He posted a heart wrenching appeal, some time after midnight, a few days on the face book page of The Caribbean Voice (www.caribvoice.org), asking for help because he was having familiar feelings of the kind that had driven him to attempt suicide once before. Immediately, some members of the group sprang into action. As we engaged him in chat, someone from the Mental Health Unit of the Ministry of Health joined in and quickly phone-messaged a counselor. It took a while, but eventually the doctor called and set up an appointment for him at the Georgetown Public Hospital, at eight am. We continued to engage him until he went to bed sometime after two that same morning, promising that he would do nothing foolish, but instead would keep the appointment the following day.
As daylight chased away darkness, he informed us that he was keeping his appointment, thankful that he was getting professional help. But his arrival at the hospital created confusion and frustration as no one could direct him to the doctor he was seeking. Frustration was turning to resignation as he texted that he was leaving and going to the seawall to end it all. As one member of The Caribbean Voice kept him engaged, the same personnel from the Mental Health Unit, who had put him in connection with the doctor, hurried to the hospital, some two hours plus after the 19 year had arrived. Yet it took that person almost another hour before she could connect him with the help he needed.
The young man was given attention but refused to stay over for observation, as he was under the popular misconception that only ‘mad’ people are held back at the psych ward and he most definitely was not mad. And while he initially agreed to keep the subsequent appointment some three days later, he later changed his mind. So, The Caribbean Voice continues to engage him, as we usually do with regards to all our cases, hoping that we can still persuade him to take the additional counseling.
This experience begs the following questions:
1. Why was it impossible for hospital staff to direct the young man to psych ward? Surely this information should be available at reception desks and known by all staff?
2. Why was there no mental health professional to meet with the young man until close to 11 am even though he had an 8PM appointment? Surely the staff at the mental health unit knows that delays and consequent frustration can concretize the final act of suicide?
In any case the young man is in an upbeat mood, since he found a temporary job, as his lack of employment was a trigger for his suicidal mindset, especially since it clearly created tension between him and his parents with whom he lives, and for whom he feels responsible. And, having once before attempted suicide, suicide ideation came very easy to him. Frighteningly, however, is that youth unemployment is 40% according to the Caribbean Development Bank, a state of affairs that is fertile ground for youth suicide ideation and actual suicides, and may well already be impacting both, given that so many suicides go unreported. Thus our concern that government seems to be going back on its election campaign promise to provide jobs for the youth. While we applaud the efforts being undertaken thus far, especially by the police and the First Lady, we strongly urge that these be extended nationwide, be as inclusive as possible and be followed by job placements, perhaps in collaboration with the various business associations. We suggest too that all high schools implement summer, work study internships for students moving into fifth forms and perhaps extend this to weekends/evenings where possible during the fifth form years. A job placement program is also needed for all tertiary level educational institutions.
Alarmingly too, the myth that dealing with counseling and the psych ward or the psychiatric institution means someone is ‘mad’, holds tremendous sway in Guyana and that may be why transparent and obvious warning signs are ignored by care givers and loved ones. Far too often, after a suicide, we hear or read that so and so had talked about wanting to take his or her life but those around him/her thought he/she was joking and/or did not take that person seriously. Thus TCV strongly urges the Ministry of Health to embark on a sustained education campaign to combat this myth. As well, we urge the Ministry of Health to make sure that mental health professionals are available 24/7 at public hospitals, especially where there are psych wards and that mechanisms, including signage providing directions, 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.
This particular case also brings to the fore the suicide hotline. Empirical and anecdotal evidence indicates that Guyanese are hardly utilizing the hotline and we do recall that an appeal last year for figures to be released was met with deafening silence in spite of claims of its success. The Caribbean Voice has been publicizing the hotline via our self-esteem pledge which has been distributed to schools and communities in many parts of Guyana. However, it is critical that the Ministries of Public Security and Health embark on an ongoing, national campaign to make the suicide hotline a household item and to encourage citizens to make use of it with the promise of absolute confidentiality every time. As well statistical and related evidence proving its extensive use and success ought to be made public, as this will bolster wide spread confidence in its effectiveness. After all, it would have been quicker for the young man to call the hotline and get help than to reach out to TCV via Face book.
On the issue of confidentiality, TCV has also found that too many Guyanese are still skeptical of counselors and counseling because of claims that confidentiality is not often kept. In fact, the grapevine revealed that a suicide prevention activist, who committed suicide last year, might have done so partly because the confidentiality she was promised was breached. That is why the promise of confidentiality with regards to the suicide hotline is so absolutely critical. And perhaps that is why, far too often, those seeking help emphatically refuse counseling in Guyana and/or by Guyanese, when we place that on the table for them.
Also, this case and many others that TCV has handled over the last two years, make it clear that mental healthcare has to be national in scope and easy of access. Thus TCV reiterates its call for mental health care to be integrated into the physical heath care system, per the recommendation of the World Health Organization, for nations like Guyana. And we urge that a look be taken at the Shri Lankan Model in this respect, as that nation has Very successfully implemented this integration.
For the record our interventions are pro bono and while we do have our own complement of counselors we also do sometimes refer cases to various counselors in Guyana with whom we have developed relationships, and who also offer their services free of charge to our referrals. Incidentally, not all of our cases are related to suicide. In fact we have handled domestic violence, sex abuse and rape, child abuse and alcoholism cases as well, and while most of our cases are from Guyana we have dealt with cases in a number of other countries as well, since people seek us out through our Internet and social media presence.