By Ravin Singh
THE cold, unpainted pavement which reeked of rotten meat and stagnant water in central Georgetown is where they’d eat, sleep, dwell and live most of their lives. Six, sometimes seven or eight of them on a given day, would lie half-naked, sprawled, and almost lifeless at popular spots, one of which includes the eastern wing of the Guyana Post Office Corporation (GPOC) in the city’s capital. Their stories are all different, one would assume. Perhaps most never being told as to why these citizens were in the state they were – perceived insanity. Neighbouring retailers claim that at times these vagrants had all experienced fearsome delusions associated with schizophrenia.
One who remains trapped in this constant battle of being mentally stable and collapsing psychologically, is Christopher France, a third- year medical student at the University of Guyana (UG), who suffers from depression, as a result of epilepsy – a condition which he was diagnosed with in 2014.
Some medical publications support the idea that causes of depression in people with epilepsy may be brain injury; the area of the brain responsible for mood may be affected in people whose epilepsy is caused by brain injury, leading to a variety of mood changes, including depression, which France admitted he first discovered in his mid-teens.
“In my mid-teens I started experiencing what we could call depression; sudden mood changes. And since then, it has been a constant battle for me.”
But mental illness is not limited to depression or suicidal thoughts. Head of the psychiatric unit at the Georgetown Public Hospital Corporation (GPHC) Dr. Bhiro Harry, explained that common forms of mental illness include anxiety, depression, substance use disorders and psychosis – better known in Guyanese terms as the “mad man syndrome.” Among these, psychosis makes up about two per cent of all mental illnesses globally.
Revealing that no one is immune from mental illness, Dr. Harry notes that every day, cases of mental illnesses are diagnosed, both locally and globally, with 98 per cent of the diagnosed cases being common in people who appear sane.
This condition can be caused by a combination of environmental, psychological and genetic factors, he said, adding that sometimes, it is the psychiatric manifestation of a physical medical illness like a thyroid disease or a low calcium level.
Additionally, the use of licit (such as alcohol) and illicit (such as marijuana and cocaine) substances can cause mental illness.
According to the American Psychiatric Association, some of the early signs of mental illness include withdrawal, drop in functioning, problems with thinking and concentration, increased sensitivity, apathy, nervousness, sleep or appetite changes, and mood changes.
And while Dr Harry agrees with this, he says most mental illnesses could be prevented through healthy lifestyles – physical exercise, relaxation, a balanced diet, no drugs and effective coping styles.
For those cases which cannot be prevented, he explains that life-long treatment is required, just as it is for Diabetes and High Blood Pressure. However, these cases are in the minority. The majority, he says, are resolved completely with appropriate treatment and healthy lifestyles.
Treatment available at the GPHC includes counselling, psychotherapy and medication, he adds.
But presently, while Guyana struggles with only six practising psychiatrists, there is currently no mental health unit at the GPHC, according to Minister of Health Dr. Karen Cummings.
Dr. Cummings, who inherited this state of the medical faction of the country from the last government, explained that mental health is currently a front burner issue for the Health Ministry, since a Mental Health Strategy has been developed by the ministry, through a collaborative effort with the Pan American Health Organisation (PAHO).
With a National Mental Health Action Plan 2015-2020 under way, and a proposed mental health unit in the pipeline, the Health Minister explains that mental health needs to be examined in its entirety, given that there are many subsets of mental illness which needs individual attention; perhaps the most important of these being suicide, since Guyana was ranked as having the highest suicide rate in the world, according to a UN report published last year.
At a staggering rate of 44.2 suicides per 100,000 people, Guyana surpasses the global average which is fixed at 16 per 100,000.
With three of the local psychiatrists stationed at the GPHC and the other three based at the National Psychiatric Hospital in Region Six, Dr. Harry is of the conviction that there needs to be more psychiatrists.
One doctor is currently being trained in Cuba in child psychiatry, Dr. Harry revealed, adding that “very soon specialists will be trained locally” as the plan is to have a mental health team in each regional hospital.
At the GPHC too, there are currently two psychologists and one psychologist at the National Psychiatric Hospital. There are five General Physicians in the department. There are two social workers in the department of psychiatry at the GPHC and one Social Worker at the National Psychiatric Hospital. But according to the head of the Psychiatric Unit, there is a need for more mental health professionals.
But with these limited resources available to a population of just over 750,000 people, health activist Sherlina Nageer, who holds a Masters’ Degree in Public Health, believes that concrete issues related to mental health are not being addressed by the relevant authorities.
According to Nageer, the scope of mental health is one which is very broad, since once has to take into account abusive relationships and poverty and the impact those have on a person’s mental health.
In light of this, and her conviction that most of the medical services are not available “out of town,” Nageer maintains that there is no understanding of the root causes, which, if promoted, could ultimately aid in addressing the issue of mental illness.
France, like Nageer, believes that there has been a shortcoming on the part of the authorities to push an education campaign. “We have all of these studies being done. All these reports coming out and articles but no work is actually being done” he says.
He reflects on an experience a few years ago, after having written a blog on suicide and mental illness, since Guyana’s suicide rate was climbing, there was no suicide hotline number to call for counselling if one was in need. This, he says, is imperative, not only in addressing suicide, but mental illness on the whole.
A “Suicide Helpline” was however launched earlier this year under the Guyana Police Force’s (GPF’s) Social Crime Prevention programme. Calls to the hotline’s number proved that it was functional.
While on academic attachment at the West Demerara Hospital, France recalls that one of the male wardens would refer to one of the wards as “the poison ward,” since everyone in the room, at some point in time, had attempted suicide.
He opines too that, “There is a stigma with depression and mental illness in Guyana.”
According to him, people are ashamed to admit that they are in need of help. And this he says seems to be woven into the fabric of Guyanese culture.
“Imagine a big strong man in his mid-thirties confiding in his bros’ that he’s depressed. People will torment him and say ‘budday you acting like a girl.’”
But mental illness is not something people can just get over. Depression, from which he suffers, is like any other illness.
“You can’t tell someone to get over cancer or diabetes, so why tell someone who has mental illness or depression to get over it? They can’t just get over it.”