By Nyan Reynolds, MPH
News Americas, KINGSTON, Jamaica, Tues. Aug. 12, 2025: Growing up in inner city Kingston, Jamaica, I frequently witnessed people experiencing mental health episodes – talking aloud, agitated, erratic. In my community, they were often immediately labeled as “madman.” That term was used casually, even with humor, but it carried deep stigma. Behind every outburst was a person suffering – someone needing support, not scorn.
The “Madman” Label: More Than Words
In Jamaican society – particularly in inner city and lower income communities – mental health is often misunderstood and stigmatized. People displaying symptoms of psychosis or mania are frequently mocked or feared. The term “madman” implies unpredictability, danger, irrationality, and often spiritual disturbance.
Public stigma in Jamaica is rooted in fear and misunderstanding – mental illness is often attributed to supernatural or spiritual causes, rather than medical or psychological ones (e.g. demon possession or obeah), according to Gallimore (2023), and Psychology Today (2021). When someone is called a madman, society often mocks him instead of helping.
Jamaica’s Mental Health Landscape: A Landscape Of Under‑Resourcing
Despite a population of roughly 3 million, Jamaica’s mental health care system remains minimal. There is only one psychiatric hospital, Bellevue Hospital, established in 1946 – originally the Jamaica Lunatic Asylum.
The specialist workforce is extremely limited – Jamaica has approximately 1 psychiatrist per 70,000 people, whereas WHO recommends 1 per 10,000. There are also only around 31 psychologists, social workers, and occupational therapists combined island-wide, according to the WHO country profile.
Eighty percent of serious mental health visits in public clinics are due to psychosis, yet community-based clinics often lack capacity or specialist staff, according to the APA‐Paho report.
Like many low- and middle-income countries, Jamaica has a treatment gap of between 70 and 85 %, meaning most in need receive no care, according to Wikipedia’s Global Mental Health entry, (2025).
Access In Theory: The Penchansky & Thomas Framework And Its Evolutions
Penchansky & Thomas, (1981), defined five dimensions of access: availability, accessibility, affordability, acceptability, and adequacy/accommodation, according to their original publication. Saurman (2016) proposed adding a sixth dimension – awareness – to capture whether people know services exist and feel entitled to them.
Levesque et al., (2013), further refined a patient centered framework around similar dimensions (approachability, acceptability, availability, affordability, appropriateness) and matched them to patient abilities (to perceive, seek, reach, pay, engage). More recent literature synthesizes these models to address barriers in low resource settings, according to Badu et al., (2018).
Access In Practice: Where Jamaica Falls Short
Availability
Jamaica has shifted from institutional care toward community-based services, and community care now accounts for roughly two thirds of inpatient treatment, according to Whitehorne Smith (2024). Still, Bellevue remains the only dedicated psychiatric hospital, and only about one third of primary health centers report offering mental health services, despite 80 % of serious cases presenting there, according to Whitehorne Smith (2024) and a recent PAHO report.
Accessibility
Many inner-city residents live far away or in areas controlled by gangs or subject to political violence, making trips to clinics dangerous or impractical. Public transport may be unreliable or unsafe.
Affordability
Public clinics aim to provide low cost or free care, but out of pocket costs remain high – private psychiatric consultations cost JMD 10,000–15,000 per visit, putting repeat care beyond reach for most, according to Barriffe (2024).
Acceptability & Awareness
Cultural distrust of formal mental health care persists. Traditional or spiritual explanations are often preferred over clinical ones, according to Psychology Today (2021) and speciallearning.com, (2021). Many Jamaicans don’t recognize that mental illnesses are treatable or that community clinics even offer help.
Accommodation
Even when people seek care, facilities are often understaffed, have long wait times, limited hours, poor follow-up, and lack transport support. Demand outstrips supply – many drop out after one visit, untreated.
The Consequences: Why Stigma Persists
Social stigma reinforces fear and avoidance. People labeled “madman” face mockery, isolation, and neglect – not referrals or help. Without access or awareness, compassion is rarely extended.
Clinically, untreated individuals may deteriorate, become homeless, incarcerated, or come to police attention – sometimes with fatal outcomes, according to Psychology Today, (2021).
Socially, families of untreated individuals often face poverty, food insecurity, breakdowns – all reinforcing stress that exacerbates mental illness further.
What Works: A Paradigm Shift in Policy
Whitehorne Smith et al. (2024), in a stakeholder-based Jamaican study, identify six subthemes essential for change: prioritizing mental health, reducing stigma, filling policy/practice gaps, addressing workforce shortages, improving infrastructure/operations, and responding to social needs.
Jamaica’s government has begun reforms: revised National Mental Health Policy, integration of psychiatric nurses into primary care, subsidized psychotropic medication via National Health Fund (est. 2003), emergency outreach programs, and transport initiatives to underserved areas, according to Whitehorne Smith, (2024) and the WHO AIMS profile.
Vision For Inner City Kingston: A Roadmap
- Local Access Hubs – Embed mental health services within inner-city clinics; expand hours; train more community psychiatric nurses.
- Affordable Medication & Care – Scale up the National Health Fund subsidy to fully cover essential meds and services for low-income individuals.
- Community Outreach & Education – Launch culturally tailored education campaigns—via churches, radio, street committees—to explain mental illness, promote help seeking, challenge superstition.
- Peer Support & Task-Shifting – Train peer counselors and community agents to screen, refer, and provide psychosocial support—bridging gaps where clinicians are scarce.
- Mobile & Safe Access – Deploy mobile clinics or outreach teams to areas where travel is unsafe; provide escorts or transport vouchers.
- Data & Accountability – Collect and publish data on clinic service availability, wait times, drop off rates. Track outcomes to evaluate and hold systems accountable.
Personal Reflections: Bridging Stigma with Empathy
I remember standing in Kingston alleys as neighbors whispered “madman” at someone shouting alone. I laughed then – but I didn’t see the suffering. I didn’t know there might be a clinic, or someone to call. Now, I see similar dynamics in policy spaces – lack of understanding, lack of access.
If we humanize those labelled “madman” – not as troublemakers, but as people suffering who deserve help – we begin a shift. Compassion and referral replace mockery and fear, and stigma starts to erode.
The term “madman” may seem like a harmless cultural idiom to some, but it is a deeply rooted manifestation of societal neglect. It echoes the absence of understanding, the lack of care, and the deep fractures in Jamaica’s mental health system. When we carelessly assign this label, we not only dismiss the lived experiences of individuals who are suffering, but we also ignore our collective responsibility to ensure that every citizen has access to health, dignity, and support.
Breaking this stigma is no longer optional, it is imperative. We must reshape how we think about mental illness, especially in inner-city and low-income communities where poverty, violence, and generational trauma already place a heavy burden on the mind. Stigma kills. It silences those in need. It drives people away from help and into isolation, homelessness, or incarceration. To combat this, we must replace mockery with compassion and fear with understanding. Our response must be rooted in empathy – seeing those who suffer not as spectacles, but as people in pain who deserve healing.
But empathy alone is not enough. It must be matched with action. The Penchansky and Thomas framework offers a clear roadmap:
- Availability of trained professionals and treatment centers in underserved areas.
- Accessibility through safe, local clinics and mobile health units in volatile or remote communities.
- Affordability by expanding subsidies, government programs, and NGO partnerships to reduce cost barriers.
- Acceptability by creating culturally sensitive education campaigns to dismantle harmful myths about mental health.
- Accommodation through flexible hours, walk-in services, and trauma-informed care tailored to real-life constraints.
- And Awareness, because services that people don’t know about, or are too ashamed to seek, are just as inaccessible as those that don’t exist.
Jamaica is not without hope. Policy reforms are underway. Community nurses are being trained. Subsidy programs have been launched. But what we need now is a cultural awakening – a collective rejection of the notion that mental illness is a personal failing or spiritual curse. We need a society where calling someone a “madman” is met not with laughter, but with concern. A society that does not just pity the suffering but acts to alleviate it.
In the end, this is not just about systems – it’s about people. The man talking to himself on the street, the woman silently battling depression behind closed doors, the youth withdrawing from school and family – they are not mad. They are hurting. And they are waiting on us to care enough to make a difference.
Let us be the generation that finally says:
“Don’t call me a madman.
Call me by my name.
See my pain. And help me heal.”
EDITOR’S NOTE: Nyan Reynolds is a U.S. Army veteran and published author whose novels and cultural works draw from his Jamaican heritage, military service and life experiences. His writing blends storytelling, resilience and heritage to inspire readers.
