Medical doctors only get 20 hours training in mental health for their degree

Jun 09, 2017 Letters

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Dear Editor,
Thanks for the publication of my letter (KN, June 8) captioned, “Abuse will continue against people with mental illness unless….” I ended that letter with a quote from another person who failed to further explain her sweeping generalizations which must be supported within context. Again, I refer to WHO-AIMS’s report “There is no computerized data entry system in the National Psychiatric Hospital or the GPHC Psychiatric department. Diagnostic information, based on the DSM-IV classification system, is recorded on the patient’s chart but is not a component of the mental health data set submitted to the Ministry of Health statistic department.” A wide variety of general medical conditions can present with psychotic symptoms.
I quote directly from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), “Clinicians assessing the symptoms of Schizophrenia in socioeconomic or cultural situations that are different from their own must take cultural differences into account. Ideas that may appear to be delusional in one culture (sorcery and witchcraft) may be commonly held in another. In some cultures, visual or auditory hallucinations with a religious content may be a normal part of religious experiences.”
Even though one may learn something in the classroom doesn’t mean they have it available in their tool-kit. GPHC is only one source of patient contact and for the writer to arrive at this inaccurate conclusion without any evidence based data is tramping on a dangerous path in this country. This type of practice will encourage wide spread abuse and misdiagnosis among the most vulnerable who often turn to our primary institutions of care for help in their desperate hour of need. Labels can last a life time.
Confidentiality, informed consent, conditions in mental health facilities, safeguards to protect against abuse, appropriate and accessible care within communities, and equality in opportunities for access to care, to employment, to shelter and to justice must be treated with urgency. Preambles are incorporated in all professional code of ethics and must be upheld by each individual. Simply using mental health terminologies such as biopsychosocial, affective disorder, mood disorders, and bipolar just to name a few, without an in-depth understanding of the meaning of these terms and adherence to its codes and sub-types is psycho-babbling.
The challenge we face in Guyana is one of cultural insensitivity which includes the following: prejudice, denial, discounting, defensiveness, bias, intolerance, cultural blindness, cultural incapacity, cultural destructiveness, cultural incompetence, and individual/institutional racism deeply rooted in our identities. Some of the behaviours rampant in our communities are: increased cases of intrapersonal and interpersonal violence, alcohol and substance abuse, withdrawal, verbal intimidation, profanity, high levels of frustration and stress, and verbal/physical aggression, these are all precursors to depression with increased cases of suicidal thoughts and attempts especially among the vulnerable resulting in children being caught in the crossfire.
Editor, more attention must be given to this least understood field of mental health practice. Attention must also be given to frontline workers who have had to work with this least understood population for years, not recognising that they too may be predisposed either directly/indirectly to mental disorders (unaware) and maybe suffering in the form of extreme burnout. Training must be broad-based and culture-specific, to include all service providers coming into contact with the mentally challenged.
I come now to training in mental health care for primary care staff. Only 20 hours of the 4-year training program for medical doctors is devoted to mental health. Approximately 2% of the training for nurses and 4% of the training for non-doctor/non-nurse primary health care workers is devoted to mental health. In terms of refresher training, 43% of primary health care doctors have received at least two days of refresher training in mental health, Page 4 of 4 while 57% of nurses and 3% of non-doctor/non-nurse primary health care workers have received such training. (WHO-AIMS) Guyana 2008.
The United Nations Declaration of Human Rights states that everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, medical care and necessary social services. Further, the right to the highest attainable health was affirmed by the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR). The Ministry of Health, as the agency of the government, must facilitate the development and realization of rights-based health policies including through ensuring that health systems and services are built on respect for the individual and ethical values.
Looking ahead at the next 80 years and beyond, it is up to our policy makers to put stringent measures in place to protect future generations suffering from mental illness. In the short run, a few may benefit from being on stage reciting and echoing their newly acquired language (psycho-babble) knowing fully-well it would take another 10-15 years (2027-2032) before Guyana can produce a competent pool of mental health professionals to serve this nation. This colossal task is achievable with the support of our rich human resource diaspora community whose gaze is fixed upon the horizon; welcome you home!
Ingrid Goodman, BSc., MSW, ABA, CSME
Executive Director
PATOIS/WOMENS’ REFUGE

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