiatry Dr. Richard Lament who is returning to Vancouver, Canada after three years in the post.

The University of Edinburgh trained psychiatrist comes on board as, for the first time, administrative and clinical responsibilities have been amalgamated into the post of Chief of Psychiatry.

With such major changes at the top there were bound to be changes in management structure further down with the aim of creating more accountability and greater clarity, Dr. Markar said.

Among his proposed long term and short term changes are: Programme co-ordinators who will take responsibility for development and implementation of ideas are to be appointed for each of three major development programmes: in-patient, out-patient and learning disabilities; Increased staff training; Increased budget decentralisation with co-ordinators running their own budgets; Reorganisation of staff with some transfers to different departments; Increased staff participation at all levels in the running of the hospital and better communication with management; Amalgamate fragmented out-patient services into a complete "care package''; and Regular evaluation of Hospital policy and services.

"Information must filter down at all levels,'' Dr. Markar said. "People should be made to feel they are wanted and listened to. At any level people should be able to come to me and say `I think we should do it this way'.

Everyone should be part of the changing process.'' But essentially, he said, his aim was to continue St. Brendan's objective of providing excellent mental health care to all Bermuda's residents.

Nevertheless what worked well in one community did not necessarily work well in another.

"You can't just take one system and put it somewhere else,'' said Dr. Markar who prior to his appointment was Clinical Director at QEII a large district hospital in Hertfordshire, England.

Over the next three years, Dr. Markar will be seeking out the attitude of the whole community through questionnaires and surveys on mental health care.

On the sensitive issue of deinstitutionalisation which has attracted criticism in the past Dr. Markar said he would be proceeding cautiously.

"We must be very careful if we are going that way and not if adequate services are established. As far as possible, changes must be safe and sound.

"The safety of the community and the safety of the individuals must be foremost.'' However, he added, there was a need for both in-patient and out-patient services. On the other hand, there was a need to destigmatise the issue of mental illness.

"It is very important to get the community involved in the changing process otherwise it won't succeed,'' he said.

Isolated patients who returned home after hospital treatment were likely to return for treatment again and again. It was therefore important to have a "care package'' of out-patient services in place before releasing patients.

"I am delighted that we have been able to attract someone so eminently qualified as Dr. Markar to St. Brendan's Hospital,'' said Bermuda Hospitals Board executive director Mrs. Sheila Manderson.

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