Mental health of a Nation - Concerns and possible solutions: the case of Guyana
The Caribbean Voice

Stabroek News
December 28, 2015

There may be some validity to the belief that a correlation exists between a nation's mental health and its economic growth. While political and economic change is generally in the forefront of the national development discussion, until recently, very little attention has been given to the psychological well-being or mental health in Guyana. This commentary recognizes the urgency of addressing this dimension of wellness, as it becomes a part of the national conversation.

The Dilemma

Cultural factors and recent trends in Guyana, including the World Health Organization report of the upsurge in the rate of suicide, warrant an examination of the country's emotional pulse and level of tolerance. In this regard, social scientists have found that vulnerability, feelings of isolation and detachment tend to promote tension and a sense of loss, particularly among young people. A past culture of political corruption and high levels of unemployment and crime can exacerbate feelings of despair and marginalization, leading to increased psychological distress. Consequently, a realistic assessment of this issue and needed resources to deal effectively with mental health problems in our dear land is imminent.

Recently, concerned Guyanese at home and abroad have sounded the alarm for the decriminalization of attempted suicide and the act of suicide. This would encourage those with suicidal thoughts to seek help in a timely manner and remove a major impediment to effective mental health intervention. Perhaps the plan of action anticipated to emerge from the government's recent call for the establishment of a task force, following a horrific double suicide (Stabroek News 1/8/16) will seriously address this issue.

Officials' views

One can argue that the high rate of suicide is symptomatic of societal and interpersonal stress, potentially leading to severe mental health problems. To put this in perspective, President David Granger, in an effort to assess and comprehend the magnitude of the problem, said, “it is a worrying factor…and as I always say, happy people do not kill themselves.” He further stated that “some people do not have the necessary tools to deal with whatever problem they are faced with”. This can be viewed as testimony to the impact of embedded cultural and structural factors on behavior, yet to be realised, but simmering in the psyche of a developing nation. One may ask, what are those needed 'tools' to which the president referred? What is the nature of the 'problems' faced, and how exactly are they connected to peoples' emotional state? The answers could be quite revealing.

Acting Chief Medical Officer, Dr. Jeetendra Mohanlall, suggested that mental health is everybody's business and communities should be vigilant with respect to changes in their loved ones' behavior. He seems to understand the critical role of primary group mutual support.

However, both Dr. Mohanlall and chief psychiatrist, Dr. Frank Beckles admitted that there is a need for adequate professional training and the provision of more resources in the field of mental health in Guyana. The deficit ratio of mental health practitioners (social workers, psychiatrists, psychologists, psychiatric nurses and counselors) to potential service consumers is understandable, but troubling for a nation in the throes of political and economic revitalization.

Some possible solutions

A significant number of the citizenry of many countries, including the USA, is likely to experience some form of mental distress in their lifetime. However, an effective response to severe mental illness requires an understanding of the core causes of this malady and a deliberative plan of action. Collaboration among the Ministries of Public Health, Social Services, Social Protection, Ministry of Communities, NGO's, and local community organizations must be committed to contributing resources, including adequate funding, and training of mental health professionals. Improving the quality of mental health service delivery in in-patient and outpatient facilities and establishing limited Day Treatment programs would be helpful.

The role of overseas-based Hometown Associations could be instrumental in this venture. Organisations such as The Caribbean Voice and the Caribbean-American Social Workers Association have taken the lead in this effort.

The University of Guyana, through its Social Work and Counseling Education Programs, should play a prominent role in research, program design, prevention and treatment of mental illness. Once established, intervention programs must be accessible and sustained to have a lasting effect.

Educating the public through community forums, cultural events, media (including the internet), and informed religious institutional involvement, would build awareness, identify causes, recognize symptoms and improve attitude toward treatment. Done with respect, professionalism, non-imposition, community inclusiveness and cultural sensitivity, this will help to overcome fears, myths and taboos based on traditional values, customs and beliefs.

These activities should be informed by local community practices (those that potentially cause mental distress, as well as those that enhance mental health), history, trends and needs. They must also extend to rural, coastal and urban districts, transcending ethnic groups, age, gender identity, political affiliation and religion.

In Guyana, increased use of pesticides for suicide underscores the need for the development and assessment of suicide prevention measures directed toward control of accessibility of pesticides, as successfully demonstrated in other countries. In addition, often overlooked is the trauma experienced by surviving families of suicide victims, for whom grief counselling should be provided.

A critical focus of intervention must be school-aged children. Particularly among teenagers, the 'confusion' of adolescence is compounded by the stresses of their social environment. In this regard, the following suicide prevention strategies have been proposed by the US Centers for Disease Control:

(1) training school and community leaders to identify the young at risk for suicidal thoughts, threats and attempts (2) restricting access to highly lethal methods of suicide (3) intervening after suicide to prevent other youngsters from attempting or completing suicide (4) educating students and parents about suicide risk factors and interventions (6) develop school-based peer support projects and (7) establish crisis centers and hotlines (manned by trained mental health practitioners).

It may be useful for the president's task force on suicide to incorporate some of these proposals in its strategic planning. Although investment in economic development tends to take precedence over socio-cultural needs, the nation's mental health, particularly of the youth, may indeed have an indirect impact on national advancement.

It is important to note that suicide, which is often preceded by depression, is only but one overt expression of mental health problems. Other symptoms of severe mental distress often go undetected, due to non-recognition or denial of such symptoms. The mental health experts on the new task force need to consider ways of correcting this.

These approaches (preventive and remedial) constitute some of the essential ingredients needed to intervene effectively to combat the challenges that produce mental dislocation in our homeland. It is hoped that the above-stated analysis and suggestions will contribute to a robust discussion of the problem, unpacking what is happening, and hopefully help to develop effective policies and solutions.

A holistic approach which takes into account various dimensions (social, economic, cultural and clinical) of this issue is essential. The assumption is that these recommendations are likely in the long run, to be less costly to the nation.