More education is needed for mental health service providers

Dear Editor, Since 2015, the framers of the National Mental Health Action Plan (NMHAP) 201520 have been talking about shifting towards a community- based mental health care model instead of institutionalised care. The two-year old coalition administration must be applauded for its quick action in addressing the mental health crisis which is crippling our nation. However, more education is needed for the populace and even more for service providers so they can recognise when people are in crisis. There is a need for objective and subjective data collection in order to make a proper diagnosis.

After perusing the NMHAP document, I was enthralled with this elaborate, ambitious, and comprehensive instrument which has been in the pipeline since 2008. Given the timeline it took to prepare such a user friendly instrument, looking ahead to 2020 we should anticipate at a minimum of a clean-up of the most severely affected among the mentally ill—our growing street population. There were a few high point in the NMHAP that particularly grabbed my attention: 1. There are no independent review bodies to protect the human rights of users of mental health services.

2. The patients admitted to mental hospitals belong primarily to the following two diagnostic groups: schizophrenia and delusional disorders (45%) while the others include epilepsy, organic mental disorders and mental retardation (19%).

3. The most frequent admission diagnosis is psychosis (86%) followed by substancerelated disorder (14%).

4. Although at least one medication from each class of psychotropic drugs is available at all mental health facilities as well as most primary and secondary care facilities in Guyana, there are no guidelines or protocols for the use of psychotropic drugs, and few health or specialized mental health workers have received any training in the rational use of these medications.

5. In terms of available treatments, both outpatient facilities offer limited psychosocial treatments and both have access to at least one psychotropic medicine of each therapeutic class (anti-psychotic, antidepressant, mood stabilizer, anxiolytic, and antiepileptic medicines) year round. The GPHC has consistent access to all psychotropic medications listed in the National Formulary, which includes at least one psychotropic medicine of each therapeutic class.

6. Mental health in primary health care, both physician-based primary health care (PHC) and non-physician based PHC clinics are present in the country. Neither have assessment and treatment protocols for key mental health conditions.

According to the WHO-AIMS report, Guyana’s mental health network consists of 1 mental hospital (with 240 beds), 2 outpatient facilities, and 1 community-based psychiatric inpatient unit (with 4 beds). Four times more outpatient care is provided in the country (with 274.9 outpatient users per 100,000 population) than inpatient care (59.2 and 33.7 users per 100,000 in the community- based inpatient unit and mental hospital, respectively). Summary for Graph 2.5: