–invest more in mental health, PAHO/WHO rep. urges

PAN AMERICAN Health Organisation/World Health Organisation (PAHO/WHO) representative, Dr. William Adu-Krow has renewed calls for decriminalisation of suicide in

Guyana even as he lobbied Government to invest more in mental health.
Dr. Adu-Krow made the call while addressing a wide-cross section of stakeholders including Members of Parliament and United Nations (UN) Resident Coordinator Mikiko Tanaka at Parliament Building on Wednesday.

He was among officials participating in a confab organised by the Parliamentary Sectoral Committee on Social Services in collaboration with UN/PAHO/WHO.
According to him, there is an urgent need for legislative changes to be made as he alluded to the Criminal Law Offences Act Cap.8:01, the Summary Jurisdiction Offences Act Cap. 8:02 and the Pesticides and Toxic Chemicals Control Act Cap, 68:09. Reference was also made to the Customs Act, the Food and Drugs Act and the Mental Hospital Ordinance Cap. 140.

Singling out Section 95 of the Criminal Law Offences Act Cap. 8:01, the PAHO/WHO representative concluded that the legislation would only fuel more suicides. According to that section, “everyone who aids or abets any person in the commission of suicide shall be guilty of felony and liable to imprisonment for life”.
“If such a person escapes prosecution! This person is encouraged to commit suicide,” he opined.

Section 96 criminalises the act, and creates provision for imprisonment. “Everyone who attempts to commit suicide shall be guilty of a misdemeanour and liable to imprisonment for two years,” Dr. Adu-Krow said while quoting the law.

NO PSYCHOLOGICAL ASSISTANCE
In addition to objecting to the criminalisation of suicide, he bemoaned the fact that the legislation makes no provision for psychological assistance to be offered to survivors.
“The current mental health system in Guyana is fragmented, poorly resourced and not integrated into the public health system,” Dr. Adu-Krow said as he turned his attention to the mental hospital ordinance.

The ordinance makes provision for the care of persons of unsound mind and for the administration and management of the mental hospital at Berbice, but the PAHO/WHO representative believes that the situation leaves much to be desired.
A review conducted by UNICEF found that there is no mental health legislation in the country but only a draft mental health policy. As such, it is recommended that a Mental Health Act be put in place to address mental health issues, including suicide and care custody and treatment of persons with mental health issues.

MORE MONEY
Additionally, he championed the cause for government to pump more resources into the area of mental health, pointing out that in countries such as Papua New Guinea mental health accounts for five per cent of the country’s health budget.
It was pointed out that in 2011, 0.11 per cent of the health budget went to mental health and by 2017, it had moved to 1.16 per cent.
While the increase is 10 times more than the amount provided for in 2011, Dr. Adu-Krow believes that it is still very low.

According to the WHO, globally every year, close to 800, 000 people take their own life and there are many more people who attempt suicide. Guyana, according to WHO, has the second highest suicide rate in the world after Sri Lanka with a rate of 30.6 deaths per 100, 000. Sri Lanka has the highest rate with 34.6 deaths per 100, 000.
Minister within the Ministry of Public Health, Dr. Karen Cummings said Guyana had an alarming suicide rate of 44.2 suicides per 100,000 people.

“With the global average for suicide being 16 per 100,000 people, Guyana had the ignoble record of having the highest suicide rate in the world. Thanks to the work done by the Ministry of Public Health, through the newly established Mental Health Unit, Guyana has now dropped a place and has the second highest suicide rate in the world,” the public health minister said.
She, however, admitted that much more needs to be done to bring down the rate.
The statistics in 2012 have shown that suicide was the leading cause of death among young people aged 15-44, and the second leading cause of death among the 20-24 age group.

Females attempted suicide more frequently than their male counterparts at a ratio of 3:1; East Indians had accounted for 50 per cent of the cases, whereas Afro-Guyanese had accounted for 26 per cent of cases, the minister reported.
The common risk factors identified were acute emotional distress and depression (37 per cent), accessibility to lethal substances such as herbicides and pesticides (64 per cent), alcohol and drug use (32 per cent) and family dysfunction (34 per cent).

ROBUST STEPS
Since entering office, the coalition Government has been taking critical steps to arrest the situation, Minister Cummings said, as she pointed to the multidisciplinary team which was formed by President David Granger to address the issue.
The Ministries of Education, Social Protection, Agriculture, Indigenous Communities and Public Security make up the National Task Force which covers four strategic areas: (1) Risk Factors Reduction, Health Promotion and Prevention; (2) Reduction of Access to the Means of Suicide; (3) Health Systems response to Suicide Behavior; and (4) Surveillance and Research.

Additionally, a National Stakeholders Conference was held at the Arthur Chung Convention Centre in April 2016.
“I must let you know that consultations have since intensified in Regions Two ( Pomeroon-Supenaam) and Six (East Berbice-Corentyne), the hub of the suicide occurrences – to ascertain the best possible way the Ministry of Public Health could affect positive change and be more strategic in targeting the communities concerned so as to stem the tide of suicide,” she told those present.

COLLABORATIVE APPROACH
Additionally, she said the Ministry has been raising awareness and prevention through education but said more needs to be done, and all must get involved.
“We need to create a tidal wave of support and policies that will effectively deal with the issues identified. We need professionals and non-medical human resources like psychologists, psychiatrists, nurses, occupational therapists and social workers; we need to train all members of the mental health staff in the mental health gap action programme, thus equipping the multidisciplinary team to not only bridge the gap between available resources and the large need for services to address mental, neurological and substance use disorders in non-specialised health settings, but to be able to have these health care workers communicate effectively and deliver good quality care to adults, adolescents, and children in an integrated approach in a Primary Care Setting involving the community,” Minister Cummings stated.

On this note, she said it has become necessary for all stakeholders to play their part in the enforcement of the Mental Health Action Plan 2015-2020.
“We must work collaboratively to bring about an end to suicide, strive resolutely to achieve positive outcomes including the Sustainable Development Goal Number Three of Good Health and Well-Being for all Guyanese. Let us work together to take Guyana further down the list of most suicides committed globally,” she admonished those present.
Though statistical reports are still coming in, Director of the Mental Health Unit, Dr. Util Thomas told those present at the confab that for the period January to May, 2017, the Guyana Police Force recorded 92 cases of suicide while the Ministry of Public Health recorded 59 cases.

In 2016, she recalled that there were 169 cases. The police at the time had reported 99. Most of the deaths occurred among persons between the ages of 15- 29, most of whom were male of East Indian descent.
Six psychologist and six social workers have been trained in addition to 40 doctors to tackle that and other mental health issues. They have been placed at key locations within the country to assist in the area of mental health.