Government says it has intensified programme on mental health

Nov 01, 2022 Letters

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Dear Editor,

Last week, on October 27, the Stabroek News highlighted some of the challenges in the delivery of mental health care and services in Guyana, alluding to more need to be done to address serious deficits in the mental health program, a position we agree with.

But the editorial ignored much of what is taking place today. This lengthy statement is an attempt by the Ministry of Health to ensure that we update citizens with what is occurring with mental health in Guyana today.

Since August 2020, under Minister Frank Anthony, the mental health sector has undergone rapid and historic developments in the span of just two years. The Suicide Prevention Bill, which decriminalizes suicide and the Mental Health Protection and Promotion Bill, which replaced the archaic Mental Hospital Ordinance 1930, are two landmark legislations aimed at modernizing mental health services in Guyana. 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 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. Presently, weekly psychiatric clinics are conducted at Skeldon Hospital and monthly psychiatry clinics are conducted at Suddie and Charity Hospitals (Region 2). These satellite clinics will be expanded so that every Regional Hospital will have weekly or monthly clinics in 2023.

The Ministry of Health is working with Columbia University, Department of Psychiatry (USA), designated as a WHO Collaborating Center to work with developing countries to build capacity for mental health care and services. Columbia University is working with the Ministry of Health to build capacity in various areas of mental health, including through a grant from the US National Institute of Mental Health (NIMH). Through this program, a Conference to help develop and implement a Mental Health Wellness Program is slated for November, 2022. More than twenty international experts will join counterparts in Guyana for a historic Conference to help Guyana roll out a Mental Health Wellness Program. One of the significant areas of collaboration is a project geared at examining the risk factors for suicide. Collaboration has also commenced with the Canadian Government Program, through the International Development and Relief Foundation (IDRF), to address mental health in vulnerable communities.

There is an ongoing, new and energized effort to address the infrastructure, management and treatment of patients at the National Psychiatric Hospital, the GPHC Psychiatric Department, Mental Health in the Workplace and Human Resource needs for mental health. One of the initiatives that can be mentioned upfront is that the Post-Graduate Program for Specialist Psychiatrists which was introduced in 2010 is being expanded to ensure that there are adequate numbers of Psychiatrists across Guyana. A second initiative is the introduction of a telemedicine program to provide psychiatrist-led, psychologist-led access to mental health consultation across remote areas beginning in 2023.

A program has been developed and is being implemented to address weak and absent workplace mental health interventions. To this end, the Mental Health Unit rolled out, since 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, the 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. In addition, a new Gate-keepers Community Training Program, a program that was abandoned in 2015, is ready to be rolled out again. The Ministry of Health agrees that these efforts must be sustained, since with funds previously from Global Fund HIV/AIDS, such programs were initiated in 2006, but were not sustained.

Staffing initiatives have been implemented to address the inadequacy of the staff at the National Psychiatric Hospital. To be clear, there are ten nursing staff at the NPH at this time and, not as believed, four nursing staff. Presently, the Hospital Medical Superintendent and Head is a trained Forensic Psychiatrist, Dr. Meena Rajkumar, who is fulltime at the hospital. She is supported by another fulltime Psychiatrist, three Medical Doctors (GMOs, Government Medical Officers), a Registered Nurse Matron, two Registered Staff Nurses, seven Nursing Assistants, eighteen Nurse Aides, seventy-four Psychiatric Patient Care Assistants, and two Social Workers. More recently, Government has deployed 37 part-time workers to support the staff in various areas, including in facilitating the general hygiene and personal grooming of the patients. The additional support by nursing aides, patient care assistants and part-time workers permit the ten nursing staff to focus on the nursing needs of the patients.

Further, efforts are being made to improve the staffing. Two additional psychiatrists will join the full-time staff at the National Psychiatric Hospital as of November 9, 2022. A Psychologist is due to begin fulltime assignment this week at the National Psychiatric Hospital. Psychiatric staff at the GPHC are presently being rotated on a visiting basis to provide support to the soon-four fulltime Psychiatrists at the National Psychiatric Hospital.

In addition, administrative support is being provided to Dr. Meena Rajkumar to free her up to provide more direct patient care and focus more on the clinical management of the patients. Further, additional Government Medical Officers (Doctors) are being deployed on a rotation basis from the Region 6 list of Doctors, particularly from New Amsterdam Hospital. From the staffing perspective, the GOG has not been non-responsive, as claimed by the editorial.

The Ministry of Health has been working with our partners to resuscitate the Psychiatric Nursing Program 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 Ministry of Health is also introducing a new curriculum to train Psychiatric Nursing Assistants. Several of the parttime workers have been identified to be trained as Psychiatric Patient Care Assistants. UNICEF is partnering with the Ministry of Health to expand the nurse training program for psychiatry. The Ministry of Health has been significantly more active in the last two years than in the preceding eight years in building the human resource for psychiatry, even if much more still must be done.

From about 2014, Occupational Therapists have been absent from the staffing complement at the National Psychiatric Hospital. The Occupational Rehabilitation Center was closed and abandoned sometime after 2015. Similarly, the visiting Psychologist that supported the Psychiatrists before 2015 no longer is available. The Ministry of Health is presently recruiting an Occupational Therapist to improve patient care at the hospital and is working with GPHC to either deploy a fulltime Psychologist or a visiting Psychologist to the National Psychiatric Hospital to support the Psychologist that is joining the staff this week. The Occupational Rehabilitation Center is being rehabilitated and reactivated. The organizing of Christmas concerts, entirely by the patients themselves, a practice that was discontinued sometime ago, is being considered for Christmas 2022, even if, for now, it is just a semblance of what it used to be.

The Ministry of Health is working with the National Psychiatric Hospital and the Region 6 Health Department to reclaim the recreation ground and the vegetable garden that were both reclaimed between 2006 and 2014. Both the recreation ground and the vegetable garden are today overgrown, neglected since 2015. A shade-house to reclaim the kitchen garden has already started construction, 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.

Significant improvements have been made in the general infrastructure of the facility. We are unable to vouch for any work that was done at the NPH between 2015 and 2020. The large sums invested in 2017, as noted by Stabroek News and claimed by Dr. Karen Cummings, remain a mystery to us. But various improvements are visible to the infrastructure since 2020. In particular, the deplorable conditions that existed in the bathroom areas have been improved. As far as the grounds and the sewer system are concerned, a massive investment is required. The already poor state in 2015 was further neglected and the situation in 2020 was desperate. We concede that much more must be done to improve the sewer and the grounds. The Ministry of Health is hopeful that as part of the infrastructural transformation between 2020 and 2025, a new National Psychiatric Hospital would be included. Those proposals are under active consideration by the GOG.

There are various other initiatives at the National Psychiatric Hospital at the moment. These address the care and treatment, living conditions and quality-of-life of the patients. New beds, with proper mattresses, sheets, pillows etc. have been put in place. By 2020, outside of the patients with acute episodes, the long-term patients had no regular psychiatric care and lived under inhumane conditions, treated as homeless. Presently, 100% of the patients receive weekly and monthly psychiatric evaluation. Daily medical clinics ensure that the medical needs of the patients are addressed. A medical block has been added to Chalet #2. Patients with medical conditions who need dressing, simple suturing, rehydration, etc. can access such services in a dedicated area.

The ad-hoc and virtually non-treatment with medicines that were 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.

Critical quality-of-life, grooming, meal and snacks, recreation, socialization indicators are being worked on. While still a work-in-progress, work is being done to ensure that patients have baths regularly, change-of-clothing, supervised recreation and occupational activities, etc. Patient grooming, ensuring patients have clean clothes, including night-clothes, nails and hair-grooming, general hygiene, etc. are now in place. To assist, new industrial washer and driers have been procured and presently are being installed. A meal plan is in place and the quality of meals and snacks has improved significantly, with a dietician organizing meals and a new modern kitchen constructed and installed. 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 6 and the NPH.

Much remains to be done. But the GOG has been actively re-energizing the mental health program and we view the situation at the National Psychiatric Hospital as a focal point of this effort.

Regards,

Ministry of Health

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