The World Health Organization has long stressed the need for mental health care to be decentralized and integrated into primary health care with the necessary tasks carried out, as far as possible, by general healthcare workers rather than by specialists in mental health. This is especially critical in developing nations like Guyana where mental health specialists are in very short supply, but the need for the delivery of mental health care is acute. According to the WHO, “By making 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. Furthermore, “research has shown that emotional and psychological distress may be an early manifestation of physical disease processes, or may itself cause such diseases (the mind/body connection).” Thus, “an important concept in primary health care is that health activities should develop horizontally to involve other sectors working within the community…intersectoral collaboration, involving governmental and non-governmental organizations is important in all areas of health.”
In fact The Caribbean Voice is among entities and commentators that have been calling for teachers, police officers, general health care workers, priests, moulvis/imams and pandits as well as social science majors at the University of Guyana to be trained in basic mental health care. Additionally, as Guyanese born, Dr. Lear Matthews pointed out in a recent article, “The University of Guyana, through its Social Work Program, must play a prominent role in research, program design, prevention and treatment of mental illness.”
Incidentally, we note that the Minister of Social Protection, Volda Lawrence, has been pushing collaboration with respect to tackling gender-based violence. In the Guyana Times of December 19, 2015, the Minister is quoted as saying, “We will be seeking help from churches, non-governmental organizations and groups of similar nature that are community based… It’s a collaborative effort, and these groups will liaison with the ministry officials who will work together in dealing with the problems.”
This need for an inclusive, holistic approach to mental heath care is imperative, given that, according to a 2008 WHO report on Guyana, “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. These projections do not include the number of patients with epilepsy and mental retardation (developmentally disabled), which are not surveyed in typical psychiatric epidemiologic studies, but are included in the population serviced by mental health care services in Guyana.”
Collaboration then is the pragmatic avenue through which good mental (and overall) health can be effectively achieved, in spited of the constraints of resources and facilities. Dr. Gregory Popcak, author, pastor, counselor and psychologist, has identified nine components of good mental health, among them:
➢ Attuned Communication—the ability to pick up on the meaning of subtle, non-verbal, physical cues (facial expressions, tones of voice, posture) that indicate another person’s emotional states and degree of well-being.
➢ Emotional Balance—the ability to maintain optimal emotional functioning; to be emotionally stimulated enough to be aware and engaged in impacting circumstances and relationships but not so emotionally stimulated to be regularly flooded by one’s own feelings and be carried away by them.
➢ Response Flexibility—the ability to pause before acting on impulses and to willfully change the direction of one’s actions if doing so is better than the dictates of one’s initial impulses.
➢ Fear Modulation—reducing fear. People with anxiety and panic disorders, especially, have a difficult time modulating the brain’s fear responses. They become easily flooded with anxiety where others might just experience nervousness or even excitement.
➢ Insight—the ability to reflect on one’s life experiences in a way that links one’s past, present, and future in a coherent, cohesive, compassionate manner. In sight helps one to make sense of both the things that have happened in the past and the things that are happening now.
➢ Empathy—Essentially, empathy is the ability to have insight (as defined above) into other people. Empathy is the ability to imagine what it is like to be another person, and to reflect on their experiences in a way that links their past, present, and future in coherent, cohesive, compassionate manner. Empathy helps one to make sense of other people’s lives, the way they think, and their feelings.
➢ Morality—the ability to imagine, reason, and behave from the perspective of the greater good. This includes the ability to delay gratification and find ways to get one’s needs met while understanding and accommodating the needs of others.
These aspects of good mental health can go a long way in positively impacting a range of issues that are mental health related: suicide which has reached crisis proportions and gender-based violence, child abuse, alcoholism, violent crimes and sexual crimes which are all significant issues. In effect the nexus between mental health and violence is a tangible one.
This nexus is referenced in the Kaieteur News editorial of December 19, 2015, which stated, “Mental illness is the major contributor to displacement of the children…It explains the growing band of young criminals who seem to have no regard for life or limb.”
It must be pointed out, however, that the mentally ill are not any more predisposed to violence nor are they more proactively violent, than the population in general. However, mental health imbalance is a definite factor in violence. For example alcoholism is known to be a factor that impacts both gender based violence as well as suicide. And alcoholism may very well be a product of mental imbalance –emotional imbalance, reduced response flexibility, lack of appropriate insight, and other maladaptive behaviors.
Additionally, it is generally accepted that a correlation exists between a nation’s mental health (as a component of overall health) and its economic growth. According to the World Health Organization, the positive impact that health has on growth and poverty reduction occurs through a number of mechanisms, such as a reduction of production losses due to fewer worker illnesses, the increased productivity of adults as a result of better nutrition, lower absenteeism rates and improved learning among school children. This relationship also allows for the use of resources that had been totally or partially inaccessible due to illnesses. Finally, it allows for an alternative use of financial resources that might normally be destined for the treatment of ill health.
Given these realities, it is so important that the collaborative approach to mental health care, be regularized across Guyana instead of being applied in a piecemeal, random manner. For example, there is one social and welfare office located at Anna Regina in Region Two, manned by three probation officers and one child protection officer. Additionally, that region also has an advocacy centre which offers forensic interviews, crisis intervention, counseling, trauma focused therapy, parenting sessions, child and family advocacy, referrals (medical examination), social services, case review, tracking, and education and prevention – teenage pregnancy, gender based violence. Why not have both centers offer the full range of combined services as well as services related to other mental health issues such as suicide, alcoholism, rape and incest, drug use and so on? And why not expand the child advocacy centers in Regions Two, Three, Four and Five to include this entire set of services as well? Already these centers bring together, in one place, professionals involved in the investigation and treatment of suspected child abuse cases as well as those who provide support to victims, witnesses and their families, so some of the required staff would already be in place for the additional services.
As well, where possible, buildings owned by NGOs can be used to set up such similar centers. For example the New Jersey Arya Samaj Humanitarian Mission’s Port Mourant Center is available according to by Pandit Suresh Sugrim. And The Caribbean Voice is aware that other such buildings may also be available for this purpose and can help to source them. This level of collaboration would save capital expenses and maximize resource deployment and utilization, while ensuring the delivery of quality mental health care, especially when operating in tandem with a decentralized and integrated primary health care system. Additionally, it can be the basis on which every region can have at least two such offices as probably a short to midterm plan.
Besides, as the Kaieteur News editorial, cited above, also pointed out, “One expects the government to provide the people who would be the counselors and the psychiatrists, and in a country like Guyana where money is not at a premium such an investment may be worthwhile. The Ministry of Education may wish to consider one or two professional counselors in the schools. This would certainly reduce the extent of errant behaviour. It would also help the child, on becoming adult, to be more receptive to the approaches of a professional counselor.”
Simultaneously, while the government must be commended for its intention to undertake minor repairs to the National Psychiatric Hospital, it is quite disappointing that much needed rehabilitation will not commence anytime soon. This, in spite of the fact that the Region Six Health Committee Chairman, Haseef Yusuf, has disclosed that the condition of the institution is inhumane and it is equipped with supplies of poor and sub-standard quality; an inoperable canteen; an acute shortage of basic items in the kitchen; leaky roofs; no fans are in the ward; shortage of beds; dysfunctional washrooms; and a deplorable laundry facility, including shortage of clothe-lines. Additionally, there are issues such as a huge, unfenced gas tank next to the kitchen, lengthy delays in processing purchase orders, the constant flooding of the compounds, among others. Hopefully, funds for major rehabilitation would be made available in the upcoming 2016 budget, as the nation’s only in-patient mental health facility, needs to function maximally.
Furthermore, we strongly urge the nation’s VIPs, celebrities and influencers and shapers of society to step forward and become advocates for various issues relating to mental health. This, along with a sustained effort by the government health sector and other stakeholders, is absolutely necessary to delink mental health issues from the existing stigma, prejudices and biases, including benevolent ones.
Also, as someone pointed out on the Stabroek News blog, former Miss Universe Guyana, and Miss World Guyana ought to, at the minimum, continue to be associated with the causes they espoused on their campaign platforms during their respective reigns. Those, like Lisa Punch, who have set up their own organizations, must be commended. Others can align with any of the existing organizations, as such associations can lend more visibility to the organizations and their work.
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