Linden healthcare professionals take on challenges in mental health

– aim at expanding, improving service delivery within Region 10


With 453 active patients enrolled within the Mental Health Clinic at the Linden Hospital Complex (LHC) in Region 10 (Upper Demerara-Berbice), staff attached to the Department are on a mission to improve service delivery and spread mental health awareness.

LHC staff – (from left) Nurse Holder, Alicock, Smith-Gray and Dr Ananguren (extreme right)

Presently, the team of professionals are in the process of rehabilitating a section of the nearby former hospital in an effort to expand mental health services to the region.
The mental health team comprises of Cuban Consultant/Psychiatrist Dr Sandra Gilart Ananguren, Social Worker Laurette Smith-Gray, Nurses Dexter Holder, Tricia McKenzie and Anna Langhorne and a visiting Psychologist from Georgetown.
Speaking with Guyana Times, Dr Ananguren believes mental health issues are quite prevalent within the region, owing to the number of patients presently attached to the clinic. For 2018, she noted, over 900 patients were seen at the clinic.
“That’s why we are trying to expand the service. For this year, we’ve had a considerable amount of patients. In January alone it was 133 patients coming to the clinic. Then, February we had 107 patients”, Dr Ananguren explained.
She noted that for a while now, the team has been conducting a four-day a week clinic as opposed to what was done previously which saw clinic being hosted just once a month. Conducting clinic once monthly, the doctor noted, has proven to be ineffective, especially since the team has not only been catering for patients in Linden, but other parts of the region, including Kwakwani and Ituni.
Dr Ananguren is presently the only resident consultant/psychiatrist in the region and is on call 24 hours daily. As a means of easing the burden on patients who have difficulty accessing the clinic, the team has begun conducting home-based visits on Fridays.
“What we do on these home visits, is we go and find out their actual mental stage and sometimes we carry medication for these patients as well. We do some psycho-education, like counselling, to the relatives as well because the patient’s care is important as well in the process. It’s not the patient alone, but the entire environment,” Dr Ananguren related.
The clinic offers counselling, psychotherapy and neurological treatment and patients are admitted if necessary. While patients are admitted mainly through referrals, the clinic is opened for anyone desirous of mental health assistance. Following evaluation, patients are treated based on the level of their mental state. One of the nurses is trained in psychology and is able to provide counselling under Dr Ananguren’s supervision.
Social Worker Laurette Smith-Gray’s job is to intervene in social aspects of patients’ lives apart from the medical attention. She said persons visit her office for several issues and based on assessment, she is able to refer them to the psychiatrist or psychologist.
She explained that the psychologist would conduct psychotherapy without administering medication while the psychiatrist would diagnose and treat when necessary.

Mental associated disorders
The Social Worker explained that mental health covers a variety of disorders.
“Mental health expands widely, it covers a wide range of problems…we have persons who may come in and they’re severely depressed…experiencing anxiety, suicidal tendencies, substance abuse and persons who’ve been in substance abuse for a long time and want to desist from those habits and they are experiencing withdrawal symptoms”, she noted while adding that the clinic also caters for walk-in patients.
Depression, she noted, is a common disorder detected, as she pointed out that it is not always severe.
“Depression can be at varying levels. You can have moderate – maybe you’re experiencing mood swing or you’re experiencing a situation that seems to overwhelm you, and then there are persons who might be clinically depressed – severely depressed. When it comes to those cases, it is definitely for the doctor to review those persons and administer medication if necessary,” Gray explained.
The Social Worker posited that they have received numerous cases of persons trying to harm themselves through attempted suicide. Then there is the issue of persons leaving the clinic against medical advice.
“The procedure is that as long as the person is brought to the institution under those conditions, they must be seen, reviewed or evaluated by the social worker, psychiatrist and the psychologist…the problems we have been experiencing…is that persons will self-harm, be brought to the institution for medical attention but at the end of whatever attention they would have been given they think it’s okay for them to leave the institution…this should not be,” she warned.
Smith-Gray explained that if someone is self-harming, it is an indication that they are a threat to themselves and those with whom they associate.
She revealed that the policy stipulates for persons to be admitted for at least 24 hours for observation while an assessment is being conducted.
“They may not display outward aggressive tendencies but the mere fact that you can harm yourself, it can lead to other things,” she noted.
However, according to Dr Ananguren, 24 hours is just not enough. She opined that such patients should be admitted for 72 hours and in extreme cases, for a week. “Especially if there are children involved in the house environment,” she stated.
Dr Ananguren is calling on family members to play a more integral role in assisting patients and mental health professionals.
“Sometimes we can do but we don’t have all the resources,” she explained.
Noting that the community is a very religious one, the Social Worker encouraged that persons displaying symptoms of mental health disorders be evaluated by a medical professional, especially in cases of suicidal attempts.
“Suicide and suicidal tendencies is a cry for help and I know that our society is a very spiritual one. So in most cases, families, when they would have recognised a family not behaving in a normal way, they tend to seek spiritual help first. My advice…even though you have a right to your belief…it is still necessary for you to have your family members evaluated by medical personnel…Generally, some people do believe that it’s demons, but still, use the option of seeking medical attention,” she urged.

Children and adolescents suffer too
Highlighting that mental illness affects people of all ages, the team of professionals has embarked on a sensitisation campaign in schools to assist students, teachers and parents. In January of this year, the team commenced its visits to schools in the form of an “anti-bullying” campaign. This initiative started in nursery schools.
Apart from Linden, Kwakwani has also benefitted from the initiative.
“Because we realise that there are certain problems that are affecting the child’s mental health since they are small. Problems such as bullying…” Dr Ananguren pointed out.
She noted that the team has since been invited to be at Parent Teacher Association meetings and the initiative has received a positive response from teachers and parents.
“We teach them how to identify some of the negative effects that these children can suffer, from emotional aspects to delay in the learning process,” Dr Ananguren related.
At Kwakwani, the initiative also focused on substance abuse, depression and suicidal tendencies in teenagers, aspects which Linden will soon benefit from. It also targets primary schools in the region. The team noted that they have so far been warmly welcomed into schools and the response has been great from both students and teachers, with them receiving requests from other educational institutions for student counselling.

Stigma and Support
According to Dr Ananguren, the stigma attached to mental health issues and suffering brings a “heavy load” to society and majorly affects those with addictive tendencies. She noted, however, that there has been a reduction of patients with suicidal attempts in the region over the past few years.
“Since we have started to run our activities here, the incidence of admission in the hospital decreased so far. So I feel it is a positive aspect. The incidence of suicidal attempts, at least for the past two years in my opinion and according to the records, have been decreasing.
“…but that doesn’t mean that they don’t need us anymore…because still, due to the stigma, we have people not coming to the hospital on time, not seeking help when they have to,” she said.
Smith-Gray also alluded that cases of repeated suicide attempts have decreased since many seem to overcome their situations and are empowered following counselling sessions. She noted, however, that attempts are more prevalent among women, most of whom experience some form of domestic violence.
Public Relations Officer (PRO) attached to the hospital Toshanna Alicock also pointed to the stigma attached to mental illness in the region.
“Nobody wants to be mentally ill, but when persons are diagnosed with it, the society has a stigma that they portray to these patients. Maybe because some of them are violent, maybe because some may say things that don’t make sense to us, but that doesn’t mean that it is something that they’re doing wilfully. Some persons are just not conscious enough. Some may have a laidback approach to move away from that person, until that person is your family member. Then you don’t have a choice but to try and help them…you don’t have to wait until it’s your family member, you can offer support to any person you think might need help,” she noted.
Further, she pointed out the importance of family members playing their part by uplifting medication for these patients, noting that oftentimes they are unable to do so themselves. She also stressed the importance of them ensuring that patients take their medication on time.
Nurse Holder also encouraged families with members who suffer from suicidal tendencies to have them attend the clinic, noting that oftentimes, suicidal attempts are caused by repeated unpleasant scenarios experienced by the sufferer.
“And many times people wouldn’t say, they would show signs – like they start losing interest in almost everything,” he said.
Nurse Holder added that family members of sufferers also need help in dealing with patients, noting that it is challenging.
“Because sometimes they don’t know how to deal with the situation and how they choose to deal with it can escalate the situation further…it’s a great challenge and they themselves need some amount of counselling and guidance…So it’s good for you to come in and talk to someone with a little more knowledge on how to deal with situations like these…the family needs support as well,” he said.

Future plans
Dr Ananguren said the team is aiming at enhancing delivery within the Mental Health Department with the establishment of a daily hospital scheme.
“It’s our interest, our purpose to create specific activities to improve the mental health conditions in our population here because it’s a lot of patients we already have attached to this clinic,” she said.
The aim, she noted, is to incorporate development skills in an effort to have mentally challenged patients reintegrated as useful members of society.
“Some of them have an acute episode, some because of circumstantial events in life and with the help we can provide them…they can go back to the society, especially the young ones,” she said.
The team also plans to develop psychotherapy for specific groups of patients such as neurological and those with addictive tendencies, as they noted that young people are seriously affected by the abuse of drugs and alcohol. They have already begun developing a campaign against drug and substance abuse.
There are also plans to develop a special support group for school teachers to identify students with addictive tendencies to have them undergo psychotherapy. The team plans to collaborate with the Education Ministry and Guyana Police Force with this initiative. Dr Ananguren said the team also plans to make the anti-bullying campaign an annual initiative since bullying is a serious issue with serious consequences, including mood disorders and suicide attempts.
Additionally, the team plans to develop a psycho-education group for pregnant teenagers and has already established links with the hospital’s antenatal clinic. “Because pregnancy is a hard process, especially if you’re a teenager with no experience, sometimes no support, family support or financial support,” Dr Ananguren highlighted.

Importance of mental health and the need for more awareness
Social Worker, Smith- Gray believes that mental health awareness is necessary and is everyone’s business, as mental illness affects persons of all ages.
“We have instances of early childhood and adolescent disorders. Being ignorant of these situations or disorders can cause us to maltreat, isolate and put persons in a state that is not fair to them. Because we might be ignorant of the fact of what that person might be experiencing. It can even cause abuse…so it is the business of everyone to grasp as much knowledge as possible on all mental health issues,” she said.
Pointing to cases of geriatric patients who experience dementia and autistic children, the Social Worker said a lack of knowledge causes family members to become frustrated.
Smith-Gray also stressed the importance of taking care of our mental health.
“Our mental status, we can and should pay keen attention to, because if that is altered, then it affects our decision-making…the way we relate to others, how we deal with everyday stress,” she said.
Meanwhile, Alicock said it is important for the public to know that mental illness is real and the hospital is doing its part to educate and treat persons.
“Education plays a big part. The more aware that persons are that it’s not just something that people make up or imagine, that it’s a real illness, the closer we get to actually treating these patients so that we can integrate them back into society,” she said.
She also pointed to the growth seen in the Department over the last few years.
“The expansion and growth that we’ve seen in the Mental Health Department, it goes to show our commitment to not only the residents within Region 10 but to the society as a whole. It fits into our mission statement, which says that we offer compassionate care. That is one of the greatest aspects of mental health. They take on a challenge that most other persons are not willing to take on or they don’t know how to take on – how to deal with these patients. We have a well-rounded team of persons who can deal with these patients effectively and it is my belief that this Department will continue to expand. And we will continue to take on more projects and programmes to educate persons to create that awareness so that our society can actually help us to help our patients,” she noted.
Alicock said the hospital also does its part in ensuring that staff dealing with mental health are educated through annual lectures and sensitisation seminars.
She noted that with the expansion of the Mental Health Department, there is need for more of these. Alicock said patient load is increasing tremendously due to the increase in the number of days the clinic is being hosted, stressing that mental health awareness should be an overall approach which should include all of society.
In Guyana, the Public Health Ministry’s Mental Health Unit’s mission is to “promote, coordinate and implement technical activities and actions directed towards strengthening the national capacity to develop policies, plans, programmes and services, thus contributing to the promotion of mental health, the reduction of the burden of the psychiatric diseases, prevention of disabilities, and the development of rehabilitation”.
According to a recent Pan American Health Organisation (PAHO)/World Health Organisation (WHO) report, mental health issues account for more than a third of the total disability in the Caribbean and Latin America. This includes substance abuse, with depressive disorders amongst the largest cause, followed by anxiety disorders.