A series of incidents in short order has underlined longstanding concerns about the quality and reach of mental health services in the country. It is even more troubling as it pertains to a cohort of patients with likely diminished capacity to represent themselves, whose rights are not respected and for whom there is weak advocacy outside of family circles. It is a matter that the Ministry of Health, its Mental Health Unit and the Ministry of Human Services should urgently address.
Earlier this month at the National Psychiatric Hospital, a Canefield, East Canje, Berbice man was killed, while another from the same village was injured. Ryan Satesh Sunthgolam, 41, was rushed to the New Amsterdam Public Hospital where he was pronounced dead on arrival. Steve Lionel Roberts, 38, was injured. It was reported that a patient pulled out a window and grill mesh which he used to inflict the fatal injuries on Mr Sunthgolam. This is not the first time that there has been a homicide at the Hospital and it speaks to the challenges of taking care of patients of a range of dispositions including dangerously violent. It is however the responsibility of the Psychiatric Hospital to ensure that no harm comes to its patients. There will undoubtedly be some type of investigation of this death. Will it lead to effective changes in the care and security of patients? There is great doubt about that.
Within days of this grievous death, a fire was set at the institution which resulted in 11 patients being hospitalised, four of them with burns. In addition, several patients fled the facility. Who had set the fire is not yet known but given the homicide days before the security systems and general administration at the hospital are clearly lacking.
At the end of May, Leonard Reece and Ronald Wong were found dead at Coomacka from chop wounds. Mr Wong who was said to have been of unsound mind had been released from prison in April this year after being incarcerated for attempted murder. He had then gone to live with his uncle, Mr Reece. It is still to be established what transpired but it is believed that after mortally wounding Mr Reece, Mr Wong suffered similar injuries. It is still to be determined whether a third person was involved.
The key concern would be whether Mr Wong has been evaluated on release from prison to determine whether it was suitable for him to be returned to the general population. It is well-known that many families have few options when it comes to care of members with mental issues. Patients are oftentimes discharged to the care of relatives who are remote from any treatment centre as would have been the case with Coomacka on the Demerara River. Which facility could Mr Wong had been referred to if this was necessary and what health services would have been present in that area to assist?
Days later, 56-year-old Wanda Patricia Wilson of Kara Kara, Linden was bludgeoned to death allegedly by her son, Hosia Ageday, who was a mental health outpatient of the Linden Hospital Complex (LHC). Mr Ageday would himself die several days later after complaining of feeling unwell while in police custody. He was taken to the LHC where he was pronounced dead on arrival. A post-mortem examination is being awaited in his case. Was Ms Wilson, a mental health patient herself, in a position to adequately care for Mr Ageday? Was he recently evaluated to determine whether it would be safe for him to live With Ms Wilson? Were medications, if necessary, available to both Messrs Ageday and Wong? These are questions which the Mental Health Unit and the regional health services must pronounce on as the care of mental patient patients has traditionally been given less attention and stigmatised.
As far back as 2008, a report of the assessment of the mental health system in Guyana using the World Health Organization – Assessment Instrument for Mental Health Systems (WHO-AIMS) had said that although there was little epidemiologic data from Guyana upon which to base assessments of mental health service need, “disease burden estimates have recognized the neuropsychiatric disorders as making a larger contribution to the burden of disease, measured in Disability Adjusted Life Years (DALYs), than other diseases such as HIV/AIDS, tuberculosis, and malaria combined. Unipolar depression alone has been identified as the fifth greatest contributor to disease burden in Guyana…”
It had further said that the “…current mental health system in Guyana is fragmented, poorly resourced, and not integrated into the general health-care system. Care of the mentally ill is provided under the legislative framework of the Mental Health Ordinance of 1930, which is antiquated and fails to make provisions for the protection of the rights of people with mental disorders”.
It had also said that mental health services were inadequate and not available or accessible to the vast majority of the population and that stigma against the mentally ill was reported to be pervasive and considered by stakeholders to be expressed by the public as well as by many health professionals, the police, and policy makers and administrators alike.
The report also cited the scarcity of medical professionals in the area of mental health.
“…few adequately trained specialized mental health professionals are available within mental health services. At the time of this assessment there were 3 psychiatrists in the public sector in Guyana, 2 based in Georgetown and one at the National Psychiatric Hospital. Besides these physicians, mental health staff has variable levels of training, and often lack the competencies required to provide adequate quality mental health care.” It concluded that Guyana’s mentally ill were markedly underserved.
It is unclear what changes have since occurred. Legislation remains archaic and the streets of the city and some of the larger towns are filled with persons with varying mental health afflictions some of whom would undoubtedly be amenable to receiving treatment.
In July, 2019, the non-profit, anti-povery organization, the Borgen Project reported that there was a “severe lack of trained mental health professionals. With very few healthcare professionals trained in mental health treatment and those who are trained working primarily in urban centers, Guyana’s most at-risk populations often cannot receive the care they need. Part of the reason there is so few people trained in this field is because Guyana has an extremely high emigration rate…Luckily, the government is mobilizing to address this issue. In 2015, Guyana pledged to a National Suicide Prevention Plan that aims to increase the number of trained mental healthcare workers. Over the past two years, about 120 medical doctors have received training for depression and suicide intervention and are now scattered across the country. The number of psychologists and psychiatrists in the country remains low, at around 27, but has increased from just seven in 2014”.
It added that access to treatment facilities was extremely limited. “Along with the lack of healthcare professionals, access to adequate mental health treatment facilities in Guyana is very limited. There are only two inpatient rehabilitation facilities in the country, and only one allows women. While some people find it easier and more effective for trained healthcare workers to visit their communities, others benefit from and require the immersive atmosphere of inpatient care. More health workers are being trained, but presently there does not seem to be any plans to expand care and rehabilitation facilities”.
The last National Mental Health Action plan ran from 2015 to 2020. It had been developed by the Mental Health Team of the Georgetown Public Hospital Corporation, the Ministry of Public Health and the Pan-American Health Organization and had been informed by consultation which included representatives from civil society, Government Ministries, NGO’s, health administrators, general health professionals, and community and institutional-based mental health care providers. This would be an opportune moment to analyse the impact of the plan, devise a new strategy and promulgate modern legislation to address mental health and the enormous repercussions on society including suicide.
