Essentializing Culturally Competent Intervention
In Part I of this series of reflections on the role of Mental Health in Transforming Guyana, I supported the view that there is a reciprocal relationship between economic development and the psychological well-being of a nation, advocating for investment in mental health infrastructure. This article emphasizes the importance of a culturally competent intervention approach to mental health care. University of Guyana Chancellor Dr. Edward Green believes culture permeates all institutional functioning. Although there is no clear indication of disparities in susceptibility to mental distress based on race, ethnicity, and cultural beliefs, it is essential to consider cultural factors in onset, assessment, symptom recognition, and intervention. Cultural beliefs and practices influence how people negotiate in all sectors, including the health care system, and are critical in planning, delivery, and outcomes.
The intersectionality of multicultural customs and norms, characterized by introspection and respect for others, can be transformative and represent a unifying force yet to be realized. These existential elements are at the core of personal care and psychosocial well-being. Respecting cultural values, community inclusiveness, and cultural sensitivity help to overcome fears, myths, and taboos based on traditional customs and beliefs. Counseling Educator Heather Vinner found that Caribbean adults are reluctant to admit having “problems” or seek help due to stigma and shame. They value discussing cultural issues but prefer therapists who are similar to them in ethnicity/race, culture, and gender.
Social analyst Anan Boodram argues that there is no ethnic impetus for domestic abuse, which is often triggered by psychological stress. His position reinforces the rejection of culturally biased causes of socio-economic and family deficiencies, which may be a factor in family violence. Nonetheless, some families need help responding adequately to mental health challenges, which are often a causal factor in disputes. The inability to recognize symptoms could lead to confusion and thwart practical remedial efforts. Children’s behavior may sometimes be symptomatic of a mental health problem signaling the need for parental/guardian healthcare education to guide effective intervention. Relative to this matter, Caribbean parents tend not to see corporal punishment as abuse. Some analysts view this belief as endemic to the culture. Notably, Caribbean immigrants have endured penalties for violations in diaspora communities where child abuse laws are enforced.
Intervention approaches and activities should be informed by local community practices, nuances, and traditions (those that potentially contribute to mental distress, as well as those that enhance mental health), history, trends, and needs. They must also extend to rural/hinterland, coastal and urban districts, transcending ethnic groups, age, gender identity, and political affiliation. It is essential to consider culturally sensitive and culturally competent interventions that prioritize and respect values, practices, religious beliefs, and backgrounds. Furthermore, the high stigma and discrimination associated with suicide and mental illness, in general, must be considered. In Guyana, increased use of pesticides to commit the act of suicide, particularly among East Indians, underscores the need for the development and assessment of suicide prevention measures to control access to lethal products, as successfully demonstrated in other affected countries. The trauma experienced by surviving families of suicide victims, for whom grief counseling should be provided, is often overlooked. Social Work Professor Paulette Henry found that families and communities in Guyana are traumatized due to guilt and the perceived inability to have identified the problem before it culminated into a fatality. She further notes that the media often sensationalize acts of suicide and suggests that all forms of suicide, including murder-suicide, need the attention of religious and other cultural organizations.
Working collaboratively with the Ministries of Human Services and Social Security, Public Health, and the University of Guyana School of Social Work, voluntary organizations (at home and diaspora) could play a pivotal role in addressing the needs of underserved, diverse groups. Increased expertise, professionalism, and skilled intervention are essential. There is a need for Family Support Groups, programs for children and families at-risk, those afflicted with chronic illnesses, and seniors. Uniformity in providing healthcare services with consistency throughout the nation should be prioritized. A piecemeal approach is unconscionable and potentially counterproductive. Positive outcomes in these areas can be accomplished by conducting more research and instituting training and development involving academics and specialists in the respective fields. Sharing information about communities in which there have been successes and those where there have been failures and frustrations would provide the lived experiences of service recipients about cause and effects. For example, regarding the COVID-19 pandemic, there were high and low success rates in Regions Five and Three, respectively. Determining the reason for such disparity and utilizing that information in assessment and programming would improve strategies and effectiveness of care across regions.
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. As mental health becomes a part of the national conversation, untenable causative socio-cultural factors and recent trends must be heeded. The upsurge in the rate of suicide in Guyana, including among adolescents, undoubtedly causes alarm. The US Country Report on Human Rights Practice found that the country’s physical and sexual abuse of children has become far too familiar. Recent reports on “the silent pandemic of suicide” and non-trusting attitudes toward mandates related to the stress of the COVID-19 pandemic are very concerning. The consequential increased worry and alienation, particularly among children, adolescents, and seniors, have been cited. Although there is no clear indication of disparities or characteristics in incidents of suicide based on race and ethnicity, it is essential to consider cultural factors in assessment, onset, and treatment. Not only are culturally informed mental health intervention strategies needed, but little or no knowledge about suicide, compounded by the secrecy of it the public, is counterproductive.
Community education in symptom recognition and conditions for reporting without serious violation of community cultural norms is essential. Behavioral and physical symptoms need to be recognized and not ignored. Done with respect, professionalism, non-imposition, and community inclusiveness will help to overcome fears, myths, and taboos based on traditional cultural values, customs, and beliefs. These should be informed by local community practices and traditions (those
factors that potentially contribute to mental distress, as well as those that enhance mental health. A complete revamping of the healthcare system will increase psychological well-being and expand the Guyanese population’s capacity to reach its full potential. Developing a comprehensive strategy targeting multiple age groups across various races and ethnicities would be strategic. Upgrade therapeutic interventions for mental health, especially among children and youth, would be beneficial. Cultural presentations to people of various races and socioeconomic statuses would help. An example of a professional-related educational program is the Biennial Conference on Mental Health and Virtual Learning, sponsored by the Ministry of Education and Guyana-Jamaica Friendship Association, a diaspora organization. It is essential
to acknowledge that there is value in recognizing the “diaspora knowledge” – that it exists, can be used, and is necessary not to be neglected. Mental health education, prevention, and intervention should be part of the school curriculum and Parent-Teacher Association agendas. Particularly among adolescents, identity ‘confusion’ is compounded by the stresses of their social environment.
Drawing from the US Center for Disease Control’s plan for responding to the suicide epidemic, educating students and parents about suicide risk factors and interventions must be prioritized. The proposed strategies should be considered with some modification based on cultural relevance, particularly the influence of religion and agriculture-based infrastructure with access to lethal means. This is particularly relevant considering the high rate of suicide in rural areas. Working with NGOs and trained mental health professionals, Hometown Associations can contribute in areas of research, training, prevention, and raising awareness. Understanding risk factors and recognizing warning signs of mental stress is essential. These include a history of suicide in the family, prior suicide attempts, child maltreatment, mental disorders, alcohol, and other substance use disorders, physical illness, domestic violence, and feelings of hopelessness. Considering these factors, the plan of action anticipated to emerge from the government’s call for establishing a task force on suicide following the escalation of the rate of suicide will effectively address the problem. Such a task force could incorporate some of these proposals in its strategic planning. Although investment in economic development tends to take precedence over socio-cultural needs, the nation’s mental health will impact national advancement. A multipronged solution, i.e., clinical and socioeconomic, is needed.
Attempted suicide, which is often preceded by depression, is only but one overt expression of mental health problems. Other symptoms of severe mental distress often go undetected due to non-recognition or denial of such symptoms. The mental health experts on the government’s task force must consider correcting this. Working collaboratively with the Guyanese diaspora, particularly those organizations with a track record in providing mental health services, is encouraged. This would augment the resources in the home country. Both preventive and remedial approaches and adequate funding are essential to effectively combat the challenges that produce mental distress that appears to be ravaging the nation. Making full use of the related technology, the introduction of the Virtual Hope Box Smart Phone APP to prevent suicide is strongly recommended. Other variables should be considered assessing the patterns of suicide and the victims’ socioeconomic status. They were likely to be poorly educated, employed in low-income occupations, residing in the same community all their lives, and in the case of adults, less likely to have children.
Understanding the ripple effect of vulnerabilities, how certain groups in society become targeted and how both intangible and indirect pain is generated is essential. This affects interpersonal realities and family life in many ways. The question of what we mean by “social problem” is thrown into stark relief. But what exactly do we mean? When we consider such problems, we think about economic inequality, poverty, unequal access to vital resources, and discrimination based on race, ethnicity, gender, political affiliation, and age. Do we think about mental health issues? Do we consider those more invisible but persistent, widespread personal and social pain sources? We need to rethink these realities, which seem to be skirted. They affect us in so many ways. Addressing mental health within a socio-cultural context seems crucial to all the quick talk about “development” and anticipated riches from gas and oil money.
The reaction to people with mental health problems and those on the cusp of psychological distress must not be ridicule, indifference, or punishment, but compassion, understanding, cultural sensitivity, and informed intervention. Fortifying mental health training programs with the recent establishment of the Behavioral Studies and Research Center at the University of Guyana is significant but not enough. Guyanese Psychologist Dr. Nathalie Caldeira emphasized the need for evidence-based research, education, and training for a successful response to mental health as a national concern. This will guarantee increased psychological well-being and expand the population’s capacity to reach its full potential. She found intense interest in participating in a specialized graduate program in Clinical Psychology.
Research in this area helps determine why some interventions succeed in one community and fail in a neighboring community. The variation may be based on differences in demographic make-up, the extent of adherence to traditional practices, or attitude toward “outsiders.” The National Mental Health and Suicide Action Plan call for enhancing integration, sustainability, and capacity-building opportunities. Complementary services should include education, job training, child-rearing techniques, and cultural sensitivity training. Linking people to services is essential, but the benefits must be there. The establishment of a Mobile Mental Health Crisis Team would be helpful. The Pan American Health Organization, acknowledging the lack of attention to mental health in Guyana, recommends increased funding in the aftermath of the COVID-19 pandemic. PAHO saw the post-pandemic uptick in anxiety and depression, noting the correlation between good mental health, economic development, and citizen opportunities. The Guyana government’s plan to introduce a Telehealth system is encouraging. In making that announcement recently, the Minister of Health stated, “As the nation expands in other industries, the healthcare sector must be improved to serve a growing economy effectively.” The USAID announced funding for 2022 to support youth security and health care. The extent to which the latter includes mental health care is not clear.
Programs such as Child Link and Family Awareness Consciousness & Togetherness (FACT), to which ExxonMobil reportedly contributed G$ 13M, are creditable non-governmental preventive projects. Though instrumental in providing a range of social services to families, such programs should be extended to ethnically variant communities. Counselors, mental health professionals, and researchers need to focus on what may be seen as a cultural perspective in conceptualizing and defining child abuse, neglect, and maltreatment. Intervention must be informed by knowing the community’s needs and openness to change. Stakeholders are encouraged to collaborate to improve the effectiveness of mental health care in communities at large.
It is one thing to enjoy the trappings of the higher office, but how officeholders can make a difference in the life of all stakeholders is much more complicated yet essential. If a “transformative trajectory” of Guyana, as promised by the President, is to be realized, all population sectors must be motivated, prepared, and encouraged. This article examined a neglected dimension of nation-building. The ideas presented could inform policy as the nation builds capacity. Cultural competence must be a functional factor in this process. If assiduously implemented inclusively, this will solace those whose productive ability has been hindered by interpersonal or socio-economic stress. It will help those “taken for granted” or left behind in a society hoping for an economic windfall. These considerations should be embraced by those who champion both human and natural treasures of Our dear land of Guyana.