Mental health in Guyana…Lack of psychiatrists, facilities, support

Since 2009 a mother has been struggling with her mentally ill son who had a promising future, but she has been frustrated by the system.

For the last four years this mother, who because of the stigma attached to the illness prefers to remain anonymous, has been going “back and forth” in her attempt to get help for her son who has also become addicted to alcohol.

He was in his late twenties with a good job when one day he was not himself and walked off the job. After she took him to see a psychiatrist he was placed on medication which he later complained was making him unwell, and consequently refused to continue taking it. She got him other employment but he kept walking off; however, she continues to seek help for him.

Gail Teixeira
Gail Teixeira

“I can’t let go, many have given up on him but I can’t, but when it gets bad I would walk out, I would pick up my computer and so on and leave the home for a while…” the mother told the Sunday Stabroek recently.

She is left at his mercy even though she has had a committal order for him since March granted by a magistrate. However, she has been unable to get the police to enforce the order even though she has been running to the station every so often.

The order is still in her car but it is no longer valid, as its seven-day lifespan has long since expired. Despite this, the mother continues to live with her son whenever she can and refuses to throw him out as he would then end up on the streets, and that is the last place she wants him.

It has been twenty years since the PPP/C government took office against a backdrop of increasing numbers of mentally ill persons on the streets, but still there does not appear to be a comprehensive plan to address the problem. Mental health experts spoken to by this newspaper point out that the numbers of doctors and the facilities available remain woefully inadequate, in addition to which law reforms have not been made. At one point there was a mass rounding up of the mentally ill so that they would not be visible on the streets during a major event, but this was not followed up by any attempt to secure treatment for them.

Minister of Health Dr Bheri Ramsarran and his lead psychiatrist in the public system, Dr Bhiro Harry, are still to answer emailed questions sent to them over a month ago on the issue of mental illness, but Presidential Advisor on Governance Gail Teixeira, who once held the portfolio of Minister of Health, does not agree with many, even on the government side, that the legislation should be changed to make it possible to take persons for treatment without a court order. Her view is that it must be clinically decided first that someone is insane and when this is done then they can be taken off the streets and given treatment.

Dr George Norton
Dr George Norton

Immediate past Minister of Health Dr Leslie Ramsammy would only say that the legislation needs to change when approached, but in 2009 while he was Minister of Health he had admitted that mental health had been sidelined both here and regionally for years because of minimal investments and general neglect. Back then he had called for a paradigm shift in how the problem was tackled. The health sector had seriously overlooked the problem, Ramsammy had acknowledged, but observed it can no longer be ignored given the burden of suicide on public health and its consequent impact on development.

But the issue continues to be ignored according to APNU’s shadow minister of health Dr George Norton. “The number of psychiatric patients on the streets of Georgetown is a direct reflection of the state of the country, and if there is one indication to point in the direction of… a failed state, this is one,” Dr Norton said.

He noted that those on the streets would have been in various stages of illness before they eventually began to live on the street, and eventually they would stop begging, eat out of the garbage and walk around with no clothes in some instances.

Programme Coordinator of the Guyana Human Rights Association (GHRA) Merle Mendonca noted that there is still a social stigma attached to the issue in the same way as it is for those who are different or have different types of diseases. People still refer to cancer as the ‘big C’ and HIV/AIDS as the ‘big truck’ she pointed out, adding that people don’t understand mental illness even though those suffering from it are seen on a daily basis walking the streets in Georgetown and other urban areas.

She noted that some of them are attacked and abused and over the years some of these individuals have armed themselves, even with cutlasses, perhaps as their only form of protection.

Cathy Hughes
Cathy Hughes

“There is an acute shortage of trained medical personnel in the field and we would emphasize that [lack of] psychiatric care throughout the country is chronic, and there are no established services to assist the families of individuals with mental illness, their teachers or the judicial system…” Mendonca observed.

For years, she said, only a single doctor and three nurses were responsible for all out-patients and a non-English speaking doctor joined them later.

“Given the chronic shortage of staff, lack of supervision and treatment management for decades why are we still so shocked that the abuses are multiplying and resulting  in deaths in some instances?” she asked.

‘National problem’
Dr Norton called for a revolutionary approach to be taken to attack the issue head on, commenting that stark poverty contributes to the volume of persons suffering from mental problems as in some cases they don’t have enough to eat and don’t have the basic amenities one needs in life. The availability of illegal drugs on the streets is also a problem, and Dr Norton said that Guyana has a national problem on its hands.

He said before the psychiatric ward at Georgetown Public Hospital Corporation (GPHC) was burnt down it was always filled with patients and he wondered what happened to the persons who had gone there for treatment since all of them could not be accommodated at the Canje institution.

 Dr. Leslie Ramsammy
Dr. Leslie Ramsammy

Norton said that in the late eighties a Guyanese graduated as a psychiatrist and he returned to Guyana and worked at the GPHC, and that now in 2013 he (Dr Bhiro Harry) is still the only Guyanese government psychiatrist.

“Now are we serious about mental health problems if it would take two decades or more before you can get persons trained in that particular area?” asked Dr Norton, adding that while he agreed that it is a primary health care concern and all must be involved, including nurses and health workers, there is need for experts.

He said that the government has to send the young doctors to train to become specialists and the conditions must be sufficiently encouraging for them to do. There is a perception that doctors do not want to be “tied” to the government for more than five years, but it is rather that they feel opportunities are not available.

Dr Norton, who is a trained eye specialist, said there is need for a psychiatrist in all the regions because the issue does not only exist in Georgetown.

“There must be a way of solving this problem, but there must exist also the desire, the political will and the support in order to find solutions,” he said, adding that the medication must be made available.

“If we don’t have oral dehydration solution available in a major regional hospital… if we don’t have panadol syrup would we have those… fancy medications?” he remarked, going on to say that there is a problem in the health system where the availability of adequate medication is a concern.

Meantime, Teixeira said if a psychiatrist decides that after treatment the patient is improving they would then have them attend the outpatient clinic.

“And sometimes that is when they slip off the bandwagon and stop coming to the clinic, but people cannot be sent to Fort Canje unless they go to court and are certified as being insane,” Teixeira repeated.

But is there accommodation for them?
“Yes, you have the psychiatric clinic…” Teixeira responded, and even after it was pointed out that there are only two doctors working in the public system she maintained that the issue is diagnosis, after which it is a question of treatment and counselling where counselling is required.

Outside of people on the streets there are people in this country who are mentally ill who live a normal life go to work and can be very difficult people to work with and live with, and they are being treated; some are not treated because they refuse to go a psychiatrist and be treated,” Teixeira said.

The former health minister feels that given the number of the domestic violence cases seen mental illness maybe their root cause.

Asked if she was satisfied with the manner in which the government has handled the issue, Teixeira said she is not necessarily satisfied but again said that one has to be conscious about the human rights issue, and that the mentally ill on the streets have rights like everyone else “who think we are normal.”

“Until a psychiatrist with a competent authority under the law that says that this person should not come out of the psychiatric ward… but they cannot keep them for life in there if they are diagnosed as being mentally insane they have to be certified by a court of law and the court has to be convinced…” she said, indicating that is the way it is done internationally and locally.

“The issue is not as black and white as the press carries it,” she said.

Complaints
According to GHRA’s Mendonca over the years the association has received complaints of brutality meted out to mentally ill persons by citizens, vigilante groups, inmates in police lock-ups or prisons or by members of the GPF. Unfortunately, she said, there is still a trend for the GPF and the courts to confine mental patients who have broken the law in prisons without recognising their condition. This situation has caused considerable disruption in the already over-crowded facility.

“Not only mentally ill persons face violence but they also face neglect, discrimination and misunderstanding by public institutions including the health care system,” Mendonca said, noting that numerous news reports over the years have highlighted the lack of adequate care and treatment for these persons.

She further pointed out that the National Psychiatric Hospital in Berbice that most people still commonly refer to as the ‘asylum’ or the ‘madhouse’ is the only residential facility for housing long-term mentally ill patients in Guyana. In 2008 she recalled that a mentally ill patient set fire to the psychiatric ward at the GPHC that burnt down, and that this along with the many media reports should have triggered an enquiry.

She said the GHRA is aware that only basic generic drugs are available for treatment in the two main public health systems, and as a result anyone requiring specialized medication or a particular brand is out of luck unless they can pay for it privately. Up to late last year, she continued, it was understood individuals could wait months before they were able to see a doctor. Those who are untreated also have a reduced capacity to advocate on their own behalf to fight for an appointment.

“We should ask ourselves what happens to families with mentally ill persons in far flung areas,” she said.

Meantime, Alliance for Change (AFC) Cathy Hughes said that the fact that the psychiatric ward at the GPHC (there is a holding room with about four beds at present) has not been replaced would give the impression that not much importance is placed on mental illness.

She recalled being at the emergency room at GPHC some Christmases ago at around 9am and the seats were all taken and the atmosphere was very humid, and a person of unsound was screaming and shouting. The only response they got from the attending nurse was to shut up and go outside.

Hughes gave this example to illustrate that there is no place that is taking the mentally ill and there is no facility they can go to directly and receive counselling and pre-emptive care.
“We have to recognise it as a real health issue, and not describe it as persons going mad; we have to put the facilities in place,” she emphasized, adding that there is need for specialized psychiatrists and psychologists to deal with them.

The AFC parliamentarian noted that the entire society is at risk, and that it appears that while there is a system in place to train doctors at a first degree level there are limited approaches to have them specialize.

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