We have neglected to deal with the mentally and criminally insane
The recent fire at the National Psychiatric Hospital in New Amsterdam, Berbice raises serious questions. The entire incident, including the physical injuries suffered by the inmates, reflects the government‘s inability to competently manage the nation’s civil mental healthcare system.
In their 2014 report, the World Health Organization WHO estimated that globally, less than
5 percent of general government health expenditures were allocated to address mental health, and additionally that this figure was significantly less in lowerincome countries (WHO, 2015). Plainly stated, mental health does not enjoy parity with physical health in terms of budgeting and attention, and this creates an unintended hierarchy where mental health is ranked lower than physical health. Addition of the element of criminality to the mixture only serves as a further carburant. The link between psychiatric illness and criminality is complex and has profound societal implications. At the correctional/court level, the term “not guilty by reason of insanity”, now changed in other parts of the globe to “not criminally responsible on account of mental disorder”, considers mental illness in terms of protection of self and others, re-offending and treatment needs when deciding on individuals to be remanded or sentenced to long term psychiatric institutions. A judge can order an individual to be hospitalized or remanded for a psychiatric exam if the person is deemed a danger to himself or others. The government is tasked with ensuring patient care and safety while in the institution.
When an individual is remanded, a variety of stakeholders such as: society in general, doctors, nurses, nursing educators, patients, governmental agencies, legislative bodies, accrediting agencies etc., have a duty of care in ensuring that patient care is safely delivered and that no harm occurs to the patient, either at his hand or those of others.
Patient safety is an essential and vital component of quality nursing care. Reports stated that the fire started by an inmate, took place in the late evening, in an area that housed inmates remanded or sentenced to the institution from the court. What manner of security checks were the inmates subjected to? How often were area checks conducted? What was the staff-patient ratio especially given the underlying criminal element? Were any smoke alarm/ water sprinkler systems in place?
As a result of the incendiary act seven inmates are hospitalized at the New Amsterdam Hospital with burns and other injuries to their bodies. In well-run institutions once the fire alarm has been activated, all staff are required to immediately
cease what they are doing and attend the vicinity of a fire alarm. Designated personnel then coordinate an evacuation response to ensure the safety of people in the building; this may include a disruption to the service on account of evacuation or relocation.
At the base of this tragedy lies the enigma that must be addressed if a recurrence or continuance is to be averted and avoided. Does the National Psychiatric Hospital fit the bill, as a residential Treatment Centre for the mentally ill? Or is it only an institution in name, and within its walls the name of the game is shifting blame? Escapes involve breaches of physical and possibly procedural security, not to mention exposure of security weaknesses, all of which certainly speaks to the rationale behind the egress of twelve mentally ill inmates. After the arson act, Regional Chairman David Armogan reiterated that he had made efforts to beef up security,
following the recent death of another inmate during a brawl in the same ward of the institution.
Instead of security the call should be for “beefed up” mentality.
An independent Commission should be created to investigate the recent incident, as well as the death resulting from the past brawl. Those found responsible, regardless of their mental status, “sane’, “plain” or just “feign” should be punished to the full extent of the law. Negligence should not be overlooked with condign treatment for guilty parties, even staff members.
Meanwhile, security measures such as enclosure of the perimeter of the institution should be immediately instituted. On a cautionary note, of satisfactory height to deter scaling, but better still made completely of concrete thereby displaying the best of Guyanese masonry.
The not-so-newly elected government is now called upon to take a more serious look and approach to mental health and criminal justice as it affects the nation at large. As clear as can be there is a call for a revision of mental health policies. Mental health should be a national policy, and political will at national level is most needed, to support mental health in public policy, (including a high profile for mental health within the Ministry of Health, liaison with other ministries and a Cabinet Committee for mental health.)
However, it is important to firstly identify and engage key agencies and stakeholders so that there is shared ownership of the vision and its implementation. Progress should be regularly reviewed using a variety of outcome measures.
What rehabilitative/ treatment services, if any, were available to those sent from the prison to the National Psychiatric Institution? What criminal justice policies that affect individual(s) with mental illness are currently available in Guyana?
This sad saga has a lesson to the government brought that while focusing on oil our national gain, we have neglected to deal with the mentally and criminally insane.
Aleuta continua ———— The struggle continues