In his 2017 budget speech Finance Minister Winston Jordan assured the nation that government would be prioritising mental health and also training more professionals in this area. The goal is to train 300 health professionals in addition to the 250 trained last year.
Jordan also spoke of the construction of a Mental Health Institute which is expected to commence in the second half of 2017. Overall, the administration has earmarked $31.2 billion, or 12.5 percent of the budget for the health sector this year.
But since the presentation of the budget there has been a growing dissatisfaction with the administration’s strategy (or lack thereof) for the delivery of effective mental healthcare services as the system continues to fail citizens in need of quality treatment.
Over the years there have been many incidences of persons allegedly of unsound mind being found dead under mysterious circumstances, or else participating in attacks on persons resulting in grievous injury or death. In March this year, a farmer from Moruca was brutally hacked to death by a man allegedly of unsound mind.
The recent discovery of Patricia Amanda Ronald’s decomposing body on a dam in Vreed-en-Hoop, West Coast Demerara again raised the question of the treatment of mentally ill citizens and whether adequate care is available. Ronald, according to relatives, had been mentally ill for the past 20 years and was a patient of the Psychiatric Clinic at the Georgetown Public Hospital. She had attended clinic just days before her body was found.
In our society, negative attitudes towards mentally ill patients remain stubbornly entrenched, and we often dismiss patients like Ronald as “mad” or “crazy”, disregarding serious diagnosis such as schizophrenia, bipolar disorder, depression, substance abuse and addiction, and anxiety and panic disorders. It is highly unlikely that society has grieved over her demise, and one wonders as to the extent of the resources dedicated to finding out why and how ‘Patsy’ Ronald died.
Mental health problems, including alcohol abuse, are among the ten leading causes of disability in both developed and developing countries according to the World Health Organisation (WHO). In particular, depression is ranked third in the global burden of disease, and is projected to rank first in 2030.
As highlighted in WHO’s Mental Health Action Plan 2013-2020, a number of evidence-based, inter-sectoral strategies have been effective in promoting, protecting and restoring mental health, well beyond the institutionalization approaches of the past. Properly implemented, these interventions represent ‘best buys’ for any society, with significant returns in terms of health and economic gains.
Prior to this government’s installation, the state’s mental health programme had suffered due to a lack of adequate human and financial resources and a lack of leadership in this critical area. While the administrations over the years have been trumpeting improvements in mental health care, not a single strategy has been implemented with visible positive results for more than five years.
For its part, the Public Health Ministry announced the establishment of a Mental Health Unit and hosted a Mental Health Conference for teenagers from a few schools in the city. In addition to its partnership with the Guyana Police Force and the setting up of a suicide hotline, this has been the full extent of any policy action taken. In short, there is no existing national mental health programme in the country and this has been the case for a considerable length of time.
Apart from the Berbice Psychiatric Hospital, there are the clinical services and treatment available at the Georgetown Public Hospital (GPHC). This means there is very little available in terms of temporary specialized housing for individuals struggling with mental health issues who may be a risk to themselves or even to the public at large.
It is not an uncommon sight to see persons who seem to be of unsound mind wandering about in the streets, potentially being a risk to others and to themselves on the basis of the stigmatisation that is attendant on their mere appearance. In January 2013, a police rank was allegedly attacked with a knife and cutlass by Jermaine Hamilton – a man apparently of unsound mind. Residents reacted by inflicting a beating on Hamilton who died from the injuries inflicted, being pronounced DOA at the GPHC.
Persons with mental health problems should not have such a difficult task accessing the right professional support and treatment, while also struggling with ingrained public attitudes that promote stigma, discrimination and isolation. In the world today, the best mental health services extend beyond diagnosis and treatment to tackle the stigma attached to mental illness, and the inevitable discriminatory practices that flow from such stigmatisation.
In the case of Patricia Ronald’s death and others like it, the spotlight is placed once more on the apparent lack of policy and action in the area of mental health in Guyana, and whether the government, through the relevant agencies, is doing enough in this area.
Since the Minister of Finance spoke about the construction of a Mental Health Institute and human resource training in his budget speech, there has been much upheaval within the Ministry of Public Health necessitating a change in the leadership and the appointment of a new Minister. However, this new Minister almost immediately became embroiled in her own controversy and one wonders what progress is being made regarding the promises in the budget.
The mental health of our people should be placed on the front burner, but with all the contretemps, tumults, and uncertainty in the leadership, it is difficult to determine exactly whether anything is actually happening.