The Caribbean Voice (TCV) absolutely agrees with the Director of Mental Health, Dr Util Richmond Thomas, that smart employers do foster their employees’ positive mental wellbeing. Such employers develop policies that support employees by ‘normalizing’ mental illnesses as health conditions that carry no shame; facilitate access to care and adopt effective work re-entry programmes for individuals with mental health problems. Employers who want to maximize work productivity need to know that they will have greater success when they spend some time and resources on addressing mental health at the office.
The fact is that six in 10 people say poor mental health has impacted their concentration at work, meaning that they are physically present but seriously underperforming. And then there are millions of workdays that turn into sick days each year due to mental health problems ‒ 70 million in the UK, 32 million in France, 18 million in Germany. One in ten employees has taken time off work for depression. One in five employees will have a mental health condition over the course of their careers that impacts performance and requires time away from work. And workers have partners, parents and children who also may have mental health conditions requiring extra attention at some point. Addressing employee mental health needs comes with a cost, but ignoring mental health in the workplace is not an option; the costs triple and quadruple when we turn a blind eye, which doesn’t make any cents. The fact is that just $1 of investment in treatment for depression and anxiety leads to a return of $4 in better health and ability to work.
Stats are not available for Guyana, but each year in the US, mental illness accounts for the loss of 217 million workdays and costs $193.2 billion in lost earnings. And the World Economic Forum estimates that the cumulative global impact of mental disorders in terms of lost economic output will amount to $16.3 trillion between 2011 and 2030.
A 2008 World Health Organization report on Guyana stated that, “75,000 to 112,500 Guyanese suffer from mental disorders and require some level of mental health care services. Of these, approximately 22,500 to 37,500 would be expected to suffer from severe mental illness. One can easily estimate the massive losses to employers and the economy because of this reality, especially since today, those figures would be significantly higher.
It is in recognition of these realities that TCV launched our Employees Mental Health Workshops last year, which like all our other workshops is offered for free to businesses. Among the issues addressed in the workshop are depression and anxiety, self-esteem, coping strategies to handle stress and challenges, self/wellness care, abuse in all forms and suicide. The workshop is interactive and uses the facilitative delivery method and the KISS approach, that includes ice breakers; diagnostic and self-knowledge questionnaires; use of fact sheets, posters and other ancillary materials; role play, simulations and games; Q&A; case studies and anecdotes; use of enabling technology such as power point slides, videos, virtual charts and graphs.
While we urge businesses to take advantage of our workshop we also once again call on the government to heed the WHO’s call for mental health care to be decentralized and integrated into primary health via a coherent and concerted national process. According to the WHO, “By making [all] 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”.
In fact this approach has been highly successful in Zimbabwe and Uganda in particular, among many other nations. In Zimbabwe lay health workers screen for common mental disorders, including depression and anxiety. For those who screen positive, a lay health worker delivers problem-solving therapy with education and support. Those who receive the intervention improve and look better six months later, compared to usual outcomes. As well, local community members without formal mental health education can be trained to deliver basic psychotherapy services as is happening in Uganda. One of the first randomized controlled trials for mental health in low and middle income countries was a landmark study of group interpersonal therapy in war-affected Uganda. The intervention led to large and significant reductions in depression for participants.
Also an innovative study in Chile demonstrated that stepped-care for depression in primary care works better than treatment as usual. The Chilean government translated the research into policy and depression is now a priority health condition, with depression treatment included in Chile’s national insurance plan. In Guyana, depression and anxiety treatment should also be covered by the National Insurance Scheme.
As well, we urge the Ministry of Health to make sure that mental health professionals are available 24/7 at public hospitals, and where there are psych wards, mechanisms, including signage providing directions, must be put in place to make access to such wards easy and quick for anyone seeking help, given that delays and consequential frustration/anger can lead to loss of lives.
Also, the media recently reported the case of an individual with mental health issues sentenced to imprisonment in the court. This begs the question as to whether magistrates and judges should not first mandate psychiatric evaluation and treatment for such persons, if deemed necessary. Perhaps government should ensure such a mandate is in place.
Meanwhile TCV is thrilled that the Public Health Ministry has decided to offer counselling to family members of teenage murder victim Leonard Archibald. We also hope that this marks the beginning of a policy that would embrace all families of abuse ‒ sexual, gender based, child, alcohol and drugs ‒ as well as suicide survivors, and that the offer of counselling would not be selectively offered. We also urge that all regions follow the example of Region Two, which, in collaboration with The Caribbean Voice, recently set up a committee to visit families of suicide and abuse victims in order to ensure that any necessary counselling be offered as needed. Towards this end the region also recently acquired the services of a psychologist.
Finally, we believe that Guyana should join other nations such as the US and UK and mandate counselling in all cases where mental health issues are identified, especially at workplaces, schools and homes. This would ensure that employers, in both the private and public sectors, become responsible for the mental well-being of their employees and consequently become the smart employers that Dr Util Thomas referred to, and that is desirable.