While acknowledging there are deficits in the mental health programme, the Ministry of Health yesterday said that there had been major improvements particularly in the staffing of the National Psychiatric Hospital (NPH) and a range of other interventions have been put in place or are in the pipeline.
In a statement, the Ministry was responding to the October 27 editorial in Stabroek News entitled `Workplace mental health and safety’ and which raised concerns about shortcomings in the sector.
The statement said that the editorial ignored much of what is taking place today. As it relates to staffing of the National Psychiatric Hospital, the ministry said that steps have been taken to address the inadequacies.
“To be clear, there are ten nursing staff at the NPH at this time and, not as believed, four nursing staff. Presently, the Hospital Medical Superintendent and Head is a trained forensic psychiatrist, Dr. Meena Rajkumar, who is fulltime at the hospital. She is supported by another fulltime psychiatrist, three medical doctors (Government Medical Officers), a registered nurse Matron, two registered staff nurses, seven nursing assistants, eighteen nurse aides, seventy-four psychiatric patient care assistants, and two social workers”, the statement said.
More recently, the ministry said that the Government has deployed 37 part-time workers to support the staff in various areas, including in facilitating the general hygiene and personal grooming of the patients. The additional support by nursing aides, patient care assistants and part time workers enable the ten nursing-staff to focus on the nursing needs of the patients.
Efforts are also being made to improve the staffing. The ministry said that two additional psychiatrists will join the fulltime staff at the NPH as of November 9, 2022 and a psychologist is due to begin fulltime assignment this week. Psychiatric staff at the Georgetown Public Hospital are presently being rotated on a visiting basis to provide support to the soon four fulltime psychiatrists at the NPH.
Administrative support is also being provided to Dr Rajkumar to free her up to provide more direct patient care and to focus more on the clinical management of the patients. Additional Government Medical Officers are also being deployed on a rotation basis from the Region 6 list of doctors, particularly from New Amsterdam Hospital.
“From the staffing perspective, the GOG has not been non-responsive, as claimed by the editorial”, the statement yesterday said.
The Ministry said that it has also been working with its partners to resuscitate the Psychiatric Nursing Programme which was discontinued some time ago. It was introduced in 2004 with the help of partners from Dalhousie and McMaster Universities and several batches of nurses were trained. Most, if not all, of those nurses are no longer serving, the Ministry lamented. In addition, the Ministry said it is also introducing a new curriculum to train Psychiatric Nursing Assistants.
Further, several of the part-time workers have been identified to be trained as Psychiatric Patient Care Assistants. UNICEF is partnering with the Ministry of Health to expand the nurse training programme for psychiatry.
“The Ministry of Health has been significantly more active in the last two years than in the preceding eight years in building the human resource for psychiatry, even if much more still must be done”, the statement asserted.
The ministry contended that from about 2014, occupational therapists have been absent from the staffing complement at the NPH.
“The occupational rehabilitation centre was closed and abandoned sometime after 2015. Similarly, the visiting psychologist that supported the psychiatrists before 2015 no longer is available. The Ministry of Health is presently recruiting an occupational therapist to improve patient care at the hospital and is working with GPHC to either deploy a fulltime psychologist or a visiting psychologist to the National Psychiatric Hospital to support the psychologist that is joining the staff this week”, the statement said.
Historic developments
According to the ministry, since August 2020, under Minister of Health, Dr Frank Anthony, the mental health sector has undergone rapid and historic developments. It cited the Suicide Prevention Bill, which decriminalizes suicide and the Mental Health Protection and Promotion Bill, which replaced the archaic Mental Hospital Ordinance 1930. The Suicide Prevention Bill is to be debated as soon as Parliament reconvenes from and the Mental Health Protection and Promotion Act has already been signed into law.
New mental health initiatives and international partnerships are also ongoing.
“These initiatives include mobile psychiatry clinics for persons who are unable to go to the hospital to receive medical treatment, psychiatry satellite clinics across the regions and alcohol and substance misuse clinics for adults, children and adolescents”, the statement said.
Weekly psychiatric clinics are being conducted at Skeldon Hospital and monthly psychiatry clinics at the Suddie and Charity Hospitals (Region 2). These satellite clinics will be expanded so that every Regional Hospital will have weekly or monthly clinics in 2023, the Ministry said.
The Ministry said that it is also working with Columbia University‘s Department of Psychiatry (USA), to build capacity for mental health care and services. Through this programme, a conference to help develop and implement a Mental Health Wellness Programme is scheduled for November, 2022. More than twenty international experts are to join counterparts in Guyana for a historic conference to help Guyana roll out this programme.
Risk factors
“One of the significant areas of collaboration is a project geared at examining the risk factors for suicide. Collaboration has also commenced with the Canadian Government Program-me, through the International Development and Relief Foundation (IDRF), to address mental health in vulnerable communities”, the ministry said.
Another initiative is that the Post-Graduate Programme for specialist psychiatrists which was introduced in 2010 is being broadened to ensure that there are adequate numbers of psychiatrists across Guyana. A second initiative is the introduction of a telemedicine programme to provide psychiatrist-led, psychologist-led access to mental health consultation across remote areas beginning in 2023.
A programme has been crafted and is being implemented to address weak and absent workplace mental health interventions. To this end, the Mental Health Unit rolled out, since May 2022, a “Mental Health in the Workplace” Initiative with ongoing workshops on Stress Management and Emotional Intelligence throughout the health sector and workplaces around the country.
So far, the Guyana School of Nursing, the Cheddi Jagan Dental School, Central Supplies Unit at the Ministry of Health, Guyana Power and Light Company, Centre for Local Business Development and the Guyana Energy Agency have benefited from this initiative. A new Gate-keepers Community Training Programne, an initiative that was abandoned in 2015, is ready to be rolled out again.
The Ministry of Health is also working with the NPH and the Region 6 Health Department to reclaim the recreation ground and the vegetable garden.
“Both the recreation ground and the vegetable garden are today overgrown, neglected since 2015. A shade-house to reclaim the kitchen garden has already started construction, with the help of (National Agricultural Research and Extension Institute) and the Ministry of Agriculture, and plans are being put in place to reclaim the recreation ground in 2023. These are important parts of the overall occupational therapy for the patients”, the ministry said.
The Ministry said that it is unable to vouch for any work that was done at the NPH between 2015 and 2020.
“The large sums invested in 2017, as noted by Stabroek News and claimed by Dr. Karen Cummings, remain a mystery to us. But various improvements are visible to the infrastructure since 2020. In particular, the deplorable conditions that existed in the bathroom areas have been improved. As far as the grounds and the sewer system are concerned, a massive investment is required. The already poor state in 2015 was further neglected and the situation in 2020 was desperate. We concede that much more must be done to improve the sewer and the grounds. The Ministry of Health is hopeful that as part of the infrastructural transformation between 2020 and 2025, a new National Psychiatric Hospital would be included. Those proposals are under active consideration by the GOG”, the statement said.
Other initiatives will address the care and treatment, living conditions and quality-of-life of the patients, the ministry said.
“New beds, with proper mattresses, sheets, pillows etc. have been put in place. By 2020, outside of the patients with acute episodes, the long-term patients had no regular psychiatric care and lived under inhumane conditions, treated as homeless. Presently, 100% of the patients receive weekly and monthly psychiatric evaluation. Daily medical clinics ensure that the medical needs of the patients are addressed. A medical block has been added to Chalet #2. Patients with medical conditions who need dressing, simple suturing, rehydration, etc. can access such services in a dedicated area.
“The ad-hoc and (virtual) non-treatment with medicines that were obvious in 2020 have now been replaced with daily routine medication rounds, just as in any other hospital. The inhumane, archaic seclusion treatment area and protocols are undergoing important modifications for more modern, humane options. Staff is working with families to increase family visits and the staff is also working on a system to have time-at-home for some of the patients. These are ambitious goals, but with hard work and commitment, can succeed”, the Ministry said.
While still a work-in-progress, the Ministry said that work is being done to ensure that patients have baths regularly, change-of-clothing, supervised recreation and occupational activities, etc. To assist, new industrial washers and driers have been procured and presently are being installed. A meal plan is in place and the quality of meals and snacks has improved significantly, with a dietician organizing meals and a new modern kitchen constructed and installed. Regular monitoring of overall non-clinical treatment of patients, with random external monitoring at meal time and sleep time have been instituted as part of the Service Level Agreement with Region Six and the NPH.
“Much remains to be done. But the GOG has been actively re-energizing the mental health programme and we view the situation at the National Psychiatric Hospital as a focal point of this effort”, the statement said.
