Dear Editor,
The Caribbean Voice (TCV) is thrilled that the need for updated Public Health legislation will be addressed during the next sitting of the National Assembly, according to Attorney General and Minister of Legal Affairs, Anil Nandlall. We sincerely hope that this process will also see two other things:
A legislative framework for the integration of mental health into the current health-care system, as advocated for by the World Health Organisation (WHO), which stated in a 2008 report on Guyana that, “The current mental health system in Guyana is fragmented, poorly resourced, and not integrated into the general health-care system. Care of the mentally ill is provided under the legislative framework of the Mental Health Ordinance of 1930, which is antiquated and fails to make provisions for the protection of the rights of people with mental disorders”.
This situation remains basically true twelve years later.
According to the LANCET Psychiatry website, “The need to integrate mental and physical health-care is indisputable. Health-care professionals know that people with severe mental illness are dying up to 20 years earlier than the general population, partly due to physical ill health, and they now know that this mortality gap is widening despite current efforts. Meanwhile, a high proportion of people with long-term physical conditions continue to be diagnosed with mental illness, around 30%, and as many as one in three primary care consultations can concern medically unexplained symptoms.”
With an estimated 25% (empirical evidence suggests that this figure is much higher today) of the Guyana population affected by mental illness, this integration is especially critical for developing nations like Guyana, where mental health specialists are in very short supply, but the need for the delivery of mental health-care is acute and the cost of private mental health-care is astronomical.
According to the WHO, “By making health-care workers sensitive to the presence of mental health problems, and by equipping them with skills to deal with those problems, much wastage of efforts in general health care can be avoided, and health-care can be made more effective”. Furthermore, “research has shown that emotional and psychological distress may be an early manifestation of physical disease processes, or may itself cause such diseases (the mind/body connection).” Thus “an important concept in primary health-care is that health activities should develop horizontally to involve other sectors working within the community…intersectoral collaboration, involving governmental and non-governmental organisations is important in all areas of health.”
We are aware that this process of integration was started under the previous PPP/C government, but it has been travelling at a snail’s pace while the mentally ill, by and large, continue to be abandoned, isolated, ignored, and suffer acutely while issues like suicide, sexual and gender-based abuse, and alcoholism continue to bestride Guyana at great costs.
Meanwhile, TCV hopes that as Attorney General Nandlall pilots the updating of Public Health legislation, cognizance would also be taken of the need to update the 1930 Mental Health Ordinance, not only to protect the rights of the mentally-ill, as the WHO pointed out, but also to ensure that outdated practices would no longer have legislative support; new technology, including virtual and telehealth practices, would be embraced; and attitudes to mental health would be ‘updated,’ so stigmas, taboos, myths, misinformation, labelling, discrimination, and lack of understanding, empathy and compassion will all be coherently and consistently addressed. Protocols to license counselors must be put in place to prevent all sorts of quacks from portraying themselves as clinical counsellors and causing greater harm, a reality that TCV can testify to with numerous examples. And reputable NGOs with the requisite skills ought to be embraced and their work fostered, so as to make mental health-care accessible across the land.
Sincerely,
The Caribbean Voice
