Sweeping changes are being implemented at Bermuda's mental care hospital in a `Police-style shake-up' correcting a catalogue of faults highlighted in a critical report.

St. Brendan's Hospital underwent a major review earlier this year, bringing in a Canadian consultant and setting up a steering committee to examine the hospital's workings.

The report showed staff suffered motivation and attitude problems, community mental health service plans had moved too fast and overlaps existed between management creating "fuzzy'' decisions.

In addition who was in charge was not clear and the Bermuda Hospitals Board and hospitals senior management had a poor understanding of St. Brendan's.

The report, published last April, also said Bermudianisation policies at St.

Brendan's "had been implemented in a manner which has lowered the overall quality of staff and therefore the quality of care''.

It also said the Bermudianisation of posts had created "staff tensions and dissatisfaction''.

Since the report, commissioned by Bermuda Hospital's Board chief executive Mrs. Sheila Manderson, several key people have left the hospital and new management appointed.

St. Brendan's hospital administrator, Mr. George Simons, was made redundant and the former chief of psychiatry, Dr. Richard Lament has been replaced by Dr. Hameen Markar, from England.

He arrived last September and is putting into place "Coxall-style'' changes concerning the running and management of the hospital designed to improve morale, training, decision-making and patient care.

Dr. Markar has put in place clear lines of communication allowing information to be passed down to staff and allowing staff concerns to reach management ears.

Management attitude, which was seen as punitive and acting on rumour, has changed, said Dr. Markar who said "people will be listened to''.

The mental health service has also now been divided into five areas to help clear up confused lines of command and the outdated Mental Health Act is before Cabinet for up-dating.

There is now an adult programme, a community mental health programme, rehabilitation scheme, a programme for learning disabilities and administration.

"They control their budget, dictate how they should develop and information is brought to the overall management team to endorse,'' added Dr. Markar.

To help clients an advocacy scheme is being considered, a Code of Practice could be introduced and training links established with the Royal College of Psychiatry and possibly Cambridge, where Dr. Markar studied.

A team of lay-people could also be established to keep an independent check on the hospital and a course for nurses to study psychotherapy is also being considered.

Three `quality improvement teams' have been appointed to make checks and recommendations and a new discharge procedure for patients set up, involving nurses, doctors and relatives.

Dr. Markar also sees as a priority the education of the public -- a topic not addressed in the review report -- to accept and identify mentally ill people and understand the treatments.

Bermuda Hospital Board meetings are now also held once every two months at St.

Brendan's and a member of the Board was on the review steering committee.

"There are a lot of Bermudians who are very capable and very hard working and who are very eager to learn. It is management responsibility to train them even further,'' said Dr. Markar.

"We have not appointed any new staff, I have looked for qualifications, quality and aptitude,'' he added. No redundancies have been made either.

Although he said it could take two or three years for the changes to fully take effect, he added: "We are already seeing the effects of the changes - staff morale is high and people are contributing more to the process, they feel part of it.''