The laws relating to mental health need to be updated
According to WHO-AIMS report (2008) on the state of mental illness in Guyana, an outdated Mental Health Ordinance of 1930 still exists which fails to include many basic elements of protection. “A commitment and willingness by our political leaders to update its law books is the first responsible step in the process of showing commitment to protecting the mentally ill. Areas with insufficient protection include: confidentiality, informed consent, conditions in mental health facilities, safeguards to protect against abuse, appropriate and accessible care within communities, and equality in opportunities for access to care, to employment, to shelter and to justice,” the report says. In the absence of legislative protection abuse and discrimination will continue to be meted out to persons suffering from a mental disorder.
Studies show, there are no mental health consumer or family associations in Guyana. However, there are two NGOs in the country involved in individual assistance activities such as counselling, housing, and support groups for persons affected by substance use disorders, ie the Salvation Army and Phoenix Recovery. Both NGOs participated in the drafting of the draft mental health policy and plan. Yet, there are no day treatment facilities in the country, and no community residential facilities available with trained professionals and para-professionals which offer non-invasive treatment and support services to families.
Again, I refer to WHO-AIMS report: “There is no computerized data entry system in the National Psychiatric Hospital or the GPHC Psychiatric department. Diagnostic information, based on the DSM-IV classification system, is recorded on the patient charts but is not a component of the mental health data set submitted to the Ministry of Health statistics department.”
The challenge we face in Guyana is one of cultural insensitivity which includes prejudice, denial, discounting, defensiveness, bias, intolerance, cultural blindness, cultural incapacity, cultural destructiveness, cultural incompetence, and individual/institutional racism deeply rooted in our identities. Some of the behaviours rampant in our communities are intrapersonal and interpersonal violence, alcohol and substance abuse, withdrawal, verbal intimidation, profanity, high levels of frustration and stress, and verbal/physical aggression. These are all precursors to depression associated with an increase in suicidal thoughts and suicide attempts, especially among the vulnerable.
Attention must also be given to frontline workers who have had to work with this least understood population for years, not recognising that they too may be predisposed either directly or indirectly to mental disorders (unaware) and may be suffering in the form of extreme burnout.
Training must be broad-based and culture-specific, to include all service providers coming in contact with the mentally challenged.
Only 20 hours of the 4-year training programme for medical doctors is devoted to mental health. Approximately 2% of the training for nurses and 4% of the training for non-doctor/non-nurse primary health care workers is devoted to mental health. In terms of refresher training, 43% of primary health care doctors have received at least two days of refresher training in mental health, while 57% of nurses and 3% of non-doctor/non-nurse primary health care workers have received such training. (WHO-AIMS Guyana 2008).
Looking ahead at the next 80 years and beyond, it is up to our policy-makers to put stringent measures in place to protect future generations suffering from mental illness. In the short run, a few may benefit from being on stage reciting and echoing their newly acquired language (psychobabble) knowing fully well it would take another 10-15 (2027-2032) before Guyana can produce a competent pool of mental health professionals to serve this nation. This colossal task is achievable with the support of our rich human resource diaspora community whose gaze is fixed upon the horizon.
Yours faithfully, Ingrid Goodman