The National Psychiatric Hospital

Dec 18, 2022 News

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– A home for the mentally challenged

Kaieteur News – Critical to the Regional Health Services in Region Six, and the health sector in Guyana, is the National Psychiatric Hospital, located at Fort Canje, Berbice. This is the only institution in Guyana specializing in the provision of rehabilitative care for persons suffering with mental illnesses.

When talking about mental health in the past, it may have been a taboo subject with a lot of stigma attached to it, but as time progressed and people became more knowledgeable and aware of mental health issues, the topic itself has become an extremely important one. The need for a better facility to assist in this regard remains high on the agenda for the Government of Guyana.

The original structure of the National Psychiatric Hospital over the years has deteriorated, and while the need is to have it preserved and even have a brand-new state of art building, the resources are not readily available. However, some enhancements will likely take place in the future.

During a candid sit down with Dr. Leslie Ramsammy, former Minister of Health, he mentioned that the service the institution provides is one that is critical to mental health, and that with the introduction of the mental health bill at the last parliamentary sitting, it comes at a time when plans are being put in place for a brand-new facility.

The rebuilding of the National Psychiatric Hospital into a modern facility, “is part of our plan and that will be done at some point. I know that every infrastructure project that we develop with the IDB and World Bank since I was minister, always included the Psychiatric Hospital but then we make the choices and now I believe finally nothing will knock it out…,” he said.

He added that the government is working towards having modern mental health programmes “and I think that while in my time, we made a lot of changes to modernize it, people didn’t see it because that is something that people didn’t pay attention to. The kind of changes now will be visible so that people could see and the intention is that a portion of the patients that come into the hospital to be returned to their home eventually, but if you are going to do that you have to ensure that there are enough case workers who will follow them, make sure that they are getting the necessary support so that they can stay in their community rather than return so we are going to do all of that.”

The idea he said is to bring back humaneness to the institution by providing patients with the same opportunities as any normal person. While he is cognisant that such changes won’t happen overnight, he is aware that it will take time but that it will happen.

“The vision has always been there, the resources were not, I know the vision is still there and I know for sure we are better off with the resources, both human and financial…” he said confidently.

He also mentioned that during his time as Minister of Health, there was a Post Graduate training programme in Psychiatry which helped to qualify some eight persons in that field. There were two before, including Dr. Mayda, whom he said deserves an award for all that she has done for mental health in Region Six. That programme was at some point discontinued but is set to be re-introduced in the year 2023.

But what do we know about the history of this institution that has now etched itself into a historic landmark for the country? While these plans are set to transform the way in which mental health is delivered in Region Six, it is also important to understand how and where it all began.

History

Dr. Leslie Ramsammy, revealed that the name, “The National Psychiatric Hospital” gained popular usage under his stewardship but said that it was previously referred to as the “Lunatic Asylum”, noting that “it indicates to you and the whole world how people looked at mental health and how they looked at it as people who are crazy and had to be locked away.”

The “Lunatic Asylum” which was later renamed the “Mental Hospital” and subsequently changed to its current name was built in the early 1600’s in Asylum Street, New Amsterdam; interestingly to note, that street was named after the institution. According to Dr. Ramsammy, the colonialist established the first one in Guyana in 1725 and it was among the first in the Caribbean. However, that structure proved to be rather small at the time and it was considered more of “a prison than a hospital” since these mentally ill persons “had to be put away and not treated.”

In 1867, it moved from Asylum Street to where it is today at Fort Canje and back then that location was called “Fort Look Out” or “Point look-out.”

“It moved to the present site in 1867 because where it was, it was a small cramped building and because by then, after the slaves were set free, hospitals were no longer for the white people, it was also for the rest of the free people and so now you have more general treatment,” Dr. Ramsammy mentioned.

The site which is considered historic was occupied by the Dutch and English as their command centre for security reasons. It was said to be the “look-out” location for their enemies, hence the name “Fort Look-out” or “Point look-out.” The English and Dutch eventually left, and the site became occupied by the staff and patients of the National Psychiatric Hospital in 1867.

“It had some small buildings, the old landmark building, the Victoria block was not built until 1899 and that was built after a doctor came from England. In those days, Dr. Robert Greaves came to Guyana in 1875 and began to look at the hospital,” Dr. Ramsammy mentioned.

Greaves, who he said was instrumental in the transformation of the institution, believed that “the people who are called lunatics were not crazy people but that they had a mental problem that can be treated. They didn’t have medicine and so on, but he pioneered occupational therapy in the Caribbean and in mental health treatment in general…”

Greaves, he said also believed that the patients should be given recreational opportunities and so he had put in place a cricket ground, kitchen garden, a sewing room, a butcher shop and more for the patients to access and for the institution to become self-sufficient. His approach was to rehabilitate patients instead of “locking them away”, and have them involved in regular activities, “because he was trying to prove that these people are not lunatics to be locked away and that they can actually go back into society…”, Dr. Ramsammy said. It was also Greaves that introduced modern occupational therapy as a treatment for mental health patients.

Queen Victoria Block

The building which was referred to as the Queen Victoria block, no longer exists today, the British had set aside $60,000 to build the structure. That structure included ten wards, six male and four female with approximately 300 female and 200 male patients, 100 both male and female attendants, one Medical Superintendent, a doctor, maids, porters and guards. Senior staff members were also housed in the compound while attendants were trained there as well.

After Dr. Greaves had left, there were some questionable methods/treatments implemented, not only at the institution but in mental health treatment around the world. The electric shock treatment was a method used to treat patients, but “today we look at them as archaic, brutal but at the time, those were the type of treatments. There was an electric shock room there at the time. At the time, they thought it was effective but today, we question whether it was”, the health ministry advisor noted.

Together with the Victoria Block, there was a King George building, a mess hall for staff and patient.

Interestingly, there was no Observation wards in Georgetown at that time and as such, all mentally ill patients were referred from various hospitals in Berbice to the institution at Fort Canje. To date, many mentally ill patients are taken to the National Psychiatric Hospital here in Berbice, in fact, according to the Regional Health Officer Dr. Vishalya Sharma, over 50% of the patient population at the institution are from Region 4.

Fire and deterioration

In 1957, an unfortunate incident occurred. The female section of the Victoria block was burnt to the ground. The building was repaired, reconditioned and re-commissioned in 1964 by Dr. Cheddie and Janet Jagan. In 1992, Ramsammy became the Minister of Health and he had paid a visit to the institution. There he said during his visit, it “was scary to see”, in that, he was “scared” to walk in the wards, “I felt like I was going to fall through the floor, it was smelly…” The building was not maintained as it should have been and in 1992, while it was one of the things high on the agenda of the government then, to have the institution up to standard, the resources were not available to do so.

“We quickly forget the new government came in where the total revenue, the debt servicing and public servants’ salary was 128% of your total revenue. Therefore, the government was reduced to a band-aid. So that was one of things I remembered well that the government put on its agenda to rebuild the National Psychiatric Hospital but the resources it would have taken, you didn’t have but you also couldn’t wait because a patient had no place to stay and it wasn’t safe to keep them there.” Some minor repair works were done on the Victoria Block building and chalets were built. The idea of building the chalets as a cheaper alternative at that time, was started by the now Minister of Parliamentary Affairs and Governance of Guyana Gail Teixeira, Ramsammy said.

He describes the building as a majestic one. “Anybody who grew up in Berbice, anybody who ever passed Canje Bridge, that building stands out, but we didn’t maintain it. From 1964-1992, not a drop of paint, the building deteriorated.”

According to him, “the history of the Queen Victoria building is the history of mental health in this country because it shows how things changed.” While the desire was still there to find the resources to have a new building, Ramsammy said there were other pressing matters that those resources had to be diverted to at that time.

“I still had that desire to find the money but there was GPHC falling apart, NA hospital, Skeldon, Port Mourant, Suddie, West Demerara, Linden and so choices had to made. And whilst we had our priority, we had to go to Plan B; building chalets, doing minor repairs to that building and those minor repairs were done only because we still hoped to preserve that building. So the greatest sentiment in government was to preserve and so we were waiting to get that big sum of money to put in there; however, time ran out and the building started falling apart.”

Thirty-eight years later, in 1995, the female Victoria block was condemned, and three new wards were constructed. The chalet type buildings housed 75 females’ inmates of the institution. However, not long after, one female chalet was destroyed by fire and that ran an estimated loss of $20M at that time.

Currently, there are over 200 patients housed with a total of 170 staff members and while there are new structures in place in the compound, there are still remnants of what existed many years ago when the institution came into existence. There have been several other small reported fires that occurred at the facility over the years and several escapes by patients, this pushed authorities to increase security at the location.

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