There is excitement among Guyanese and the international community about the prospect of accumulating wealth that the gas and oil industry promises. However, a humanitarian problem is also being ignored, i.e., mental health care. Political and economic change is generally at the forefront of the national development conversation. The tendency to focus on the business sector, including inviting investors, is understandable. Unfortunately, this overshadows the provision of resources to address problems related to psychosocial wellbeing.
The argument that there is a correlation between a nation’s mental health and economic growth is convincing. The World Health Organization views mental health as a state of well-being in which the individual realizes her or his abilities, can cope with everyday stresses of life, works productively, and can contribute to his or her community. WHO established that there is a link between mental health and economic productivity. Making a similar connection, economist Nava Ashraf urges governments and academic institutions to address the problem both in how mental health can affect economic productivity and how good mental health can be an outcome of improvements in economic development. Qualitative human relationships and good psychological health are among the foundations of nation-building. I will attempt to put this interdependent connection in perspective, propose strategies for addressing emergent problems, and provide possible solutions.
Nation-building needs steady hands and sound minds across the ethnic, racial, religious, and social class spectrum. This is a reasonable gauge of civil society reaching its full potential. Human capital, i.e., the economic value of people’s experiences, skills, and expertise, is diminished by mental/emotional stress. Caribbean nations have not attached enough importance to vulnerable populations such as the mentally ill and the related problems including domestic violence, substance abuse, homelessness, developmental disability, and adjustment of returning deportees. According to the Regional Investment Promotional Agency Association, a substantive number of people in the Caribbean are employed in the medical field, but only incremental strides were made in providing resources for mental health. Although acknowledging the problem as immutable, there has not been a consistent response to mental health in Guyana. Vulnerable groups, including the mentally distressed, elderly, homeless, those labeled as “street dwellers,” and the LBGTQ community, are marginalized and treated as second-class citizens, evidenced by the lack of sufficient resources and interest in their welfare.
A history of discrimination and bias against the mentally distressed exacerbates their vulnerable disposition. They become more targeted during increased ethnic/racial/political conflict, social unrest, and economic depression. The emotional impact of exposure to violence cause fear, anxiety, frustration, ambivalence, confusion, anger, and depression, all precursors to mental health maladies. Violent crime and the perceived threat of crime are detrimental to one’s emotional state. These conditions lead to diminished participation in social activity and decreased work productivity. Little attention is given to the correlation between the high cost of living and psychological stress. As a way of coping, some families “move in” with distant relatives and friends or become reclusive. Those who can afford to do so travel overseas to seek medical attention or “a better life.”
The above phenomena affect people’s mental capacity and their ability to self-care and cope with personal and societal stresses. The aforementioned vulnerable groups are generally stigmatized and viewed as a liability to social progress. The mantra “survival of the fittest” imply their “place” on the fringes of society. It also distinguishes between “able-bodied” and “dependent” citizens, clearly making a poignant distinction and judgment about inequality. These and other contributing factors to the mental/emotional health problem have not been adequately contemplated and addressed. Quantitative analysis of these intangible or indirect costs of addressing these problems is neither prioritized nor easily achievable without firm commitment and the ability to project clear goals. The capacity of stakeholders to follow protocol and fulfill civic responsibilities often depends on their social and economic situation.
Social analysts suggest that the exigencies of economic and political factors in a region where there have been varied claims on limited resources such as funding and expertise tend to determine the nature and immediacy of response to sundry psychosocial problems. There seems to be a degree of tentativeness and lack of will to act on behalf of the victims of what is perceived as a secondary or non-essential societal problem. Advocates are few. As mental health becomes a part of the national conversation, untenable socio-cultural factors and recent trends have not been given the attention needed. Specifically, the upsurge in the rate of suicide in Guyana has been a cause for concern. Innuendos and verified reports warrant an urgent examination of the country’s emotional pulse, i.e., extent, impact, preparedness, resources, ethnic fallout, and planned intervention strategies.
In assessing the causes and effects of mental health problems, it is essential to understand that vulnerability, feelings of isolation, and detachment from social institutions result in tension and a sense of loss, particularly among young people and the elderly. Prolonged culture of political corruption, past and recent crises of confidence in governance, and periods of high unemployment and crime, exacerbate feelings of despair and marginalization, leading to increased psychological distress. These factors also account for the escalation of family violence. Domestic violence “is the most pervasive form of interpersonal violence in Guyana.” A U.S. Country Report on Human Rights Practice found that physical and sexual abuse of children in Guyana has been common. There is a correlation between mental health, societal tension, educational performance, and the capacity to fulfill a civic duty. More than a tepid response is needed to make children and adolescents less vulnerable. One can argue that the high rate of suicide is symptomatic of societal tension and interpersonal stress. The fallout from the COVID-19 pandemic has been a trigger for various emotional problems, including hypervigilance and lethargy among children and adults.
Not only are the victims of these maladies put at risk, but unabated, the population as a whole becomes vulnerable to fragile interpersonal relationships, social functioning, and productive capacity. A realistic assessment of these problems and provision of needed resources to deal effectively with conditions that impact mental health is imminent. There are burgeoning impediments to effective mental health intervention. The perception, assessment, and treatment plans in response to these troubling maladies must be recalibrated and urgently addressed. However, pre-emptive attention to legal and cultural barriers must precede any attempted significant changes. Concerned Guyanese at home and abroad have sounded the alarm regarding a seemingly cavalier, misguided attitude toward psychological well-being. This includes the criminalization of attempted suicide and the act of suicide based on outdated Colonial law. Undoubtedly, such a law discourages those with suicidal thoughts from seeking help and dissuades general reporting. Having a Suicide Hot Line managed by the Police Department has deterred victims, family, and friends from seeking help. Several proposed solutions, drafting a National Mental Health Plan and Suicide Plan, including changing the aforementioned edict, have been discussed but not fully implemented.
The high rate of suicide is symptomatic of societal and interpersonal stress, potentially leading to severe mental health problems. A significant number of the citizenry of all age groups and ethnicities in many countries experience mental distress in their lifetime. Indeed there has been a shortage of mental health professionals, paraprofessionals, and the infrastructure for delivering quality mental health care. The deficit ratio of mental health practitioners (social workers, psychiatrists, psychologists, psychiatric nurses, and counselors) to potential service consumers/clients is understandable but particularly troubling for a nation in the throes of social and economic revitalization. Guyanese psychologist Dr. Natalie Caldeira’s study reveals several reasons for Guyanese aversion to mental health services and the lack of effective interventions. Unlike other societies, stigma and cultural beliefs affect attitudes and dispositions about mental illness. There is a lack of awareness and trained professionals in research, diagnostic methods, and treatment interventions, including in Schools and Correctional institutions. Despite anticipated gains from the gas and oil industry, Guyana’s leadership has the unenviable task of healing a nation that could teeter on the brink of unrest, adding to the stressors of potential emotional problems.
Mental Health and Nation Building: Collaboration with the Diaspora
Diaspora Hometown Associations help with family independence, capacity building, sustaining communities, and pre-empting stressors associated with conditions of poverty and mental distress. The activities of these organizations contribute to self-care and investment in nation-building by enhancing citizens’ capacity to develop their communities. Collectively, community development is national development. With the increase in diaspora engagement, a new field of public policy called “Diaspora Strategy” emerged. The nature and expediency of a country’s engagement with the diaspora could determine the success or failure of contributions from the diaspora. Engaging through the work of skilled practitioners and non-profit organizations will help decrease the pervasiveness of mental distress and stymie human and economic costs. Mental health professionals attached to these organizations or working with NGOs have been instrumental in prevention, treatment, and rehabilitation.
In a forum sponsored by Caribbean Voice, Dr. Dawn Stewart warns that suicide and mental health are not recognized as severe issues in Guyana. Workshops conducted by Lesley University/Guyana Program and Center for MulticulturalGlobal Mental Health promoting public awareness and practitioner training exemplify diaspora contributions. The Caribbean American Social Workers Association has conducted workshops on domestic violence and mental health, drawing from the research of University of Guyana Lecturer Paulette Henry. This ensures culturally competent intervention. Indications are that Hometown Associations will continue in partnership with local non-profit entities and the government to provide funding and other resources to expand mental service, particularly in underserved communities.
Much of the HTAs’ assistance is informed by connection to the care and development of specific communities. Some organizations and individual donors have expressed disappointment with the lack of follow-up and continuity of care in overseas health/mental health service assistance. This must be corrected to avoid gaps in care and the risk of health relapses. HTA executives have emphasized the importance of sustained institutionalized structures and qualified, committed providers. The government would do well to re-establish confidence in its ability to engage the diaspora with transparency, consistency, and earmarked funding. Healthcare donors should be supported in efforts to develop coherent strategies. The Diaspora Engagement Strategy Document of 2015 identified several service areas, including health/mental health and social welfare. The diaspora’s willingness to share expertise has been positive, though implementation needs thorough preparation and commitment from both sides. The International Organization of Migrationrecommended connecting young people from the diaspora with those in the home country through short-term programs with scholastic, emotional, social, and environmental issues and life skills components. The reciprocal learning from such transnational relationships is invaluable. A country with so much land should fully use its unlimited open spaces by sponsoring/funding more constructive outdoor activities for children and young people as a natural preventative therapeutic community.
The diaspora has been generous in their contribution to healthcare. Volunteer Nurse Practitioner Kathy Lambert acknowledged that in time the government would be able to effectively manage the health care system. But is essential to seize the opportunity to make the most of diaspora knowledge and skills building through partnering with local practitioners, reaching and treating as many local citizens as possible. Re-establishing confidence in the government’s commitment to embracing the diaspora’s role in health care and other social and technical services is paramount. Collaboration with the Ministry of Health has ensured life-saving services when initiated, funded, and delivered by diaspora organizations. However, local counterparts’ lack of follow-up services causes serious relapses in care. Hopefully, the latest government-promised initiative to re-align mental health services and tap into the diaspora will benefit civil society, especially the underserved.
Former president David Granger predicted that the good life for everyone beckons. However, hope and wishes anxiously anticipated by new money sources can have a dark side. Consequently, strategic planning to regulate costs and avoid ominous mistakes is essential. The path to economic development is not shaped by “expected riches” but by sustaining critical assets, including honest, transparent leadership and good mental health.