Tackling mental health problems remains tough challenge, says Ramsammy

-ministry charting suicide profile

Faced with consistently high suicide rates and the prevalence of alcohol and substance abuse disorders, Health Minister Dr. Leslie Ramsammy says improving mental health is one of the key challenges on the health agenda and he referred to it as a priority area.

The increase in depression cases though minimal has also triggered concern within the sector, he said, as the need for building and implementing effective solutions increases. He admits that suicide has been difficult to address. Suicide has ranked seventh of the ten major causes of death in Guyana for years, averaging around 200 deaths annually. It comes in behind ischemic heart diseases, diabetes, HIV/AIDS and hypertension among other diseases.

Ramsammy said that the ministry has long recognized that one of the greatest causes of morbidity in the country is mental health. Confronted by the problem and faced with calls for a more effective strategy, the ministry has recently implemented what Ramsammy described as “a follow-back programme,” aimed at studying suicidal behaviour in an attempt to identify early signs.

Ramsammy explained it as going back to every suicide case and working with the families “to begin to chart a profile” and raise critical awareness among health care providers and social workers  “so that they have a better way of looking at somebody and concluding that maybe we should be doing more work with this person.” “It is impossible to sit here and ask who in Guyana is about to commit suicide and we can go in and prevent it, but if we take the cases that have happened already and study them it might give us clues as to what to look for,” he pointed out.

Ramsammy said that the ministry realized a short while ago that not enough of a “post-mortem of suicide cases” had been undertaken. He called it a critical observation, saying that the sector needs to accumulate knowledge on suicide cases to frame a more effective response. He noted that there are some clues, like persons with a tendency to express ending their lives, people who are alcoholics, persons who are substance abusers.

He disclosed that the final draft of Mental Health strategy was destroyed in the fire which destroyed the ministry, adding that officials are in the progress of reconstructing the document.

But even as focus increases on the follow-back programme, he said there is a need for a public awareness campaign on mental health as was done with HIV/AIDS since, according to him, “people still treat this illness like it is connected to some unknown force.”

He referred to comments about “possessions” and “people getting do” as those which are part of public beliefs which goes against genuine mental health diagnosis. He declared that the public needs to be on onboard as they lift the mental health profile in the country. The minister said that it is clear from assessing what is currently being done in this area that “the mental health profile in the country needs lifting.”
Critical investment

Ramsammy notes that the burden of disease caused by mental health and the investment in mental health did not match over the years, adding that low levels of investment are often equated with high levels of morbidity. But he stresses that this is a problem globally.

He said that Guyana has never invested as much money as it is now in developing training programs, noting that over $300M has been allocated to mental health. He said that the investment is critical and “indication that we are trying to walk the walk and not just talk the talk.”

There is a willingness on the part of government to do more, he said, but cited problems such as limited human resources. He said that greater emphasis is now being placed on training, observing that the country only has three psychiatrists-Dr. Maiyda in Berbice; Dr. Bhiro Harry at the public hospital; and Dr. Frank Beckles in private practice. He noted that they supplement sometimes with a Cuban doctor at public hospital. “It is true that much of mental health can be managed and many of the things for which they treat people at national psychiatric hospital, but we need more trained persons in the system and continued investment in this area,” he explained.

As the Ministry sharpens its focus on mental health, he said, that they have to begin to confront a number of things, including substance abuse.  “I believe that addressing the substance abuse problem will impact on many persons affected by suicide,” he noted. He said too that they also have to deal with depression, since studies have shown a great co-relation between depression and suicide. Currently there are developed guidelines for depression which are in use in the system.

By identifying the major contributory factors for suicide and initiating the follow-back programme to address suicide, Ramsammy believes that the health sector will reduce the number of cases but not eliminate it. Further, he said the ministry intends to do map community assets to identify resources available in each community and how they can be incorporated into the mental health strategy. The drive to de-centralise mental health has been ongoing for sometime, he said, noting that the ministry refers to it as backyard surveillance. “The person who is going to commit suicide rarely knows that he/she needs help, it is somebody around them who cares who would know,” the minister said. He noted that they are looking to empower individual households to start putting the pieces together and make persons more aware.

He stressed that whatever the ministry is doing has to be a collective response inclusive of public involvement, adding that “we have to start getting people to think about it, not to conclude what it is but to begin the suspicion.”
Suicide statistics

Suicide rates have always been high in Guyana, with figures dating back to 1988 being particularly high. But according to Ramsammy, data collection from the 1980s was not as reliable. He said the figure in 1988 was 144, but considering an estimated 30 percent underreporting it could have been higher, at around 200.

The figures for suicide have held constant since 1988. Statistics from the Ministry of Health’s Suicide Surveillance Unit reveals suicide deaths ranging from 201 in 2003 to 186 in 2004. In 2005 there were 171 deaths, followed by 202 in 2006 and 186 deaths in 2007. The numbers from last year are being compiled.

Most of the deaths occurring between ages 15 and 49 and as to where it there are occurring in terms of location, the region with the most recorded deaths has been Region 6. With the exception of one year, 2004, Region 6 has ranked above all other regions. Region four follows behind, with the majority of cases recorded are on East Coast and East Bank Demerara.

Regions 2, 3 and 5 are the other regions with several suicide deaths. In recent times there have been a few cases in region 1, 9 and 10. Most years there have been no suicide deaths on record in Regions 7 and 8.

The statistics also show a gender imbalance that tilts towards men, with figures showing that 156 men died by suicide in 203 while 47 cases were reported for women. Between 2004 and 2007 the male cases more than doubled that of women.

In terms of the nature of suicide deaths, pesticide ingestion has been the leading cause of death. During the period 2003 to 2007, there were 117, 113, 100, 112 and 118 suicide deaths respectively, by pesticide ingestion. Out of 201 deaths in 2003, 117 persons ingested pesticides and similarly, out of 186 deaths in 2007, 118 persons committed suicide by drinking pesticides.

The second most used mode is hanging, strangulation and suffocation; 65 deaths were recorded in this category in 2006 with figures showing an average of 45 in the other years. Other methods recorded include people ingesting poison, others burning themselves and gunshot wounds. Figures indicate that people also overdose on medication drugs such as valium, but the numbers have been low.

Prioritizing mental


Ramsammy said that there has been a push regionally and globally to put mental health high on health agendas and to keep it there. He said that Guyana, through his advocacy, has been pushing for a mental health discussion in the region, and that the response has been positive. On September 7 a three-day regional workshop on suicide is scheduled for Trinidad where Guyana, Suriname and Trinidad are expected to address the issue in depth. Ramsammy said that they also hope to share experiences.

But at the end of the month he said that the Directing Council of the Pan American Health Organisation (PAHO) is putting up mental health as the main subject for discussion. “This is important because we have talked about lifting the profile of mental health here and it is about to be raised regionally,” Ramsammy said.

In addition, he noted that Guyana has received tremendous support in drafting its national suicide strategy earlier this year from its international partners. He referred to PAHO as the major partner in suicide prevention while noting too that Dalhousie University in Canada is another important partner.

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