Coil: Mental health and the people who litter

by Vidyaratha Kissoon

Hot Friday afternoon . A man is walking towards me, smile on his face. He is tall, about my height, brownish hair blowing and wearing glasses. I think I am looking in a mirror – man is thinner but walking quickly though not purposefully – much like how I walk. He sees me looking at the sign board for the Mental Health Institute.

“Like yuh looking fuh a wuk? … Dis is de place yuh does guh when yuh head aint good and dem gun find a wuk fuh yuh.. is de occupational health place”.

He walked fast past me, and I said .’oh, oh. You ever went in here?” and he said “nah.. “

I had just been at the Guyana Revenue Authority to render unto Caesar what was Caesar’s.

The visit was interesting – two men in shorts, women in sleeveless and straps and so. The security guards seemed relaxed and not so tense up like the last time I visited. I think they must be relieved at not having to do the dress code thing any more and just focus on who got knife and gun and so to rob the GRA.

I wanted to ask the security guards how they were feeling now after they did not have to monitors of dress codes and get into quarrels with people who they would not ordinarily quarrel with. But it was busy.

Maybe the Government will do a survey of the impact of the dress code policy on the stress levels of the security guards.

Inside the GRA was the usual chaos which I think it requires a steady focus and sound mind to get through your business. Or maybe it does not require a sound mind.

A man and I started gaffing in the line. Conversation turned to litter. He took out his camera and showed me the pictures around the country. We talked about crazy it was that people would throw litter on nice clean places. He showed me the garbage piled up at Parika, Tuschen, Tuschen New Housing Scheme, Ogle, Better Hope, Plaisance. There was construction waste. There was damage from burning rubbish.

I was a bit worried for the man, having this constant record of the illegal dumping of rubbish and nothing nice to show. However, he said look at this – a man on a horse cart at the Lusignan Dump site, doing the right thing.

The obsession with litter is on my mind as I see the green rubbish bins with the signs ‘Green and Clean Guyana’ on the Camp Street avenue. There is something about the bins, in their cages. The bins are overflowing. There is something about the way the bottles and boxes and bags decorate the bins and the cage. It is probably the sign of prosperity. I try to imagine that the litter decorating the protected bins are like flowers and candles and other offerings of worship at an altar. Gratitude that many Guyanese, many of them who would never feel the need to visit a mental health practitioner, would throw their offerings at the garbage bin deity which might no longer be able to absorb the offerings.

Littering though is not a sign of mental illness it seems, nor is living, walking and liming among the litter. My obsession with cleanliness could be a sign of mental illness.

Article 24 of the Constitution of Guyana says that “Every citizen has the right to free medical attention and also to social care in case of old age and disability’

Guyanese should be proud of the commitment to free health care.

The next article of the Constitution goes on to say :-

Article 25. Every citizen has a duty to participate in activities designed to improve the environment and protect the health of the nation.

And later on in the Constitution,

Article 149J. (1) Everyone has the right to an environment that is not harmful to his or her health or well-being.

The GRA is around the corner from the site of the proposed Mental Health Institute of Guyana in Quamina Street. The buildings which are being repaired currently house the Mental Health Unit of the Ministry of Public Health.

The prevalence of suicide and the controversy over the efforts to reduce suicide has increased the expectations of the performance of the Ministry of Public Health, and specifically the Mental Health Unit.

There is no dress code on the gate. Some people who were sitting away from the heat, “under the house” told me to come in. There are some nice plants in the tidy yard. There is some junk piled up and locked away – many public buildings have to store the junk until the procedure for writing off assets is followed.

I thought I was interrupting a meeting. I recognised two of the staff. They explained that with the repairs, and the heat in parts of the building, they came out to enjoy the breeze. I thought it was a nice place to do a group therapy.

The Senior Psychologist , Mr Balogun Osunbiyi explained that the Unit has a Director (acting) who would speak on behalf of the Unit. He spoke on his own behalf. The Director is Dr Rajkumar.

I asked about the Suicide Hotline. A young Hindu woman had told me she had called in March 2016 and was referred to a Pastor. She was surprised . She was told at the time there were no pandits on the roster.

Mr Osunbiyi said that as far as he knew, the current protocols for the hotline were that the operators did a front line assessment. The referrals would be to police, or to appropriate persons in the public health system who have been trained to help persons who are dealing with crises.

I did not get the impression from him that the suicide hotline was meant to be a prayer line, even if persons from faith based organisations are key to the support.

Mr Osunbiyi also offered his phone number – 690-1824 – in case people had questions or comments about the hotline or any of the mental health services which are available.

It seems that Unit is still in its formative stages. There was the sound of work men and I got the impression from the people I spoke to that work is in progress.

A GINA news item though, describes the unit as refurbished. The GINA news item has more details of the structure of the Unit and its functions.

The unit is working on the activities in the current Mental Health Strategy.

The Draft Mental Health Strategy (2015 to 2020)

The Draft Mental Health Strategy (2015 to 2020) follows on from a previous strategy which obviously was not implemented or Guyana would not have one of the highest suicide rates in the world.

The document is a fascinating one to read. It is in draft and so things could be changed. According to the document,

“

• 10 to 15% of Guyanese with 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.
• 3 to 5% of our population has a severe chronic mental disorder.
• Approximately 20,000 Guyanese suffer from severe mental illness.
• Unipolar depression is fifth greatest contributor to disease burden in Guyana;
• Suicide is a leading cause of death among Guyanese: 20 to 24 years (3rd), 10 to 19 (4th) and 25 to 44 (4th). The Guyanese rate per 100,000 Guyanese is 25.6; this is well above the 7.3 rate for the Americas. “

The statistic for suicide might be misquoted. There is a figure which says the rate is 44.7 per 100,000 Guyanese., higher than that quoted in the plan. There is no way to know whether the other figures for the number of persons with mental illnesses is higher than that estimated in the plan.

The plan has adopted the WHO explanation of mental health as ““state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”

Littering, which is not a contribution to the community , is not a sign of mental illness. It might not be a sign of mental well-being though.

The draft document refers to the problems in the provision of mental health services and identifies several actions. These actions can be summarised as follows :-

• Enact legislation (National Mental Health Law)
• Develop codes of practice for psychiatry.
• Establish the mental health unit, and supporting mechanisms
• Allocate 5% of Government health budget mental health
• Engage relevant stakeholders and improve capacity of organisations supporting persons with mental health problems
• Decentralise the services and improve access to mental health at community level and primary health care facilities. The plan notes that “It also implies the delivery of services that are culturally appropriate, equitable, and free from discrimination based on gender, race or ethnic group, sexual orientation, social class, or other conditions “
• Develop human resources
• Examine alcohol and other drug use, and implement prevention strategies
• Reduce the suicide rate
• Improve data collection, do research and disseminate findings.

What is missing?

A man told me of going with a reluctant friend in crisis to the GPHC clinic. He found that the doctors were rude to the patient and to him. He thought that there was some method or reason for the rudeness but there was no explanation. His friend had to seek private medical attention subsequently as the medication did not work. He was cynical about any other referrals to GPHC.

The Draft Mental Health Strategy does not mention “empathy” or “compassion” or even “accountability. Socialist Guyana no longer exists and the constitution guarantees ‘free medical” attention’ but there is no mention really of quality of the attention.

There is something clinical and mathematical about the plan – beds, money, rates. There is an acknowledgement of some of the systemic issues like violence, and the prevalence of violence including violence against women. The document was written by psychiatrists and medical professionals.

There is no indication that persons with mental health problems actually contributed to the document. (Stakeholder consultations in my experience are not active participation) Would persons who are suffering with mental health be as concerned about the mental health laws as they would be about access to proper care with mechanisms to ensure that the professionals are accountable for their delivery?

At the end of the document, there is a proposed resolution, with the name Dr Bheri Sigmund Ramsaran. Sigmund as in Freud.

There is no scope in the plan to deal with the irony of Dr B. Sigmund Ramsaran’s fantasies of violence towards a woman who was demanding accountability. There is no scope in the mental health action strategy to deal with the cultural reality that people were willing to help Dr B. Sigmund Ramsaran enact his fantasies of violence .

The draft Mental Health plan does not seem mention alternative ways of care.

A young man referred me to this meditation practice which he said helped him. I could imagine if he had an input into the plan he would have wanted to expand the options available. There is nothing in the plan which looks at things like yoga and meditation or other helpful practices.

There is public interest and concern about mental health, especially suicide prevention. The public interest is a resource to ensure persons who have mental illnesses could access free quality health care as intended by Article 24 of the Constitution. The public is also responsible to eliminate the environmental, social and cultural factors which are risk factors for mental illnesses.

The mental health services in Guyana cannot be like the garbage bins on Camp Street Avenue, there in reality. but not serving their purpose due to the lack of proper attitudes.

Resources

The Guyana Inter-agency Suicide Helpline operates 24 hours, and is organised by the Guyana Police Force.

Telephone -223-0001, 223-0009, 223-0818

Cellphone – 600-7896 (toll free from Digicel phones), 623-4444

Email – guyagency@yahoo.com

Bbm pin – 2BE55649, 2BE56020

Twitter – @guyanaagency

Whatsapp – 592-600-7896 592-623-4444

Referrals, some kinds of counselling, public education and awareness are offered by the following :-

Crossroad Suicide & Mental Health Awareness Services Tel : 231 4328

Guyana Foundation – Tel – 276-3057

Help & Shelter – 225-4731, 227-3454

Roadside Baptist Skills Training Centre (Region 6) – 338-4215/4213

Ms Vieria who writes a column in the Sunday Chronicle encourages persons to attend the following support groups at Woodlands Hospital: Outpatient Department
Drug and Alcohol group meetings – Mondays 4:15
Good mental health group meetings- Wednesdays 4:15

At GPHC, there is a Drug and Alcohol Group meeting on Mondays at 9am.

There are no charges for any of these meetings.