The passage of the Suicide Prevention Bill in the National Assembly on Monday now means that attempted suicide is no longer a criminal offence and it lays the foundation for the establishment of the National Suicide Prevention Commission.
The bill is seen as a major win for Guyana’s mental health services and it is the hope of the Ministry of Health that it becomes a model law for the Caribbean. Further, a wide range of measures have been included in the bill to counter the high number of suicides in the country.
Guyana, for many years, has topped the charts for the number of suicides per capita and according to the government, the bill is seeking to provide measures to fight what is considered an exceptionally high number of suicides and attempts.
The seven-part bill provides for the establishment of a Suicide Prevention Commission. It will repeal sections 95 and 96 of the Criminal Law (Offences) Act which deals with procuring or abetting the commission of suicide and attempt to commit suicide, and Section 202 of the Summary Jurisdiction (Offences) Act also dealing with attempts to commit suicide.
Under Guyanese law, attempted suicide is punishable by up to two years in prison upon conviction.
Part II of the bill stipulates that the Commission be comprised of the Chief Medical Officer, Chief Psychiatrist, Director of the Mental Health Unit of the Ministry of Health, Director of the Child Care and Protection Agency, and Chief Education Officer as ex officio members. The Minister of Health is empowered to appoint a person to chair the commission, a medical practitioner, a psychiatrist, a nurse nominated by the Nursing Association, an attorney-at-law nominated by the Bar Association, two social workers proffered by the Association of Professional Social Workers, a representative of the Guyana Police Force, a representative of the Ministry of Human Services and Social Security, a civil society representative nominated by the Private Sector Commission, a representative of the National Toshaos Council, and a representative from each of the three major religions.
The Commission will be responsible for the preparation of a National Suicide Prevention Plan and the planning, design and implementation of public programmes to reduce suicides and attempted suicides. It will also be tasked with the establishment of Suicide Prevention Centres across Guyana and suicide prevention training for human resource personnel.
Minister of Health Dr Frank Anthony in his address told the House that the bill was crafted after inputs by a multi-sectoral team that worked consistently to reduce the deaths by suicide and international mental health experts.
“To save one life is as if you have saved the world. This bill presents us with an opportunity not to save one life but many lives,” Anthony said.
The commission, he informed, will be responsible for developing a comprehensive suicide prevention plan for early intervention and prevention of suicide.
Presenting the facts to the House, the minister said that suicide is a serious global public health problem and that every 40 seconds, a person takes their own life, resulting in 800,000 suicides worldwide each year. He added that there are at least twenty times as many attempts to do so, frequently ending up with persons being disabled by the psychological, physical, and social consequences of their attempts.
“In 2019, for the region of the Ameri-cas, suicides accounted for 97,339 deaths, 74,918 in men and 22,421 in women. The number of deaths from suicide increased by 56%, from 62,401 deaths in 2000 to 97,339 deaths in 2019. With Guyana, Suriname, Uruguay, the United States of America and Haiti, among the countries with high rates,” he pointed out.
He further stated that in the United States, suicide is the number 10 cause of death, costing the healthcare system about 44 billion dollars annually.
Promising
Turning his attention to Guyana, the minister told the House that progress has been made in reducing suicide, from 222 deaths in 2015 to 165 deaths in 2021 with the numbers for 2022 looking promising. “The suicide statistics between 2017 and 2021 show that the number of deaths dropped from 184 (2017) to 165 (2021). All regions saw a decrease in deaths, except regions 3 and 10. Suicide affects all races; East Indians account disproportionately for about 70 per cent of all cases, while the remaining 30 per cent is divided among Africans, Amerindians and others. In terms of sex, four-fifths of the cases are males.”
According to Anthony, the bill interconnects with existing legislation to form a comprehensive network of anti-suicide measures in Guyana’s laws.
The bill boasts of new innovations such as the formulation of a national suicide prevention plan, the functionality of and composition of the commission, along with avenues for research on distal and proximal factors of suicidality.
He explained that while the proximal suicide factors include psychiatric illness, chronic medical illness, psychological stress and availability of means, despite these advancements and understandings, the most potent risk factor for suicide is a prior year’s history of a suicide attempt. Part 3 of the bill will use this type of data to develop an evidence-based plan to prevent suicide in Guyana.
“If the data does not currently exist, new surveillance systems would be built to monitor and evaluate morbidity, mortality, suicide attempts, and all the attendant factors,” he added.
Parts 4 and 5 of the bill which are interlinked contemplate helping healthcare professionals and organisations achieve clinical competence in suicide prevention care. It will incorporate evidence-based and best-practice approaches to preventing suicide and provide optimum care for those who attempt suicide. There will be a paradigm shift in the provision of suicide care, where those who need crisis intervention will receive a prompt response, but more emphasis will be placed on primary healthcare.
There will be focus of care on four broad areas: screening, safety planning with means reduction, direct treatment of suicidality and supportive caring contacts, the minister outlined during the presentation to the National Assembly.
Safety plan
In its safety plan, the bill aims to carry out a “lethal means reduction” to remove all means of self-harm, especially those identified by the patient. The identification of risks and the implementation of the safety plan is a standard discussion at each visit, Anthony said before stating that physicians must be trained to do direct treatment for suicidality.
“The Ministry of Health would have trained primary healthcare physicians using the Mental Health Gap Action Programme (mhGAP) in 2023. This training programme would again be offered to primary health care physicians. It is essential that the patient’s mental health condition is diagnosed correctly and that proper treatment is provided. While the patient is on treatment, it is also important that healthcare workers provide patients with cognitive behaviour therapy sessions.”
These sessions should be more frequent during the acute risk and can be minimised as the threat subsides.
Additionally, the bill also caters for cognitive behaviour therapy (CTB) which is an evidence-based method that focusses on reducing suicidal thoughts and or feelings of self-harm.
‘We will be training our healthcare staff on the various forms of CBT, such as cognitive therapy for suicide prevention (CT-SP), dialectical behaviour therapy (DBT), this is used more in patients with chronic suicidality, or collaborative assessment and management of suicidality (CAMS), this form of therapy can be done in an outpatient setting.”
The health minister added that they would help patients to cope with and solve problems, such as replacing suicidal thoughts.
The bill also caters for bereavement support. Anthony stressed that this facility will be offered to family members and loved ones of victims as they often feel some sort of guilt.
“The survivors’ search for explanations can result in blaming and feelings of anger towards themselves, others, or the deceased. It can be tough and painful for a bereaved person to admit or express feelings of blame and anger. This is why it is essential to provide support.”
The minister said that they will be moving to expand the helpline services with the establishment of the Suicide Prevention Commission.
“In addition to the helpline, the Bill provides for the establishment of a quick response. The Ministry of Health’s mental health unit has established a mobile psychiatric unit (MPU), this unit, once contacted through the helpline, will assist mental health patients,” he explained.
According to the Minister, for this year, the MPU was successful in their response to three calls from patients requiring urgent assistance, resulting in the averting of possible suicide.
“Under the ambit of this new law, the intention is to build similar responses in other regions with relatively high rates of suicides…” Anthony said while commending the team’s proactive approach to the mental health unit.
Meanwhile, Minister of Human Services and Social Security, Dr Vindhya Persaud, had this to say: “This bill addresses many critical areas, and I believe that it is pertinent at this point in time, because in this country, we are still encountering persons who attempt suicide and self-harm. If persons are to stop… every effort must be made to ensure those persons understand quite clearly that attempting suicide is not a crime, but an appeal for help.”
With the establishment of the commission, Persaud added that there will be a slew of strategies and programmes to tackle prevention of suicide.
According to the Explanatory Memorandum of the bill, Clause 20 seeks to ensure that there is no reporting of deaths by suicide or attempted suicide before the coroner approves the reporting. Reporting in the context of the bill speaks to media coverage including broadcasting, print, social media, and blogs among others.
Part V of the bill speaks to the provision of outpatient mental health services for persons contemplating suicide. Medical personnel may also recommend hospitalization for persons believed to be acutely suicidal. It also establishes emergency helplines and quick response vehicles for persons requesting help in relation to suicide.
The bill also imposes the responsibility to report attempted or contemplation of suicides to the commission or a centre, for immediate intervention. Medical personnel are also mandated to report suicides or cases of poisoning to the police.
The Court can order a person to receive temporary in-patient mental health treatment if their condition makes them likely to attempt suicide.
The bill also provides for a $2 million fine and 10 years of jail time for a person who “aids, counsels, procures or abets another person to commit suicide.” It also exonerates any person who, in an attempt to prevent suicide, uses reasonable force against the suicidal person.
