Mental health policy being drafted
Suicide to be key focus
By Miranda La Rose
May 17, 2004
The government is currently formulating a draft policy on mental health which will focus on the growing problem of suicide, Chief Medical Officer, Dr Rudolph Cummings says.
Dr Cummings told Stabroek News in a telephone interview that the current laws governing mental health are archaic and there is no policy in relation to suicide. Three years ago, Health Minister, Dr Leslie Ramsammy had promised that the issue of mental health would be placed on the front burner to help address the serious problem of suicide, cases of which were being reported daily in the local media. To date, not much has changed.
Suicide is one of the leading causes of death in rural Guyana, particularly in Region Six (East Berbice/ Corentyne) and Region Two (Pomeroon/ Supenaam) in the 16 to 45 years age group. And attempted suicide is 20 times more prevalent. Survivors are left with damage to the trachea, scars from burns and other physical deformities depending on the mode of the attempted suicide.
In December 1999, Dr Ramsammy, then chairman of the Georgetown Public Hospital Management Committee overseeing health reforms, had stressed the need for a national mental health programme to improve the psycho-social well-being of Guyanese.
In May 2001, the Ministry of Health declared suicide a major public health issue and Dr Ramsammy said it would be given priority attention along with other mental health issues. He made this announcement at the presentation of a study commissioned by clinical psychiatrist Dr Frank Beckles. Dr Ramsammy said the findings of the study, which was done by sociologist Dr Ken Danns et al, were not new but needed, as there were no hard facts or data available to formulate policy.
There was then, and still is, no government policy on suicide. To date no other studies have been conducted.
In August 2001 as Minister of Health, Dr Ramsammy promised to appoint a director of mental health at the Health Ministry so as to appoint psychiatrists to provide services at each of the country's public hospitals.
Dr Ramsammy admitted that to date no one has taken the job. Stabroek News understands that someone was nominated for the post of director but the candidate had not accepted the job. There were other candidates but none has accepted to date.
Dr Cummings said the Ministry of Health does not have a programme for the collection of suicide statistics. He said people die from the ailment diagnosed and not the cause. For example, in a road accident, the data would indicate that a person died from a ruptured liver and not the accident, which caused the liver to rupture. Similarly, if suicide was committed by poisoning, the record would show that the person died by ingesting poison and not suicide. Therefore, the available data may not be accurate as not every case of poisoning will be self-inflicted, he said.
The Danns et al study showed significant suicides in 1999 and in 2000. While 11 suicide cases were recorded for December 1999 in East Berbice, four were recorded for the first week in January 2000. The underlying factors were reportedly either depression or substance abuse.
Mental health is one of three priorities regional ministries of health submitted to the Heads of Government meeting in the Bahamas in 2001. The others were HIV/AIDS and chronic non-communicable diseases.
In the case of mental health, it was recognised that there was need for governments to formulate policies and a regional strategy. Since then at the regional level, PAHO has established a Caribbean Lifestyle Intervention Programme, which is engaging the attention of the Caricom Council for Human and Social Development (COHSOD). Dr Cummings said that though COHSOD has not as yet been able to solicit funding for a regional strategy, the Pan American Health Organisation (PAHO) has begun work on developing a strategy and is currently looking at available models.
Mental health is not only a medical problem but also a social community problem, Dr Cummings said. He noted the need for the modernisation of laws. The laws currently in place say the police must order that a mental patient be hospitalised and not a medical doctor. "The medical authorities can only diagnose the mental problem but the police have to issue the order."
This, he said, needs to be changed.
Port Mourant centre and national
In attempting to deal with the problem of suicide, former minister within the then ministry of human services and social security Indra Chandarpal and the New Building Society (NBS) had developed the idea of establishing a centre for counselling potential suicide victims.
This idea came to fruition and NBS erected a state-of-the-art building at a cost of $40 million in Port Mourant. The construction was completed a year ago and based on information from NBS the building was scheduled for opening in August, last year.
However, to date the building has not been opened for the purpose it was intended and Dr Ramsammy told Stabroek News no arrangements or schedule was in place for its opening.
The issue of mental health and suicide, Dr Cummings said, should not be seen in terms of a building. Studies on the epidemiology and pathogenesis of suicide indicate the need to provide community support.
He said it was easier to treat the psychotic patient but very difficult to treat those with psychological problems bordering on stress which do not reach the level of psychotic behaviour.
In 2001, a National Committee for the Prevention of Suicidal Behaviour was established. The committee, headed by psychiatrist, Dr Bhiro Harry was expected to develop a strategy for reining in suicides as a priority. The rate at the time was said to be ten suicides per every 10,000 persons.
The committee was to have organised seminars for parents, teachers, priests and religious leaders, police and journalists on how to detect suicidal behaviour; to establish crisis-intervention centres in Berbice and at the Georgetown Public Hospital in 2001 and subsequently in other parts of the country.
The objective of the committee's programme was to reduce premature deaths resulting from suicide; lower the rate of suicidal behaviour; decrease the harmful aftermath and the stigma associated with suicidal behaviour and the traumatic impact of suicide on family and friends; promote awareness that suicide was preventable and train more persons in recognising mental health problems.
Stabroek News understands that the committee met on two or three occasions and has not met since.
In Berbice, free suicide counselling is offered by the St Francis Xavier Youth Club at Corentyne. Last week, Jacqueline Cummings, a social worker attached to St Francis Xavier told Stabroek News that ordinarily potential suicide victims or those who attempted suicide did not seek counselling unless referred by the police or the hospital.
Because of the frequency with which suicide is committed in the agricultural area of Black Bush Polder, Ms Cummings said St Francis Xavier has set up an office in a non-governmental organisation building at Mibicuri in Black Bush Polder. She said that since people do not visit the centre or would not want to be associated with it, she and other volunteers would visit homes and talk to people.
She said many of the suicides in the area were as a result of 'match' weddings, frustrations in relationships particularly among young adults and problems of not meeting bank-loan commitments usually associated with rice cultivation.
St Francis Xavier in collaboration with the Guyana Volunteer Consultancy conducts skills-training exercises in the area, which have been a turning point for mainly women in the area.
One woman from Mibicuri who contemplated suicide because her husband left the matrimonial home told Stabroek News that since she enrolled in the skills-training programme her livelihood has been enhanced and she now has much to look forward to.
Another woman in Lesbeholden said when she joined the cake-making and floral-decoration classes her husband was against the idea. She said he added to her "stress", which was the reason she had enrolled in the classes in the first place. She said there was little avenue for relieving stress in the area, as there was no cinema or place for entertainment in the area except for some rum shops. She said her husband claimed she was "going to look for man." Her husband, she said is now proud of her newly- acquired skills.
One of the counsellors who preferred not to be named said more young men than women in Black Bush Polder tended to commit suicide. She said the males were more reluctant to seek counselling than the females who would talk more openly about broken relationships than the men. She feels that young men, especially need to be targeted.
This fact was brought out in the Danns' et al study, which found that suicide was one of the leading causes of death particularly among young males in Guyana and took as many lives as HIV/AIDS. HIV/AIDS is now another factor leading to suicide.
The study, which is still unpublished for the lack of funding, found that eight out of every ten suicides were male; 52.7% of all suicide cases were found in Berbice; two of every three persons who committed suicide in Guyana were below the age of 35 and young adults 20 to 24 years over-represented those who committed suicide. That study complemented the findings of other local psychiatrists and advocacy done by a number of persons including Dr Madan Rambarran and ROAR Guyana Movement Leader Ravi Dev.
Since 1997, Dev had been advocating locally for the problem to be declared a public health issue.
Ms Cummings said suicide in Black Bush Polder is generally committed by ingesting poison used in rice cultivation. These poisons she said could be found "under the step, under a tree in the yard or they can just go and buy it because it is readily available to rice farmers."