The World Health Organisation (WHO) report which named Guyana as the country with the worst suicide rate in the world has revealed more than the statistics that shocked some and sent others into denial mode.
While Head of the Presidential Secretariat Dr Roger Luncheon blustered about WHO overestimating the statistics and the figures being inconsistent with locally gathered data, he had no stats of his own to counter what was produced in the report.
On the other hand, Minister of Health Dr Bheri Ramsaran seemed to calmly accept the report, acknowledging that there was indeed a problem and virtually admitting that not much was being done about it as he dismissed the National Suicide Crisis hotline as a failure.
It was not news that the helpline was abandoned. There had been no word of it for quite a while; no advertisements targeted at those vulnerable to taking their own lives or attempting same.
Dr Ramsaran was emphatic when he spoke to this newspaper about the termination of the crisis line: “I will say this, the suicide hotline was a failure.” The hotline had been launched in 2010 and according to Dr Ramsaran, it was receiving only 2.5 calls a week and an estimated 9 calls a month, some of which were not even suicide related. Dr Ramsaran said an attempt was made to link the suicide hotline with the one attached to the National AIDS Programme Secretariat, since both were underutilised, but this also did not lead to any upward movement in calls and funding was subsequently lost for the project.
What Minister Ramsaran failed to mention, or perhaps did not check, or maybe thought no one would remember, was that the hotline was initiated as a pilot project. It was slated to last 10 months, beginning in September 2010 and ending in June 2011, following which it should have been evaluated and extended or strengthened as was necessary.
Crisis hotlines for suicide exist all over the world, the majority of them are run by non-government organisations. One of the more well-known ones, Samaritans, has been in existence since 1953. A recent study of eight suicide hotlines in the US revealed that overall, there was promising evidence that the outcomes were consistent with reducing immediate risk of suicide.
The local hotline faced severe deficiencies from the get go. It was set up by a government ministry. Eleven people were trained to man the crisis line, but they were drawn from the Ministry of Health and the Georgetown Public Hospital. These were people who already had full-time jobs/careers and may or may not have been interested in mental health. University of Guyana social work graduates would have been a better choice. They would have had some exposure to counselling already and many were graduating with no real prospects.
The hotline was only being manned for 12 hours a day. Granted it was better than nothing, but did no one consider that someone contemplating suicide would be unlikely to wait 12 hours to be able to call for help?
At that time the current Minister of Agriculture, Dr Leslie Ramsammy was the health minister. It has to be said here that in that former position, Dr Ramsammy was driven and the health sector had actually recorded some achievements during his tenure.
The suicide rate in 2010 was given by Dr Ramsammy as 20-25 per 100,000. He had also said that suicide was ranked seventh of the ten major causes of death in Guyana for years, averaging around 200 deaths annually. Minister Ramsammy had noted that mental health had been neglected for years, but vowed that it would have a priority place on the health agenda.
Unfortunately, that was not to be. General elections were held in 2011. By the time the suicide hotline pilot would have come to an end in June of that year, things were starting to heat up and politicians were on tenterhooks. The suicide hotline and mental health had to take a backseat.
Fast forward to 2014 and we have the WHO reporting Guyana’s suicide rate at 44.2 per 100,000, almost double where it was in 2010; an 8.5% decline from 2000 when it was 48.3 and the worst in the world. Minister Ramsaran’s response to this was that he was aware of the “studies”; that the ministry was examining a more evidence-based approach where it would engage people at the community level through governmental and non-governmental intervention; that the ministry was currently training people to reach out to the vulnerable and also working to get rid of the legislation which brands suicide as a criminal offence. Three years after the ‘failure’ of the crisis line, and the ministry is now in training mode.
Dr Ramsaran said too that mental health had been pushed to the ‘backburner in the health sector’ but was now on the front burner in the ministry’s new 10-year health strategy—words that almost twinned Minister Ramsammy’s pronouncement in 2010, expect that Dr Ramsaran is not given to making vows about anything being given priority.
But he is right about one thing: this has complete failure written all over it. And it’s not just the suicide hotline that has failed, it’s the country’s entire mental health programme. It is a complete failure because it took second place to political ambition and manoeuvrings. As of now, for all Dr Ramsaran’s pontificating, it is still on the back burner, still failing and so is the minister.