Tackling mental health – an ongoing Ministry of Public Health initiative

Dec 27, 2015 News

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By Sharmain Grainger

Like so many diseases, mental disorders do not target people of a particular race, gender, creed or even age – everyone is vulnerable.
A recent visit to the Georgetown Public Hospital Corporation (GPHC)’s Psychiatric Clinic proved this notion to be very true. The waiting area was packed to capacity; some patients were mumbling incoherently, some were reading newspapers, others were chatting about issues of concern to them while a few just sat quietly awaiting their names to be called.
What they all had in common was that they had some mental ailment and were seeking help to get better – a laudable move on their part.
But oftentimes it is the move to get help that is the hardest for people with mental disorders. This may simply be because some people are not aware that there is help available to them.
And immense efforts are being made to arrest this challenge by the Ministry of Public Health.
According to information released to this publication by Chief Psychiatrist within the public health sector, Dr. Bhiro Harry, the most common cases of mental disorders seen are depression, anxiety disorders and acute stress, alcohol- and drug-induced psychosis, other psychosis and schizophrenia. These, according to Dr. Harry, have been identified as the five main contributors to the disease burden in Guyana.
Without treatment, mental disorders can have devastating outcomes. A well-known result that many of us know all too well is suicide. Suicide – which is the act of taking one’s own life – has over the years become much too frequent; a genuine source for concern.
In fact the Public Health Ministry has recognized this situation as a “serious social problem” and has assured that it is not being taken lightly, especially since Guyana has earned the reputation of being the suicide capital of the world – recording the highest number of suicides per capita worldwide. This was a few years ago.
But although the data for 2015 are not yet available, it is believed that Guyana has retained this unflattering “title” within South America and the Caribbean.
BUILDING CAPACITY
Guyana currently has an estimated population of 750,000 and the Mental Health Unit of the Public Health Ministry has predicted that an estimated number of 75,000 to 112,500 Guyanese suffer from mental disorders and require some level of mental health care services.
While facilities to aid treatment are available and sustained efforts are being made to expand services throughout the country, there are limited specialists trained in the field of psychiatry to help tackle mental disorders. This state of affairs was acknowledged by Dr. Harry, who related that there are currently a total of five trained psychiatrists in the country. Three of these trained specialists, including Dr. Harry, are based at the public hospital’s Psychiatric Department, while the other two are attached to the National Psychiatric Hospital – the Ministry’s rehabilitation centre for persons with severe mental disorders located in Berbice.
Care provided at the mental hospital is primarily custodial and heavily reliant on pharmacologic intervention, and more recently include the introduction of psychotherapy treatment and Electro-Convulsive Treatment (ECT).
According to informed reports, ECT is a procedure done under general anesthesia in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental illnesses. It is said to be an efficient method when all other treatments fail.
Even as he emphasized the important role of psychiatrists, Dr. Harry shared his conviction that “anybody else who claims they are trained psychiatrists should be jailed and lots of people are claiming that they are psychiatrists, but they are not.”
But the number of trained psychiatrists in the system is not nearly enough, and is in fact below the world reference average of 4.2 per 100, 000 population, according to the World Health Organisation standards, says Consultant Psychiatrist at the GPHC, Dr. Jorge Tomas Balseiro Estevez.
The Cuban national has for the past year been rendering his expertise to the GPHC.
He disclosed that in order to complement the efforts of the trained psychiatrists in the system, the public health sector has within its employ five General Medical Officers (GMOs) trained in psychiatry. These GMOs are based at the Psychiatry Department of the GPHC along with two psychologists. One other psychologist and an occupational therapist are based at the National Psychiatric Hospital.
In addition to this, Dr. Estevez related that there have been training sessions for specialized mental health professionals and even some non professionals.  And training, he noted, is continuing with support from McMaster University in Ontario, Canada.
“Mental health staffers have received various levels of training and share experiences with some professional mental health specialist overseas,” he intimated.
ADVANCING STRIDES
But in order to fully understand the state of mental health and the care required, a number of researches were conducted by staff of the public hospital, Dr. Estevez said. The most important one done thus far being the “Profile of suicidal behaviour in Guyana: A retrospective study from 2010 to 2012.”
The research was in fact a complete review of the characteristics and style of suicide and suicide attempts in the country. It was presented at the 60th Caribbean Public Health Agency Conference held in Grenada, while similar studies were presented at the second Caribbean Suicide prevention symposium held in the Cayman Islands earlier this year.
Based on the strides that have been made, a report from the Ministry’s Public Health Unit has been able to conclude that “Guyana is improving step by step, and has been integrating care for the mentally ill more and more into the general health-care system.”
This therefore means that mental health services are increasing in number, with a view of reaching more communities across the country, Dr. Estevez asserted. As part of the expansion efforts, the Ministry has been doing monthly psychiatric clinics at Parika, Linden and Suddie, even as plans are apace to incorporate similar services at Bartica, Baramita and other areas by early next year.
Available treatment, according to a report out of the Ministry, currently sees at least one medication from each class of psychotropic drug (relating to or denoting drugs that affect a person’s mental state) being available at all mental health facilities as well as most primary and secondary care facilities in Guyana.  It was also pointed out that there are guidelines or protocols in process for the use of psychotropic drugs, and some mental health workers have received training in the rational use of these medications, Dr. Estevez pointed out.
In essence, the Ministry of Public Health in its quest to arrest a daunting mental health situation has been implementing all necessary and possible measures that have thus far been yielding favourable results. This has particularly been possible not only through strategic collaborations, but by ensuring that mental health services are incorporated at the primary health care level which the Ministry has been increasingly embracing.
More on the state of mental health in next Sunday’s Edition.

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