Three multifaceted studies are expected to aid in grappling with the high rate of suicides in the country, a mental health conference heard on Monday.
According to the World Health Organisation (WHO), 248 men and 68 women in Guyana died by suicide in 2019 resulting in the country having one of the highest per-capita rates of suicide. However, experts on the ground believe the 315 reported suicides are not reflective of the reality of Guyana’s situation.
Professor Christina Hoven, a Professor of Clinical Epidemiology in Psychiatry at Columbia University in the US is of the opinion that the number is severely underreported owing to misclassification of suicides. She proffered her opinion at the opening of the Guyana Mental Health and Well-being Conference on Monday.
Hoven, who is working with a psychiatric epidemiology group to help Guyana bring its suicide rate down, explained that many times suicides are classified as accidents, unintentional harm and natural deaths for a number of factors. She added that it is most common with elderly suicide since the element of shame is associated.
The Professor further related that some deaths classified as vehicular accidents are in fact suicides.
“Many religions you can’t be buried in the cemetery (if you commit suicide). So you died of natural causes rather than suicide. It’s a cultural phenomenon that we hide cases, meaning that it’s worse,” she opined.
On that note, she announced that the group would be embarking on three studies with the intention of providing updated data to help craft plans to address the plague of suicide.
“Every death matters. 77% of all deaths are in low and middle-income countries and we also know that there are at least 20 attempts for every completed suicide. Every single attempt is a traumatic experience for that person and frequently the person in their life. So when you think about the horrible rates of suicide, you have to think about how that gets expanded many times over,” Hoven told participants at the opening of the four-day conference being held at the Arthur Chung Conference Centre.
The studies are multifaceted and are aimed at uncovering the risk architecture in relation to suicides. Hoven said that the team would be exploring lots of unique approaches to the studies in an effort to paint a comprehensive picture.
“We are, as the psychiatric epidemiology group, a global group and we always take the global life course perspective, that is, we look at all of these things in every study, to the best extent possible. A lot of it is unusual. What people do (when they conduct studies), they do one or two of these things, two or three of these things but they don’t usually do all of them to the extent possible,” she explained.
Zeroing in on the methodological approach, Hoven said that the first study is going to be national with a developmental focus. Referencing the high rate of suicide among Guyana’s teen population, she related that the team would be exploring what was the thought process and traumatic events that preempted the suicide attempts and successful suicides among the teenagers.
The study which is being funded by the US National Institute of Mental Health will focus on providing context and is being dubbed as the Guyana Well-being Study.
“The first (study) is a national representative community cohort. It’s 5,000 people, it’s been done throughout the country. It will be a national representative of 5,000 people ages 15 and over. It would be longitudinal. There will be two follow-ups. So there’s a lot of unusual things about that,” she explained.
Professor Hoven further explained that those criteria are unusual for any suicide study but they have selected them since it will provide more context about suicides in Guyana.
The second study is a clinical attempters’ sample, focusing on persons who would have attempted suicide. The group would set up crisis clinics for the assessment of persons and the methodology would be almost identical to the Guyana Well-being study. Though this study is national, it would not be longitudinal owing to funding issues.
A longitudinal study refers to a correlation research study that looks at a number of variables for an extended period of time.
“The third one is a survivor sample. That is a loved one – a mother or a father or a sibling or a spouse – of a person who died by suicide. We are going to interview that person and one other person (so it is) two people who are closely aligned with that person who died,” she explained.
However, it would not be national since the team has not yet secured adequate funding to go big. It would be focused on five of the ten administrative regions in Guyana.
Silent pandemic
For years Guyana has been fluctuating among the top five countries with the highest per capita suicide rate. It is currently at the top of the table for the Caribbean Region and the second worldwide. There have been very few strides in developing comprehensive plans to tackle the suicide epidemic that has gripped the country.
While cases continue to rise, the authorities continue to develop plans but not enact them. The legislative framework to deal with mental health issues in Guyana is archaic at its best, and while there have been multiple oral commitments no updated legislation has been brought to the National Assembly.
Suicide stills remains a criminal offence and one can serve up to two years in jail if they attempt to take their own life.
“Suicide, on the other hand, is Guyana’s ongoing private pandemic, private plague placing this beautiful country at the top of the list of countries around the world for its high rate of suicide. As with COVID-19, we can turn this around…we must make sure there is an understanding of what constitutes suicide behaviour so that we can intervene. We need to know what to do. We need to know how to more effectively reach out, how to help a person at that critical turning point when they’re thinking of suicide,” Professor Hoven said.
She noted that the criminalisation of suicides in Guyana is a major deterrent in creating conversations with persons who are thinking of taking their own lives.
More proactive action
Health Minister Dr Frank Anthony acknowledged that very little has been done to address the delivery of mental health care in Guyana. However, he did commit to taking a more proactive approach to addressing the challenges.
He noted that in the past they have attempted to understand the reasons behind the suicide “plague” and crafted solutions based on the generated data but seemed to be having little success.
“We really need to think about other ways of how we are going to affect those (suicide) numbers. Certainly, whatever we are trying, while they might help in some ways and in some regions, it is not helping us to bring down those numbers. We have, over the years also attempted to create a more enabling environment, (in) which we can do research and in which we can also be able to practice the things that we need to do to prevent suicides,” he explained.
He added that they have reached out to the Attorney General to aid in the crafting of new mental health and suicide prevention bills to be tabled in the National Assembly. He said that the draft mental health bill has already been circulated once and is in its finishing stages for another round of consultation.
“Hopefully we can get that on the parliamentary agenda and if we do this year, then we will be able to pass it and change those things that are there that have not really created an enabling environment…I hope that we’ll be able to move that piece of legislation to parliament because I think a lot of people are very receptive to us having such legislation,” the Health Minister said.
