Guyana is in a mental health crisis of sorts

Dear Editor,

It was distressing reading the papers of Saturday, December 1, with their description of the cruel and demeaning squalor in which the country lives.

Mr Nazar Mohamed, whose business is in the heart of the mess, tells of numerous contacts with and complaints to City Hall. All fruitless. His call is for us all to take the discontent beyond simple discontent and to start doing something. Starting with City Hall.

There is also the letter from Mr Sultan Mohamed, graphic in its depiction, and particularly touching as an example of the way normal human beings respond to the tragedy of seeing our mentally ill brothers and sisters reduced to this.

He makes the point that community and even ethnic organisations should re-organise to do more. I recall Swami Aksharananda and Ravi Dev among others, sounding the alarm about suicide rates in some parts of Guyana and I think an action plan of some sorts was proposed if not implemented.
Then there is, on the same day, a professional’s approach by Ms S Nageer in which it is made clear that the health administration could and should do more for the mentally ill.

What Mr Mohamed’s letter makes clear is that the neglect by the government and social forces is only part of the problem. There is also our own bad habits.

The peeing wherever nature calls, the littering and abandon of waste in the public way, the impotence or indifference of those responsible,  not only for cleaning up after us, but also for the public education and repression that should be the administrative reflex after the automatic revulsion.

I live now in a country where fifteen to twenty per cent of the population is estimated as suffering from some type of psychological disorder at some stage of their life.

A 2004 World Health Organisation study shows that in general 26% of  Europeans and 24% of the population in the United States have been troubled by depression and other illness, occasionally leading to suicide. Globally, it is felt that one in ten people are afflicted at some time of their life.
The statistics do not translate into a generalised incapacity or 25% of hospital beds occupied by the anxious or disconnected. The figures seem more to indicate levels ranging from prolonged unhappiness to depression, to include the three or four per cent that would have to be restrained and eventually placed under care. It fixes the relationship between mental disturbance and suicide, for example.

By these measures, Guyana is in a mental health crisis of sorts. A public health crisis. Certainly the politicans imposing upon us a dirty city are themselves in need of care and rehabilitation. We, in thrall to the demon of the racism of some, and apparently dirty by habit, have reached a level of tolerance with the filth.

Apparently it may be thought the price to pay for this or that political end. Apart from the filth, itself an indication that something is wrong with many of the people in a country, there is that visible and growing of human distress in the presence of the wandering mentally ill. At least something needs to be done about this along with fixing the garbage collection and equipping the public pissers, perhaps with more urinals.

In Guyana the breakdown of the mental health services has been rapid. Most of us growing up would remember the time when the publicly ‘mad’ were a few known characters. Fewer in the countryside than in town.

Then, for reasons that must have been the subject of a study somewhere, the seventies seem to have seen the explosion/ exteriorisation of problems at a mental health level. People I knew had ‘nervous breakdowns.’  In some cases drug induced. And it was shameful, some years ago, to arrive with foreign born and based family and to come upon a totally nude man roaming unmolested on High Street. A youth man from the Essequibo Coast I knew idles, spaced out, with the band on Bourda Green. We recognise each other. He tells me he had spent years in jail and now had no home.
There evidently existed no halfway house or re-integration structure and probably not enough psychiatrists and other professionals.

The work of Help and Shelter and similar institutions is clearly not large enough or sufficiently wide for the numbers and varieties of the abandoned, the vagrant, the abused, the hungry and all the other categories of victim that we continue to throw up. Ms Nageer mentions the need for trained specialists. In France, as in Germany, the number of psychiatrists is about 10 000 nation-wide for seventy and eighty million people respectively. Ms Nageer says in Guyana we now have two. Given the size of the country this is difficult to manage, one imagines.

It would appear that successive governments have done little to improve the conditions. I emerged from a reporter’s visit to the New Amsterdam psychiatric hospital in the early eighties thankful to God that we had been spared such a fate. Witnessing mental health problems is, distressful. I learn that it has been much improved. I understand that Dr Leslie Ramsammy made much effort to solve the problems when he was at the Health portfolio. But apparently the system is just overwhelmed. And clearly under-managed in some areas.

Mental health in the Caribbean and under-developed world is a complex problem, with cultural aspects to take into account. In our case there are social and ethnographical dimensions to the situation that perhaps need reviewing. I read a newspaper report from the sixties that mentions a study which broke down the type of mental health problems by race. Afro-Guyanese it said, were more prone to neuroses, Indians to psychoses. Amerindians appeared at the time to have been affected hardly at all. Impossible now to decide on the value of the data and conclusions…

The mental health problem in the society is manifest not only in the street, but also in the levels and types of crime. And before it hits the street or emergency ward, it would have been manifest in the homes, schools offices, reception desks, police force. Suicide rates are generally felt to be a prime indicator of mortality due to mental problems. Another would be murder rates. The explosions of domestic violence and persistence of  high rates of suicide in some segments of the population have to be broken down by age, race, zone of residence. And the responses of the various communities to this phenomenon need to be exposed.

But the rise in common crimes like armed robbery and the joblessness and despair that could be contributory causes suggest that the political leadership has to look at a total approach to the regulation of the social sphere. Not only help to the beggars on the streets, but also improvement of institutional care, recovery of street dwellers, creation of a cleaner environment.

There is, if we are to acknowledge the sages, a link between the discourse, public and private, that we emit, the deeds we commit, and the quality of life we generate around us. Clean the city, yes. But clean the whole thing while we are at it.

Yours faithfully,
Abu Bakr            

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