Mental health and the prison system

Recently, the violent arrest, by members of the City Constabulary, of a man said to be of unsound mind shocked many who read about it in the formal news media, or viewed it on social media and television. The very next day, that same man was shot dead by a City Constabulary member while he allegedly tried to escape custody.

This incident is a stark reminder that mental health as an important issue in Guyana has been placed so far back on the back burner as to appear to have fallen off the stove entirely. And it wasn’t too long afterwards that the acting Director of Prisons, Mr Gladwin Samuels acknowledged the increasing numbers of “vulnerable persons” being incarcerated, with the number of known mentally ill prisoners within the prison system totalling 75 persons. The comments of the acting Director of Prisons were made against the backdrop of the opening ceremony of a United Kingdom funded ‘Handling of Vulnerable Prisoners’ Training Course on February 5th.

Minister of Public Security, Khemraj Ramjattan, also speaking at the commencement of the Handling of Vulnerable Prisoners Training Course, pointed to the final report of the James Patterson Commission of Inquiry and noted the difficulties encountered not just by mentally ill prisoners, but also physically disabled, sick, and HIV-positive inmates, acknowledging a key concern that, “Sometimes the prison staff is totally unaware of their special needs and the requirements for special treatment.”

There are many cases of mentally ill persons being placed before the courts in Guyana and subsequently sentenced to prison time. It would seem that in the absence of adequate and functioning mental health facilities in Guyana, the prisons have become a repository of sorts for those mentally ill persons who run afoul of the law. But this is not a scenario limited to Guyana alone.

In the much vaunted bastion of democracy and all things good, the United States of America, a 2014 report by the Treatment Advocacy Center (a non-profit organization dedicated to making treatment available for severe mental illnesses) has openly stated that “prisons and jails have become America’s ‘new asylums.’” Slate.com reporting on the issue and citing the Treatment Advocacy Center’s report, writes that, “Ten times more mentally ill people are now in jails and prisons than in state psychiatric hospitals: In 2012, approximately 356,268 inmates with severe mental illness were in prisons and jails, while about 35,000 severely ill patients were in state psychiatric hospitals.”

This mind numbing statistic relates to inmates with “severe mental illness” and when one considers that this terrible tragedy is occurring in the United States of America, one is left to wonder at the potential for a similar occurrence here, or even the possibility that the situation is already statistically worse here in Guyana.

This is not to debunk the stated number of 75 mentally ill inmates given by the acting Director of Prisons. Unless the Guyana prison system has the capability for diagnosing mental illness among its inmates, then we have to assume that the number of 75 mentally ill given by  Mr Samuels is based on persons declared mentally ill by the court before being sentenced to prison time. The National Psychiatric Hospital in Berbice is said to house approximately 200 patients, so by current comparison the ratio of mentally ill prisoners to patients is only 37%. However, it is quite possible that the number of mentally ill inmates in the Guyana prison system can be much higher.

The Ministry of Public Health does indicate that it runs a clinic at the Georgetown Prisons where mental health services are available; however, there is little indication that it has had any kind of positive transformative effect on the lives of the 75 inmates that the authorities say make up the full complement of mentally ill inmates in the prison system.

In his 2018 Budget Presentation, the Minister of Finance said that “mental health also remains a major concern for Government” and that they (the government) “expect to train almost 500 health professionals over the period 2017-18 to better detect and treat mental illnesses.” However, blasé statements like these have replicated themselves in budget speeches over many years, and do not usually result in any tangible or visible improvements in the areas that they purport will benefit.

Despite the concerns for the treatment of the vulnerable inmates, including those mentally ill within the prison system, there should be equal concern shown for the treatment of the mentally ill in society at large, particularly those who live economically challenged lives. Indeed, it is not uncommon to see violent beatings being meted out to drug addicts or ‘junkies’ for various infringements, mostly stealing, by victims or representatives of victims.

Drug addiction is a form of mental illness as it changes the way a person’s brain operates, and disrupts the normal hierarchy of needs as defined by Maslow. The disdain and disrespect felt by many in society for such persons quickly result in them being seen as less than human and they are routinely exploited for labour and a merciless beating can follow any infringement. This type of treatment of the mentally ill can only be exacerbated in the narrow confines of a penitentiary.

Any solution to our growing mental health problems cannot be achieved without the government itself, through the Ministry of Public Health, leading from the front and prioritising the completion of several projects critical to mental health issues. The rehabilitation and adequate staffing of the National Psychiatric Hospital in Berbice, the completion and setting up of the Mental Health Institute – also with adequate and specialist staffing ‒ and specialised mental health diagnostic testing for prisoners with the aim of identifying and treating cases of severe mental illness in the prison system, are some of the steps needed to avert a mental health crisis.

 

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