Poinciana Rehabilitation Centre Wins Design Award: Puts Cayman Ahead of the World in Mental Health Care Treatment

By Stuart Wilson

The Poinciana Rehabilitation Centre (PRC) in Grand Cayman has taken the Island from a place where there was previously no long-term mental health facility to a model that has become the regional standard.

Located in the District of East End, the Cayman’s first dedicated mental health and drug rehabilitation facility has already won an international award for its design, which offers a safe and supportive space for recovery and reintegration into society.

The European HealthCare Design Institute, which is the internationally recognised entity/body for health care architecture around the world, awarded Cayman’s PRC with the first place prize for 2025.

Part of that winning design are several features that pay homage to Cayman seafaring heritage and mirrors designs from buildings such as Elmslie Memorial Church, where the roof is made in to mimic a ship’’s hull.

The cottages where residents live on the Site are also made in the likeness of the traditional Caymanian style cottages of long ago.

Sitting on 15 acres of land, with over 50,000 square feet of programmable space, the facility includes an activity area, a basketball court, a labyrinth (for mediation), a gym and a track.

“It is the first of its kind in the Caribbean; specialising in residential rehabilitation for individuals who require ongoing therapeutic care and support to aid in their recovery in a structured environment,” noted Psychiatrist Dr. Marc Lockhart M.D., who also serves as the Chairman of the Poinciana Advisory Council.

He said the facility is not a prison or detention centre but a therapeutic residential programme where clients participate voluntarily or through a referral under the Mental Health Act (2021 Revision) via a treatment order.

If someone has a serious and persistent mental illness, which affects their ability to recognise the need for treatment and they are a potential harm to themselves or others, they can be placed in care. However, after being examined by a government psychiatrist, those individuals still have the right for a second or third opinion

Persons can also end up at the PRC via a Court order from the Drug Court or the Mental Health Court.

Up to 50 percent of people with serious and persistent mental illness also have drug use, according to PRC Officials. That number tends to increase with persons from lower economic and social support such as living on the street, no supervision with treatment or they cannot afford medicine and are not taking it on time. 

“Once individuals are stabilised and settled at a hospital such as HSA, Doctor’s Hospital or Health City and can understand and accept what is happening to them in terms of their mental illness or drug use, they would then begin their residency here,” noted PRC Director, Mrs. Marcia Mullings-Thompson.

She noted that there are currently 16 residents at PRC, which has a capacity for 54 residents.

“One of the major challenges facing the programme is staffing, which is the next step in progressing the facility to be at full residential capacity.

Dr. Lockhart explained why staffing a facility is particularly difficult in the mental health field:

“Staffing is a universal problem for mental health facilities because we don’t have the requisite number of young persons and professionals going into this field.

“In the United States for example, there are only 30,000 psychiatrists and worldwide there are a few hundred thousand for billions of people. It’s a very hard thing to get these professionals.

“Psychiatric trained nurses and occupational therapists that focus on mental health treatment are difficult to find.”

Dr. Lockhart pointed out that during a recent recruitment drive and interview process, none of the occupational therapists who came forward had a mental health background.

“We have the funds, we have the ability to hire persons, we are approved by the government to hire someone for this role and we simply cannot find somebody to fill it.”

“….We are trying to establish relationships on Islands with UCCI and other training entities to identify young people who are studying things like psychology and encourage them to come back for us to set up training programmes to open this up as another pillar in a sense,” he remarked.

Budgetary constraints also add to challenges in terms of hiring, according to officials at PRC. However medical tourism is another option that may assist in supplementing the funding for the facility.

The original business case for the PRC facility highlighted medical tourism as a possibility for one or two of the cottages.

“Mental health facilities generally do not make money and in the case of PRC, the programme is a non-profit entity but if we are able to bring in extra income and it is not a huge part of our offering, it is definitely worth considering,” said Dr. Lockhart.

“Community support is also welcome,” he added, explaining that we are currently behind in that regard.

“Very few hospitals can stand on their own; government or private,” he said.

For decades the idea was floated that Cayman needed some type of long term health care facility to treat mental illness.

Dr. Lockhart noted that the idea for the model that now exists in Cayman was crystalised in his mind after Hurricane Ivan when - as the only psychiatrist on the Islands at the time - he observed that those with the least, persons who were marginalised, unemployed and not participating in society, had a new found sense of belonging to the community because the community relied on them in the clean up and help after the storm.

“I ran into some of my patients who were going out in a little canoe to feed the stingrays and some who were cleaning the sand off the West Bay Road.

“One day I was getting some ice at the Lion’s Centre after the devastation of the storm and two  guys who were there singing and laughing were patients of mine. These guys were full of life. They were needed by their community and had dignity.

“I realised then that we have to have a proper facility that will not be based on the typical medical model,” he said.

“We need to have a community,” he exclaimed, “…… a place isolated from the city and the noise with enough land and space that replicates the home and town and societal set up on a smaller basis to give our people the skills and preparation so that it’s real rehabilitation and prepares them to go back out into the community and be productive citizens,” said Dr. Lockhart.

The approach starts with the design of the facility, which has nine cottages in pods of three that have an entrance area, a seating and living room area with a refrigerator and television.

“The idea is to promote dignity and replicate any other housing set up that would be available in the real world and not a typical hospital setting,” Dr. Lockhart noted.

He said each individual has their own room to avoid institutionalising them or make them reliant on an institutional setting, where in many cases they wouldn’t even have to make their own beds.

“That’s not preparing you to go home and take care of yourself and wash your clothes and clean your place,” said Dr. Lockhart. “Here you have to do a little basic care. It’s guided by the staff,” he added.

Each cottage also has a washer and dryer.

“The first step is what we call activities of daily living. That’s a part of the design where you have some basic requirements on a daily basis to start to get the right habits.

“The second thing is that we have a large enough compound. In typical medical settings everything is more compact. You are not moving around, getting fresh air, etc. Here, the residents have to move around. Exercise  is built into the design,” he remarked. 

Thirdly, there is training for the residents from different companies on the Islands. There are also rooms for Alcoholics Anonymous and Narcotics Anonymous programmes. 

The facility also has a gift shop and coffee shop, with the former being stocked with creative items made by residents of the facility and the coffee shop being stocked with baked goods also made by the residents.

These activities will give the residents skills to go back into the community and also teach them how to manage money, how to organise and work as a group, how to resolve conflicts and differences, according to PRC Officials. 

Persons will also be rewarded with profits from their input.

Dr. Lockhart said there are currently several gaps in terms of treatment needs in the Cayman Islands, which he hopes PRC will be able to address including:

1. Child and Adolescence; there are not enough beds for young persons with mental issues

2. Dual Diagnosis treatment; Caribbean Haven handles the therapeutic part of rehabilitation. However, they do not have the medical detox and management component or the mental health treatment component. As a result many people have to be sent overseas for rehabilitation, which can cost up to CI$30,000 per month.

3. Treatment for Elderly; easy Onset of dementia treatment and recognition, early management of the behavioral and other types of disturbances associated with dementia. Currently The pines are for late stage dementia but the person who is just diagnosed and dealing with wandering and forgetfulness often needs care for which many families hire a helper with no expertise in these areas. 

Some of the cottages at PRC will also be used as a dementia, memory care, day hospital for short term stabilisation treatment.

“It can take weeks to get dementia patients adjusted. To put them in the mental health care ward at the hospital is not ideal,” according to Dr. Lockhart.

He said, “Our thought here is that we use one or two of our cottages to stabilize such persons. Admit them for two or three weeks, we can have activities for them, start the treatment, give the family time to prepare their house, hire a caregiver, etc.

One of the issues affecting the likelihood of persons accessing the services at the facility is the stigma surrounding mental health.

However, Dr. Lockhart, the staff at PRC and the Advisory Council of PRC have gone above and beyond to make sure the structure, design and programmes offered at the facility are world class and serve every facet of the community’s needs.

PRC is a place where persons can heal with privacy and dignity in a setting that is structured and safe.