By Anthony Autar
Anthony Autar is a New York-licensed attorney-at-law, with a background in mental health and healthcare law. Mr. Autar holds a Juris Doctor degree, with honors, from the Hofstra University School of Law where he was a Health Law & Policy Fellow, and Associate Editor for the Hofstra Law Review. He is currently engaged in private legal practice, and is the Managing Director of the Guyana Foundation. This article was first carried on http://medium.com/@autarlaw, a blog started by Anthony to raise awareness about mental health and related issues in Guyana.
On August 26th, the Kaieteur News reported that Eda, a female patient of the National Psychiatric Hospital, was murdered during a fight with another patient. According to the crudely-written news article that referred to patients as “inmates,” the fight occurred in a secluded room where the deceased, the attacker, and a third patient were placed because they had all been exhibiting aggressive behavior. Only one nurse was on duty in the ward when this tragedy occurred in the afternoon, and it is unclear whether she was aware of the fight and attempted to intervene.
In addition to detailing the gruesome manner in which Eda’s life was taken, the article highlighted the appalling conditions at the most important mental health facility in the country, stating that:
“Nurses at the National Psychiatric Hospital continue to express fear for the conditions under which they work. A number of times one nurse is assigned to a ward which houses as many as 31 patients. The place is very bushy, there are hardly any lights, and sometimes there are no guards working. As of last evening only one nurse was available to work in each ward.”
This is not the first time that such concerns have been publicly raised about the state of this institution — and not the first time that such concerns have been met with silence from the majority of stakeholders. I fear, therefore, that like so many others who have died in prisons and hospitals across Guyana, that Eda’s death will be relegated to a mere footnote — and that in just a few days’ time, she will be forgotten.
I also worry that there will be no inquiry into the state of the mental health sector in Guyana, nor a comprehensive investigation into the routine violation of patients’ human rights, allegations of inhumane living conditions, an acknowledged shortage of qualified human resources, and poor working conditions for staff at this facility.
In fact, recent incidents suggest that the expected improvements in healthcare delivery under the new administration are much farther away than anticipated. For instance, months after Dr. George Norton, the then newly appointed Minister of Health, slammed the condition of the institution as “disgraceful” and lamented that “[i]t is pitiful to see the conditions where we have our Guyanese brothers and sisters dwelling…,” it is unclear whether conditions at the institution have improved. If any measures to protect the safety and human dignity of patients were implemented, they clearly have not worked — because a patient is now dead.
The same Minister stated at the time that “[t]his has been going on for two months, this is totally unacceptable.” I reiterate his statement. It is totally unacceptable that the basic principles of mental health care, as outlined by the World Health Organization, are routinely ignored by healthcare institutions throughout Guyana. It is totally unacceptable that the existing mental health framework does not facilitate the provision of basic, quality, least restrictive type of mental health care to every individual in need. And it is totally unacceptable that there is no mechanism to provide redress to individuals with mental illness and their families in the event of the violation of civil liberties or basic human rights.
For too long, our silence has created an environment where the powers that be feel comfortable making lofty public proclamations about plans to address the mental health crisis in Guyana, but follow-up with sloth or inaction. I am deeply troubled by the death of Eda, because it highlights the low value placed on human lives in Guyana. Had our leaders understood the importance of good mental health for the national development of this country, its public security, its economic growth, and long-term stability, and had they believed that the people of Guyana are its most valuable resources, we would not have witnessed the slothful efforts to remedy some of the most pressing, yet easily-fixed challenges of the system, or the public hand-wringing and complaints about the unavailability of funds for the mental health sector.
There would have been adequate rooms to individually and safely house patients found to be exhibiting aggressive behavior so they are not a danger to themselves or others, and there would have been quality supervision of patients in every section of the hospital.
Sadly, there is scant evidence of the bold leadership required to confront this situation and effect urgent improvements. Instead, this crisis in the mental health sector appears poised to continue affecting the most vulnerable among us, who have a significantly higher risk of experiencing mental health problems. This includes members of households living in poverty, individuals with chronic health conditions, infants and children exposed to maltreatment and neglect, adolescents exposed to substance use, the elderly, the LGBT community, prisoners, etc.
The toll that untreated mental illnesses has had on these lives is unimaginable. Similarly, the damage done by this murder is unthinkable — with a family now having to grapple with the harsh reality that a loved one was killed in a facility where she was placed for her own protection, and with others now contemplating whether it may be safer to keep relatives with mental illness at home, instead of seeking to have them institutionalized.
So where does this leave us? The choices ahead are clear. We can continue to ignore this crisis and the devastating toll it has taken and will continue to take on families across Guyana. Or we can collectively break our silence in the recognition that there is no hope for this nation if the mental health needs of its citizens continue to be neglected and ignored.
I believe that every Guyanese has a role to play in improving the state of the mental health sector, because the evidence clearly indicates that the determinants of mental health and mental disorders include not only individual attributes as the ability to manage one’s thoughts, emotions, behaviors and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, living standards, working conditions and community social supports. This affects us all.
Those of us with training and expertise in mental health and its associated disciplines have a duty to speak up to ensure that no other individual loses his or her life in such a brutal manner as Eda. As a lawyer with a background in mental health law, I am reminded of this duty, and am driven to write by the words of a prominent New York attorney, Thomas Moore, who stated that: “We have been given this grace, to be able to stand in and speak for people who can’t do anything for themselves, and to give a measure of quality of life and dignity to what they once were, what they’ve lost and now what they can re-achieve in a different way.”
I hope that others will join this call for justice, the protection of human dignity and civil liberties, and the provision of quality mental health care for our Guyanese brothers and sisters. We cannot continue to lose our most precious resources under such avoidable circumstances.
