-Health Ministry says

SINCE taking office in 2020, the Government of Guyana has done lots to improve the mental health sector, including the strengthening of legislation and the hiring of more full-time staff.

This is according to a statement from the Ministry of Health issued on Sunday

It was emphasised that in the span of two years, under the Minister of Health Dr. Frank Anthony, the mental health sector has undergone rapid and historical developments.

The Suicide Prevention Bill which decriminalises suicide, and the Mental Health Protection and Promotion Bill, which replaced the archaic Mental Hospital Ordinance 1930, are two landmark legislations aimed at modernising mental health services in Guyana, are among the developments the statement said.

The Suicide Prevention Bill will be debated as soon as Parliament reconvenes from its annual break. The Mental Health Protection and Promotion Act has already been signed into law by President, Dr. Irfaan Ali.

“New mental health initiatives and international partnerships are also ongoing. These initiatives include mobile psychiatry clinics for persons who are unable to go to the hospital to receive medical treatment, psychiatry satellite clinics across the regions and alcohol and substance misuse clinics for adults, children and adolescents,” the statement said.

Presently, weekly psychiatric clinics are conducted at Skeldon Hospital and monthly psychiatry clinics are conducted at Suddie and Charity Hospitals in Region Two. These satellite clinics will be expanded so that every regional hospital will have weekly or monthly clinics in 2023.

Additionally, the statement said that the Ministry of Health (MoH) is working with the US-based Columbia University’s Department of Psychiatry, which has been designated a World Health Organisation (WHO) Collaborating Centre, to work with developing countries to build capacity for mental health care and services.

There are also ongoing works by Columbia University with the MoH to build capacity in various areas of mental health, including through a grant from the US National Institute of Mental Health (NIMH).

“Through this programme, a conference to help develop and implement a Mental Health Wellness Programme is slated for November 2022. More than 20 international experts will join counterparts in Guyana for a historic conference to help Guyana roll out a Mental Health Wellness Programme,” the statement stated.

Another collaboration is a project geared at examining the risk factors for suicide. Collaboration has also commenced with the Canadian government through the International Development and Relief Foundation (IDRF), to address mental health in vulnerable communities.

There is also an ongoing, new, and energised effort to address the infrastructure, management, and treatment of patients at the National Psychiatric Hospital, the Guyana Public Hospital Corporation (GPHC}’s Psychiatric Department; mental health in the workplace, and human resource needs for mental health.

An initiative that can be mentioned is the introduction of a telemedicine programme to provide psychiatrist-led and psychologist-led access to mental health consultation across remote areas will begin in 2023, the statement said.

In light of absent and weak workplace mental health interventions, the Mental Health Unit rolled out, in May 2022, a “Mental Health in the Workplace” initiative with ongoing workshops on Stress Management and Emotional Intelligence throughout the health sector and workplaces around Guyana.

“So far, the Guyana School of Nursing, Cheddi Jagan Dental School, Central Supplies Unit at the Ministry of Health, Guyana Power and Light Company, Centre for Local Business Development and the Guyana Energy Agency have benefited from this initiative,” the statement said.

Additionally, a new Gate-keepers Community Training Programme, a programme that was abandoned in 2015, is ready to be rolled out again.

The MoH said that these efforts must be sustained, since funds were previously available through the Global Fund HIV/AIDS. Such programmes were initiated in 2006, but were not sustained.

Further, it was pointed out that staffing initiatives have been implemented to address the inadequacy of the staff at the National Psychiatric Hospital (NPH). According to the statement, the NPH has 10 nursing staff at this time and not four as was initially thought.

Presently, the hospital’s Medical Superintendent and Head is a trained forensic psychiatrist, Dr. Meena Rajkumar, who is a full-time employee. She is supported by another full-time psychiatrist, three medical doctors, a matron, two registered staff nurses, seven nursing assistants, 18 nurse aides, 74 psychiatric patient care assistants, and two social workers.

The statement said that more recently, the government deployed 37 part-time workers to support the staff in various areas, including the facilitation of general hygiene and personal grooming of the patients. The additional support by nursing aides, patient care assistants, and part-time workers permit the 10-member nursing staff to focus on the nursing needs of the patients, the statement said.

While efforts are being made to improve the staffing, two additional psychiatrists will be joining the hospital full time in early November 2022. Additionally, a psychologist is due to begin a full-time assignment within the week at the NPH.

Psychiatric staff at the GPHC are presently being rotated on a visiting basis to provide support to the full-time psychiatrists at the NPH.

MORE WILL BE DONE
Meanwhile, the MoH has been working with partners to resuscitate the Psychiatric Nursing Programme which was discontinued some time ago. It was first introduced in 2004, with the help of partners from Dalhousie and McMaster Universities and several batches of nurses were trained. Most, if not all, of those nurses, are no longer serving.

In addition, the MoH is introducing a new curriculum to train Psychiatric Nursing Assistants. Several of the part-time workers have been identified to be trained as Psychiatric Patient Care Assistants. UNICEF is partnering with the ministry to expand the psychiatry training programme.

The MoH has been significantly more active in the last two years than in the preceding eight years in building the human resource for psychiatry, even though there is much more to be done.

Since around 2014, occupational therapists have been absent from the staffing complement at the NPH.

The occupational rehabilitation centre was closed and abandoned sometime after 2015. Similarly, the visiting psychologist that supported the psychiatrists before 2015 is no longer available. The MoH is presently recruiting an occupational therapist to improve patient care at the hospital and is working with GPHC to either deploy a full-time psychologist or a visiting psychologist to the NPH to support the psychologist who is joining the staff.

The Occupational Rehabilitation Centre is being rehabilitated and reactivated. The organising of Christmas concerts, entirely by the patients themselves, a practice that was discontinued some time ago, is being considered for Christmas 2022, even if, for now, it is just a semblance of what it used to be.

The MoH is working with the NPH and the Region Six Health Department to reclaim the recreation ground and the vegetable garden. They were both reclaimed between 2006 and 2014 and have been neglected since 2015.

A shade house to reclaim the kitchen garden is being constructed with the help of NARI and the Ministry of Agriculture, and plans are being put in place to reclaim the recreation ground in 2023. These are important parts of the overall occupational therapy for the patients, the statement said.

The MoH is hopeful that as part of the infrastructural transformation between 2020 and 2025, a new NPH will be included. Those proposals are under active consideration by the government.

The statement pointed out that there are other initiatives presently ongoing at the NPH. These address the care and treatment, living conditions, and quality of life of the patients. New beds with proper mattresses, sheets and pillows, among other things, have already been put in place.

Before 2020, outside of the patients with acute episodes, the long-term patients had no regular psychiatric care and lived under inhumane conditions.

Presently, every patient receives weekly and monthly psychiatric evaluations. Daily medical clinics ensure that the medical needs of patients are addressed. A medical block has been added to Chalet number two and patients with medical conditions who need dressings, simple suturing and rehydration, among other things, can now access such services in a dedicated area.

“The ad-hoc and virtually [sic] non-treatment with medicines that were [sic] obvious in 2020 have now been replaced with daily routine medication rounds, just as in any other hospital. The inhumane, archaic seclusion treatment area and protocols are undergoing important modifications for more modern, humane options. Staff is working with families to increase family visits and the staff is also working on a system to have time at home for some of the patients. These are ambitious goals, but with hard work and commitment, can succeed,” the statement said.

Patient-grooming, which ensures that patients have clean clothes, including night clothes, nails and hair-grooming and general hygiene, is now in place. To assist, new industrial washers and driers have been procured and are presently being installed.

A meal plan is in place and the quality of meals and snacks has improved significantly, with the dietician organising meals and a new, modern kitchen constructed and installed, the statement said.

Regular monitoring of overall non-clinical treatment of patients, with random external monitoring at meal-time and sleep time have been instituted as part of the Service Level Agreement with Region Six and the NPH.

“Much remains to be done, but the GoG has been actively re-energising the mental health programme and views the situation at the NPH as a focal point of this effort,” the statement added.