Growing problem of mental health still plaguing Guyana

…new holistic approach to be implemented – CMO

By Kristen Macklingam

The latest information provided by the Pan American Health Organisation/World Health Organisation (PAHO/WHO) suggests that the challenges of mental health in Guyana consume more resources than HIV/AIDS, malaria and tuberculosis (TB) combined. This is an idea of the extent of the problem.

While mental health issues have been dealt with from a reactionary standpoint over the years, Guyana’s Chief Medical officer (CMO), Dr Shamdeo Persaud, in an exclusive interview with Guyana Times on Monday stated that a more holistic approach is needed to tackle mental health, which has become an unpalatable pill to swallow.
“What we have started to do is started to develop the Primary Healthcare Integrated Mental Health Programme. So our efforts, with support from PAHO, have been to implement training on the mental health treatment gap. It is a module that PAHO developed that allows us to train the primary care doctors who are general practitioners on measures for mental health intervention.”
He explained that the Public Health Ministry is aggressively pursuing tackling the issue of mental health challenges in Guyana and, therefore, the focus is no longer on only deploying social workers and psychologists in every region by 2020 to tackle the growing problem of mental disorders. The Ministry now has a much broader goal.
“So it is just not psychiatry now, it is mental health and the Mental Health Unit of the Ministry has about nine modules that are being done with regard to training these primary care doctors throughout the country. So in addition to the gatekeeper programme, which was an intermediate programme where we were training community members, in this instance, we are training health professionals, doctors, nurses and other categories of health workers to establish community-based services. So that is our main thrust at this point in time,” the CMO further stated.

Recruitment of psychologists
Presently, there are some voluntary groups which assist the Public Health Ministry in relation to providing much needed services in addressing mental health issues, however, there are now more psychologists available to help Government-run health facilities in identifying and treating mental disorders.
“We have been working with those voluntary groups, and in addition to that, we also now actively recruit psychologists at the Ministry. So we have nine psychologists who are working with us. Also, several institutions have also started to employ psychologists, including the Georgetown Public Hospital Corporation (GPHC) and they are providing counselling support along with the social workers.”
Dr Persaud elaborated that all of the above is in keeping with consolidating the Primary Healthcare Integrated Mental Health Programme towards the direction of “service delivery”.

Community capacity development
According to the CMO, focus will still be placed on the capacity development of communities to tackle the growing problem of mental health issues and this includes the Gatekeepers’ Programme that armed communities with lay counsellors who took proactive action to not only prevent the act of suicide but also addressed various forms of abuse.
“We will revisit again the Gatekeepers’ Programme and some other community-based efforts but what we want to do is build capacity in the communities among the health professionals first. This year, by the end of this year, we will make a decision on how we go forward with any additional supporting mechanisms at the community level. We do have some support groups and we still have the PEER Education Programme for drug demand reduction and those two still are running – the general support groups and the PEER educators programme.”
The PEER Education Programme was an initiative adopted some years ago that saw youths across Guyana being trained as peer educators to help tackle the social ills that were/are affecting various communities.
Additionally, the Suicide Implementation Plan also caters for a number of partnerships to be developed with stakeholders to raise awareness as a means of reducing suicides and suicidal attempts while simultaneously strengthening the supporting network for persons who are in need of counselling services.

Stigma and discrimination
Touching on the issues of stigma and discrimination associated with mental health conditions, the CMO posited that targeting this problem is high on the agenda of the Public Health Ministry.
“Persons who display mental health illnesses are even excluded from their own families. You see a lot of persons living on the streets and they have mental health issues and then they fall into drug abuse and it just becomes a desperate cycle of despair. We recognise that deficiency and we hope that community interventions can help to start addressing that stigma.”
Dr Persaud added that a lot of stigmas associated with mental health disorders are rooted in how both families and communities react and respond and that although it may take a while for the Public Health Ministry to develop and implement a programme that could address this problem, public education is one of the first steps in overcoming it.
“It might take a little while for us to put a programme in that could address it but definitely public education, I think, is one of the first steps.”
According to PAHO/WHO, half of all mental illness begins by the age of 14, but most cases go undetected and untreated. In terms of the burden of the disease among adolescents, depression is the third leading cause.
Suicide has been identified as the second leading cause of death among 14-29-year-olds while the harmful use of alcohol and illicit drugs among adolescents has been pointed out as a major issue in many countries and can lead to risky behaviours such as unsafe sex or dangerous driving.
PAHO/WHO is of the view that much can be done to help build mental resilience from an early age to help prevent mental distress and illness among adolescents and young adults, and to manage and recover from mental illness.
“Prevention begins with being aware of and understanding the early warning signs and symptoms of mental illness. Parents and teachers can help build life skills of children and adolescents to help them cope with everyday challenges at home and at school. Psychosocial support can be provided in schools and other community settings and, of course, training for health workers to enable them to detect and manage mental health disorders can be put in place, improved or expanded,” its website states.