Barrels of Liquor Flowing at CPL? What’s Wrong With This Picture?


To say that we at The Caribbean Voice are aghast that barrels of liquor flowed at CPL matches at the National Stadium would be an understatement. We do understand that the liquor companies are businesses that must do promotion and focus on the bottom line.
However, we believe it is time for these businesses to recognize that social responsibility goes beyond sponsoring events and activities. To this end we urge liquor companies to recognize the fact that alcoholism is at the very core of many social pathologies in Guyana. We also to urge them to craft and execute strategies that would help to tackle this issue, including statements in their advertisements and commercials emphasizing, ‘responsible drinking’, ‘don’t drink and drive’, ‘no drinking by pregnant women’, ‘no drinking by minors’, ‘regular excess drinking can lead to addiction and various health problems’ and the like.
The fact is that statistics show that the Guyanese drinking culture (rum culture) where most persons “drink to get drunk”, frequently at excessive and harmful levels, is associated with many forms of entertainment and participation in social events. Flowing barrels of liquor at sports actually play into this cultural trait with no consideration given to its debilitating effects, not to mention the messages conveyed to youth and minors, hundreds of whom were at these matches. So what are the quantitative indicators of this trait and what are its effects?
On average, Guyanese, aged fifteen or older, consumed more than eight litres daily of pure alcohol in 2010, compared to the global figure of 6.2 litres, the World Health Organisation (WHO) said in a 2014 report. However, the average drinker in Guyana consumed more than 3.5 gallons/13.7 litres of total alcohol daily. One-seventh of this consumption (14%) was unrecorded – homemade alcohol, illegally produced or sold outside normal Government controls.
About 15.2 per cent of male drinkers (10% of the population aged 15+) engaged in heavy, episodic drinking, that is, consumed at least 60 grams of pure alcohol at least once per month. Also, 8.6% of males and 5.9% of all Guyanese aged 15 and older are classified as having alcohol use disorder (a pattern of alcohol use which causes mental or physical damage to health), with 3.9% and 1.9% respectively classified as alcoholics.
A 1997 study found that 54% of youths aged between 12 and 25 years, were occasional drinkers and 7.5% were regular drinkers. Also, a 2013 survey by Organization of American States/ Inter-American Drug Abuse Control Commission (OAS/CICAD) found that the overall average among the Caribbean (Guyana included) for first use of alcohol was about 12 years old. Furthermore, the average for males was about 11.9 years and for females 12.5 years. The survey also found that Guyana outstripped all the other Caribbean nations in terms of binge drinking among students.
It must be noted that all those figures quoted above would most likely be higher today.
Also, children and young people who misuse alcohol are at greater risk of suffering negative health and social outcomes compared to adults, because they have not yet fully developed their mental and physical faculties. Data and research on underage sexual activity shows evidence that indicates a positive correlation between early regular alcohol consumption and the early onset of risky sexual activity with attendant high risks of teenage pregnancy (Guyana has the highest teenage pregnancy rate in the Caribbean) and STDs, including AIDS (The Caribbean Voice is aware of a number of such cases with at least one young lady becoming suicidal).
While reliable statistics are not available, it is a fact that alcohol has an overall economic cost to all nations and takes a toll on workplace productivity. In fact alcoholism has been identified as a major reason for absenteeism in Guyana’s sugar industry. Other substantial costs to society include property damage, job loss and health service costs. Alcohol abuse has many potential consequences including accidental falls; burns; drowning; brain damage; impaired driving resulting in accidents, deaths and injuries; poor school performance; work productivity loss; sexual assault; truancy; violence; vandalism; homicides; suicides; lowered inhibitions and increased impulsivity; risky sexual behavior including early initiation of sexual behavior and multiple sexual partners often leading to pregnancy and STDs.
Also, it is generally well known that a relatively small proportion of incidents, involving alcohol-related violence, are reported to police, making it difficult to determine the full extent of alcohol-related violence. Media reports continually cite alcohol as an important risk factor for domestic violence, child abuse and neglect. The high rate of alcohol involvement in intimate partner homicide continues to be widely reported. The consumption of alcohol, either by the offender or victim or both, is also a significant contributing factor in incidents of non-fatal domestic violence, with research demonstrating that women whose partners consume alcohol at excessive levels are more likely to experience domestic violence.
Additionally, alcohol use and abuse does often lead to increased family dysfunction and to other family members ending up with mental health problems such as anxiety, fear and depression, as well as increased criminal behavior as alcohol loosens inhibitions and makes it easier for individuals to become prey to peer pressure, and/or to be coerced and manipulated. Who knows whether alcohol may not be contributing to the current high crime rate among the youth (including teenagers) as inebriated youngsters wanting to fit in, became involved in that first act of crime and then its downhill from there. In fact, The Caribbean Voice is aware of a number of such cases.
The direct alcohol death rate for Guyana is 1.6 per 100,000, but again this figure could be much higher today. And since alcoholism also plays a significant part in suicides, and in domestic violence and child abuse, which often lead to fatalities, the overall death rate (direct and indirect) would also be much higher.
Against this background existing realities serve to foster alcohol consumption and alcoholism. According to the WHO, while some countries are already strengthening measures to protect people, including increasing taxes on alcohol, limiting the availability of alcohol by raising the age limit, and regulating the marketing of alcoholic beverages, Guyana has, “No written policy adopted or revised pertaining to the fight against alcoholism, no legally binding regulations on alcohol advertising and product placement, as well as no legal regulations on alcohol sponsorship sales. A national legal minimum age limit for purchase of alcohol exists, however, it is not enforced.”
Furthermore, Guyana has only four in-house alcoholism treatment centers, all of which have high costs associated with their programs, all of which are located in Georgetown and all of which show only about a 25% recovery rate. Then there are:
• The failure of the Criminal Justice system to appreciate rehabilitation as an alternative to incarceration as well as lack of any structured rehabilitation program in prisons;
• A benevolent attitude towards alcoholics and drinking on whole, often with wives and mothers actively fostering this as a social activity among fathers, husbands and children;
• The easy availability of alcohol not only with respect to licensed liquor bars/rum shops openly selling liquor to all and sundry but also with respect to unlicensed bottom house bars springing up all over the place.
So what then, should be done? In addition to the need for liquor businesses to expand their concept of social responsibility as pointed out above and need for the implementation of measures referenced by WHO above, other steps include:
➢ Creating substance abuse-related education, assessment, intervention, treatment and recovery services and making them available nation wide;
➢ Expanding the number of behavioral health provider options in an effort to increase the number of citizens served;
➢ Exploring new funding sources from donor communities for behavioral health programs, services, and providers and increasing gov’t funding for same;
➢ Partnering with NGO’s and Faith Based Organizations to implément evidenced-based prevention programs that teach personal responsibility for one’s health.
➢ Maximizing the use of social media to its fullest public health potential to educate the public, particularly those under the age of 18.
➢ Improving the internal culture at the Health Department by attracting and engaging high quality staff; ensuring professional excellence by concentrating on ongoing professional development and training, providing training funds and tracking all training; developing leadership competencies; and developing a succession plan and mentorship program.
➢ Leveraging technology/infrastructure by implementing an electronic health record (EHR) system.
➢ Establishing at least one Rehabilitation Treatment Center in each of Guyana’s ten regions, which was a goal of the previous government.
It must be pointed out that these measures would not be stand alone ones but inclusive and scaffolding. Thus treatment centers can also deal with drugs and mental health issues. And social media can be harnessed to promote overall health care. Ditto for funding and training. In fact all of this can be built into an integrated health care system, as advocated by WHO, so that resources are maximized and health care becomes comprehensive and inter-related.
Finally, may we suggest that from next year, the government enters into an agreement with CPL to foster awareness of suicide, alcoholism, drugs use, teenage pregnancy, trafficking and related issues. In addition to posters and banners strategically placed around the stadium (and which can be used continuously over time), cricketers can deliver messages via mass media, commentators can deliver messages during commentaries and so on. This collaborative approach is very cost effective and can be a policy that harnesses every opportunity – sports, culture, entertainment, mass assemblies, training programs, festivals and so on. For example Mashramani is another great opportunity to focus on these issues.
There has been enough rhetoric and excuses; it is time for the government to rework priorities relating to the welfare of the citizenry!

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Guyana – A Proposed Model for Integrated Healthcare


Guyana’s chief psychiatrist most recently called for the integration of mental health into primary care. The Draft Mental Health Strategy of Guyana 2015-2020 confirmed ‘minimal numbers of general health human resources with the necessary mental health competencies to provide mental health services at any level of general health care’. Also, ‘there are no national or institutional standards for mental health care, facilities or human resources’. Given the scarcity of psychiatrists, psychologists, social workers, psychiatric nurses and other mental health professionals, TCV backs the call for integration to be implemented using the Sri Lanka Project; a training programme for primary care.
We know from Government figures included in the Draft Mental Health Strategy 2015-2020 that 10 to 15% of Guyanese suffer from a mental disorder at any one time. This means that 78,000 to 114,500 Guyanese are suffering from a mental disorder and require some level of mental health care service with 3 to 5% of the population having a severe chronic mental disorder. Approximately 20,000 Guyanese suffer from severe mental illness with unipolar depression as the fifth greatest contributor to disease burden in Guyana. Suicide is the leading cause of death with the Guyanese rate being 44 per 100,000. These figures do not include people with epilepsy, mental retardation and alcohol abuse.
The Guyana government’s stated aim is mental health for all. Given the prevalence of mental health rates and demands, with minimal available resources as described, it is essential to integrate mental health into primary care to ensure the general population have equitable access.
TCV looked at different models of integration and recommends the Sri Lanka project which was based on an endeavor to establish a systematic ‘Train the Trainers’ programme. This programme was funded by the World Psychiatric Association (WPA) and we urge the Government to explore possible funding from this organisation as a means of achieving integration. In Sri Lanka the WPA allocated funding to train 155 trainers in order to equip the trainers to roll out the mental health training on a continuous basis.
Sri Lanka and Guyana have similar and parallel health care structures. Sri Lanka had very high suicide rates, mental health needs and a Government funded health system that was decentralised with funding by central government and locally by provincial councils, the Guyana equivalent of Regional Health Authorities. There was approximately one psychiatric consultant per 500,000 people, no specialised psychiatric nurses and very few psychologists, occupational therapists and psychosocial workers as in Guyana. Estimating the expenditure on mental health services was not possible since mental health expenditures were integrated within the general health budget. Mental health facilities include one psychiatric hospital, psychiatric beds in general hospitals, outpatients departments and community facilities as in Guyana.
To respond to the burden of mental health, the Sri Lanka project aimed at integration through a Train the Trainers program with the Sri Lanka Ministry of Health working collaboratively with the National Institute of Mental Health and the WPA. People were specifically selected from each region of the country based on their ability to roll out the training to others. Criteria for selection included psychiatrists, medical officers with mental health experience and other mental health professionals who were able to commit time to the subsequent roll out of the training programme to primary care staff.
The Sri Lanka project delivered training to 45 psychiatrists, 110 medical officers of mental health and 95 registered medical practitioners through five courses in different regions of the country. Due to the scarcity of mental health professionals in Guyana TCV would advocate that the criteria for selection be expanded to include religious leaders, teachers, police, social workers, child protection officers and other relevant and appropriate people. Guyana has administrative regions and Regional Health Authorities under the control of the Ministry of Health and links with NGO’s that can be involved and assist with the planning, organising and delivery of the training programme.
Also, the Sri Lanka project for primary care staff was a five-day course over forty hours, which covered five modules. The first module focused on mental health and mental disorders and their contribution to physical health and economic and social outcomes. The second module covered communication skills, assessment, mental state examination, diagnosis and management, managing difficult cases, management of violence and breaking bad news. The third module encompassed neurological disorders, epilepsy, Parkinson’s disease, headache, dementia and toxic confusional states. The fourth module covered psychiatric disorders based on the WHO primary care guidelines for mental health. The fifth module focused on health and other sector system issues of policy, legislation, links between mental health, reproductive health, HIV and malaria, roles and responsibilities, health management information systems, working with community health workers and with traditional healers and integration of mental health into operational plans.
TCV believes the modules and core concepts of the training programme are relevant to Guyana and would recommend the training in its current form. However, we understand that changes may be required in the context of Guyana to include social and cultural differences and an understanding of suicide; its causes, impact and preventative measures.
The course was dynamic and taught through theory, practice, role-plays, discussions and WPA videos on depression, psychosis and somatisation. The emphasis of the course was for primary care staff and others to acquire practical skills and competencies for assessment, diagnosis and management. Participants had to complete 25 supervised role-plays on different topics over the week and to observe and comment on 25 role-plays conducted by others. Each participant was given both a hard copy print out and a CD of the guidelines plus all the teaching slides, role-plays and teacher’s guide. Participants in the training programme were subject to pre-and post
TCV firmly believes that the implementation of the Sri Lanka type project can have impact on two fronts. It can contribute to the development of national and institutional standards for mental health care in Guyana and underpin the Government’s realisation of mental health care for all.

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The Caribbean Voice Invites Nominations for the El Dorado Awards


The Caribbean Voice, an NGO involved in suicide prevention, is inviting nominations for its Second Annual El Dorado Awards to be held in July 2016, date and venue to be announced later.
The El Dorado Awards was launched in August 2015 to recognize affirmations agents on Guyana’s social landscape (see http://www.caribvoice.org/2015-honorees.html for the list of inaugural honorees). Supported by Sueria Manufacturing, Gafoor Group of Companies, Cara Hotel, Metro Office Supplies, Galaxy 21 Communications, Office Resources (New York City) and a sponsor who prefers to be anonymous, the awards was very well received by stakeholders, attendees and the general public and a decision was taken to make it an annual event.
Affirmation agents are individuals, businesses and organizations that give back to communities and causes, promote and support social causes and/or engage in charitable work to empower and positively impact lives. Those who give so much of their time, efforts and resources to make a difference are often unacknowledged and even unrecognized. The purpose of the Ed Dorado Awards is to ensure that the Guyanese nation become aware of the work of these sterling individuals and entities.
Award categories and eligibility criteria can be accessed at http://www.caribvoice.org/el-dorado-awards.html. Nominations, to include name, address, phone number, email and short bios or background information, should be sent via email to caribvoice@aol.com, bibiahamad1@hotmail.com or deodatpersaud25@yahoo.com or via instant messaging (IM) on facebook to Annan Boodram, Bibi Ahamad or The Suicide Epidemic page.
The Caribbean Voice is also inviting sponsors for the awards. For inquiries or further information please call 223-2637 or 621-6111(Guyana) or 718-542-4454 (Canada, USA) or send email to any of the email addresses above.

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Pesticide Safety


Feb 18, 2016: In an interview with the Guyana Times on Monday January 25, Minister of Education, Dr. Rupert Roopnarine had indicated that most aspects of the Central Counseling Body had been finalized and all was to be implemented within 10 days. According to the newspaper, the Minister was, among other things, referring to placement of counselors in all schools. Well that should have been done by February 5th. So why the holdup?
Incidentally The Caribbean Voice is thrilled about the basket of initiatives outlined in the recent budget debate in parliament but we sincerely hope that words would quickly translate into action. Meanwhile as we wait, hopefully, for the re-launching of the Gatekeepers’ Program, we welcome the Pesticide Board’s intention to share out to farmers, 150 cabinets to add to the 150 distributed last year. However, given that there are tens of thousands of farmers in Guyana, we suggest an urgent and extensive campaign to educate farmers about pesticide safety. That campaign must clearly propagate that:
• all agro-chemicals and other poisons to be purchased by someone who’s very reliable (preferably provided with some sort of official permission to buy such chemicals) and who would immediately safely store the chemicals upon reaching home, in cabinets/strong boxes secured by farmers/householders themselves;
• all agro-chemicals and other poisons are safely stored at all times with the key being held by the most reliable family member so that no one else can have access to these poisons;
• the chemicals/poisons are only given to whoever needs to use them, on the days when they are to be used and that usage is keenly supervised;
• the chemicals to be returned to the safe as soon as possible after usage and that any empty containers are safely disposed of immediately;
• all households are sensitized to the dangers of all poisons purchased are always alert to any unauthorized efforts to access them;
• all community members are sensitized to the dangers of all poisons used by the community;
• all Gatekeepers’ training include pesticide safety to supplement and reinforce the work of the pesticide board.
Meanwhile, with at least two sports competitions already focusing on suicide awareness, we urge the Ministries of Health and Social Protection to reach out to all sports organizations and persuade them to include suicide awareness and information dissemination in their sports programs, not only with respect to suicide prevention but also related issues such as abuse, for example. We also urge all regional administrations to follow the lead of the New Jersey Arya Samaj Humanitarian Foundation (NJAS) and other entities (EBB, Linden, MMZ, Herstelling) and organize walks and rallies, in collaboration with various ministries and other stakeholders to foster awareness and pass on information as well as to encourage collaboration.
The Caribbean Voice also highly commends the Ministry of Health for its upcoming stakeholders forum to address suicide prevention. And, we strongly urge that this forum set up a national coordinating committee that can help to foster collaboration, map all that is happening so as to avoid duplication, ensure follow up, maximize resource use and plug the gaps. This would facilitate that a structured approach, and regular feedback drive an ongoing national campaign and provide citizens with the wherewithal to help save lives. Of course the Ministry of Health (MOH) must build a comprehensive database of NGOs and others involved in suicide prevention and social activism. The Caribbean Voice has an extensive list that we are willing to share with MOH.
As well, in keeping with the theme that suicide prevention is everybody’s business, The Caribbean Voice urges all and sundry to please touch base with the Ministry of Health, Education and Social Protection, regional health authorities, health institutions, regional social workers and NGOs to help build a national approach to suicide prevention. Please do bear in mind that the life you save may be that of a loved one.
Meanwhile, we must point out that the closure of Wales Estate creates a potential for an increase in suicide among the affected population. Thus, we sincerely hope that a safety net is put in place to ensure that any suicide ideation is not acted upon. Ditto for farmers severely affected by the current drought. Also we echo the calls of many others for UG to take the lead in suicide (and other social issues) research, build models to actualize redress and provide training necessary to implement the models. And we appeal to Digicel and GT&T to add awareness and information dissemination messages along with the suicide hotline numbers to their regular fare sent out to their mobile customers on a daily basis.
Finally, we urge everyone to keep the suicide hotline numbers handy and to call the suicide hotline numbers at the slightest suspicion that someone may be at risk. It is better to err on the side of caution that to ignore a situation only to lament afterwards; it is better to make a mistake than to lose a life. Also always feel free to contact The Caribbean Voice at email at bibiahamed1@hotmail.com, caribvoice@aol.com, deodatpersaud25@yahoo.com, goldenomdharmic@yahoo.com or phone 621-6111, 223-2637 or 627-4423.
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Urgent Need for Gatekeeper’s Program


Georgetown, Guyana, January 25, 2016: Two colleagues were having a conversation. One, who was facing a rough time, was asked by the other, “How do you feel?”
The response resulted in a process that saw the respondent, in spite of his protestations, being escorted by the police, to the hospital, for an evaluation, as an assumption was made that he was suicidal. At the hospital he was held overnight, again in spite of his protestations, so as to be monitored, and the following day, just like the previous day, he had to undertake evaluations by social workers and psychiatrists. Additionally, a family member also had to be interviewed. In the end it was decided that he was not a danger to himself and so was discharged.
The above scenario reflects a reality that happens quite regularly, in the US. Given this reality, the many hotlines, the availability of counselors at the touch of a button and so on, why is it that over 42,000 persons commit suicide annually in the US making it the tenth leading cause of deaths in the US? And why is it that 650,000 plus persons attempted self-harm annually?
Clearly something else is missing and The Caribbean Voice strongly believes that it is the absence of first responders, trained eyes and ears in every community, neighborhood and blocks.
In Guyana, the missing piece becomes integral, given the absence of the sophisticated US system referenced above. Yes there are not enough counselors by any stretch of the imagination and yes resources are lacking, but the reality remains that if warning signs can be identified and individuals suspected of being at risk are able to open up to others they can trust, then there is already a very strong possibility that they will never transform intention into action. And given its numerous villages and integrated communities, Guyana is ideal for the process of training and deploying first responders.
The fact is that the time has long gone to move beyond mere awareness and to arm citizens with the wherewithal to combat suicide at the community and household levels. First responders can do much more than simply identify warning signs and take action. They can encourage households to practice safe use and storage of poisons, especially agrochemicals as well as safe disposal of containers. Also, they can help families to understand and practice empathetic communication so that whatever are the issues, children would not see suicide as the answer. Furthermore, they can assist those with relationship issues to get help before the relations become dysfunctional and tragedies ensue. They can help families to tackle abuse and help prevent its occurrence. And they can train others to do all of this, thereby creating an ever-widening circle of individuals who help to save lives, enhance relationships and make communities safe.
A perfect example of how this works was narrated recently to The Caribbean Voice. A teenaged student at a school in Berbice cut herself. Teachers at the school called a pandit, someone whom they were familiar with and trusted. After persuading the student to list down the things that were bothering her, the pandit took the student to a counselor. The upshot was that the student was provided with needed services and then taken home, where the parents were informed that the home environment was not safe for the student and that a trusted family member or relative needed to be identified as caretaker for the student.
Of course, the ideal thing would have been for the student to be identified as suicidal, even before she attempted to harm herself. And with first responders in the community, this could well have been possible. It is within this context that The Caribbean Voice has been calling for a return of the Gatekeepers’ Program. Now with a suicide contagion raging and everyone becoming puzzled as to why no action is being taken by officialdom to bring back the Gatekeepers’ Program, The Caribbean Voice is appealing to regional administrations, religious institutions, mass based organizations, NGOs and community based entities to please get the ball rolling. We are willing to help coordinate. Please reach out to residents in communities or through community institutions such as mandirs, mosques and churches, sports clubs, youth clubs, women’s organizations and so on and arrange for training sessions.
For more information and every sort of help, including finding trainers, please touch base with the Ministry of Health or Social Protection, regional health authorities, health institutions, regional social workers, or The Caribbean Voice. The Caribbean Voice can be reached at bibiahamed1@hotmail.com, caribvoice@aol.com, deodatpersaud25@yahoo.com, goldenomdharmic@yahoo.com. Call 621-6111, 223-2637 or 627-4423.

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2016 Wish List


If The Caribbean Voice were to present a pragmatic wish list for the year 2016 elimination of the law criminalizing attempted suicide would probably top the list. Prior to May elections, we had discussed this issue with two current cabinet members and both had expressed an interest in exploring he possibility of instituting a process to get rid of the law. We now appeal to both those gentlemen as well as the government in general and members of the opposition as well to please move with alacrity to take steps to discard this archaic law that was premised on premises that have long been debunked.
Other very doable measures, all of which have been ventilated many times in the public domain include:
1. Bringing back the Gatekeeper’s Program or a similar replacement in order to train first responders within every community not only with respect to suicide prevention but also to tackle related issues such as domestic violence and child abuse.
2. Instituting a program to address pesticide suicide. Earlier this month a forum on suicide in the Cayman Islands, attended by a number of government representatives, had a one-day focus on pesticide suicide. Additionally The Caribbean Voice has presented to both government agencies and in the media the highly successful Shri Lankan Model of Hazard Reduction as well as other models that were also successful.
3. Placing counselors in high schools. When President Granger suggested that the government could not afford this, he might not have considered strategies that have been publicly presented by TCV and others to identify teachers with social work training and use their knowledge and skills as well as to employ social work graduated from UG. Additionally the government may want to consider the one-year diploma in counseling that was in place in the seventies and eighties, with classes held on Saturdays.
4. A phased integrating mental healthcare into the general healthcare system as the World Health Organization has suggested for developing nations like Guyana.
5. Fostering awareness and in formation dissemination by reaching out to the media to offer public service announcements as part of heir social responsibility. Also the business sector can be requested to offer space on their billboards and electronic advertisements for the same purposes. Simultaneously, sports and performing stars as well as other influentials can be persuaded to become spokespersons for suicide and related causes.
6. Harnessing NGOs on the social landscape to set up a coordinating committee to foster collaboration, establish a national network, and broaden collaboration on suicide prevention and related issues. This would facilitate mapping and eliminate duplication, while fostering cost effectiveness maximal use of resources.
7. Aggressively publicizing and promoting the suicide hotline also by harnessing he media and private sector billboards and electronic advertising, as well as social media, NGOs, religious and educational institutions and so on.
We are very much aware that much more than this needs to be done but the measures referenced here are practical, affordable, and easily implementable and sustainable. The most fundamental requirement is political will, underpinned by an attitude of caring concern.

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Need for a holistic, concerted, sustained and multi-pronged approach to suicide


Caribbean Voice absolutely commends the initiative of President David Granger in convening a high level cabinet meeting to craft a viable response to suicide, which seems to be sprinting towards a runaway crisis. However, we humbly and sincerely hope that this meeting catalyzes a holistic, concerted, sustained and multi-pronged approach, as anything less could end up being an exercise in futility.
And while we are certain that the level of expertise and abilities at that meeting, would have considered every possibility, we seize this opportunity to reiterate the following, almost all of which have been in the public domain for some time now:
1. Convene a meeting of selected NGOs and other stakeholders as a next step in the process with the aim of setting up a national coordinating committee and, perhaps down the road, regional coordinating committees. This would ensure that duplication is avoided, scaffolding takes place, resources are maximized, follow up is sustained and the work of NGOs and activists are coordinated, monitored and supported. Incidentally a call for such a committee was mooted at the National Stakeholder’s Conference on Suicide and Related Issues, organized by The Caribbean Voice and its partners in August 2015, at Cara Hotel.
2. Focus on collaboration, rather than an insular and individualistic approach, to maximize impact as widely as possible, and foster piggybacking, so that suicide prevention awareness can take place regardless of the forum and so that the greatest possible amount of persons can be involved in promoting prevention.
3. Take steps to extend the suicide hotline nationally and engage in an aggressive promotion campaign that can involve all the media, the private sector, the education and health sectors and celebrities, VIPs and high profile spokespersons.
4. Reach out to suicide survivors (those who had attempted suicide as well as loved ones of those who committed suicide) and engage them in sharing, as their experiences can have a defining impact as well as create emotive connections with their audiences. This can be one facet of an intense education program that addresses myths and misinformation about suicide, dispels the taboos that surrounds it and enable the average person to be more understanding and more sensitive about suicide and its connotations.
5. Bring back the Gatekeepers’ Program and use it as a mechanism to train first responders in every community. These are the persons who can be the eyes and ears of the community to proactively identify warning signs and put in train a process to help those in need. It must be noted that such persons may also be able to build trust much easier that ‘strangers’ and provide comforting/safe scope for those in need to open up. No one can doubt that a large part of the problem is that so many who commit suicide kept things bottled up and thus family and friends invariably exclaimed that they never saw/knew that anything was wrong. After all they are not trained to identify the warning signs and to engage in empathetic communication, as first responders would be.
6. To the current terms of reference for the Poison Control Centers, integrate measures that would ensure the safest possible use and storage of agro-chemicals, the safest possible disposal of containers and a process that would not only ensure that bona fide farmers are the only ones allowed to purchase such chemicals but that they are monitored to ensure the highest degree of responsibility in handling and usage. We have already, many times, referenced the Shri Lankan Model of Hazard Reduction as an exemplar in his respect.
Social Activist, Sherlina Nageer recently expressed online, her frustration in trying to get embracing help for a woman who seemed suicidal. It was clear that had there being a coordinating committee fostering a holistic approach, the person in question would have gotten all the help needed, rather than piecemeal and uncoordinated assistance that was provided and that did nothing to get her out of the suicidal mindset. In fact, this experience makes it clear why so many fall through the cracks and why so many more never want to seek help.

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