There is excitement among Guyanese and the international community about the prospect of accumulating wealth which the oil and gas industry promises. There is also a humanitarian problem that is being ignored, i.e., mental health care. The tendency to focus on the business sector including inviting investors and technical infrastructure is understandable. Unfortunately, this overshadows the provision of resources to address problems related to psychosocial wellbeing. This two part article supports the argument that there is a correlation between a nation’s mental health and economic growth. I will attempt to:
(1) Put this connection in perspective as it obtains in Guyana
(2) Make the case for culturally competent mental health services, while advocating for diaspora engagement, and
(3) Propose strategies in response to this neglected dimension of a changing Guyana.
Poor mental health can negatively affect self-care and contribution to economic development. Good mental health can be an outcome of improvements in nation building, which need steady hands and sound minds across the ethnic, racial, religious and social class spectrum. It is reasonable to conclude that human capital, i.e. the economic value of people’s experiences, skills and expertise, is diminished by mental/emotional stress. Some Caribbean nations including Guyana, have not attached enough importance to the life-experiences of vulnerable populations. The latter include the mentally ill and related precipitating or outcome factors such as domestic violence, substance abuse, homelessness and developmental disability. According to the Regional Investment Promotional Agency Association, a significant number of people in the Caribbean are employed in the medical field. However, only incremental strides have been made in providing resources for mental health care. Guyanese Dr. Dawn Stewart warns that mental health is not recognized as a serious issue in the region. Although acknowledging the problem, there has not been a consistent response to mental health needs.
Vulnerable groups, including the mentally ill, homeless, those labelled “pavement dwellers”, “Squatters”, the elderly, differently-abled, those with substance use disorders and other marginalized groups tend to be ostracized. This is evidenced by the lack of sufficient resources for, and disinterest in their welfare. A history of discrimination against the mentally distressed exacerbates their vulnerable disposition. Many are compromised and insecure in various life-sustaining areas, are often in crisis and targeted in times of economic depression, institution transformation and social unrest. The emotional impact of exposure to violence causes fear, anxiety, frustration, ambivalence, confusion and depression, precursors to mental health maladies. The perceived threat of crime is unsettling to one’s emotional state. These conditions lead to diminished participation in social activity and decreased productivity. Little attention is given to the correlation between the high cost of living and psychological stress. As a way of coping, some individuals “move in” with relatives and friends, seeking refuge, or they become reclusive.
These phenomena do not only affect people’s mental capacity, but their ability to self-care and manage personal and societal stress. Vulnerable groups are stigmatized and viewed as a liability to social progress. The idea of “survival of the fittest” implies their “place” on the fringes of society. It also distinguishes between “able bodied” and “dependent” persons, making an indirect but poignant statement and judgement about inequality. Adding to this socio-cultural quandary is the growing number of immigrants/refugees seeking to adjust to Guyanese society with varying challenges of acculturative skills. These and other contributing factors to the problem of mental/emotional health have not been adequately addressed. Quantitative analysis of the characteristics and cost of responding to such problems is not prioritized. Understanding the problem and demonstrating a firm commitment and ability to project clear goals are essential.
Social analysts suggest that the exigencies of economic and political factors in a region in which there have been varied claims on limited resources such as funding and expertise, tend to determine the nature and immediacy of response to psychosocial problems. The capacity of stakeholders to follow protocols fulfilling their civic responsibilities often depends on their social and economic situation, which in turn influences coping skills. There seems to be a degree of ambivalence and lack of will to act on behalf of the victims of what is perceived as a non-essential societal problem. Advocates are relatively few. Although mental health has gained some traction in the national and international conversation, untenable socio-cultural factors and recent trends have not been given the attention needed. The upsurge in the rate of suicide in Guyana has been a central cause for concern. Alarmingly, criminalization of attempted suicide and having a Suicide Hotline manned by Police Services are stark deterrents to seeking help or “reporting” by family and friends. The current state of mental health warrants urgent assessment of the country’s emotional pulse, i.e. the sentiments, capacity, preparedness and disposition of the populace. The ability of the citizenry to adapt to social and economic transformation depends on available resources to sustain the nation’s well-being.
Importance of Culturally Competent Mental Health Care
Culture (customs, values, traditions, beliefs and practices) permeates all social institutions. Cultural competence enables a system and people to work effectively in cross-cultural situations. With regard to mental health, it is important to consider cultural factors in assessment and symptom recognition, all of which guide intervention. How cultural beliefs and practices influence the way people navigate the health care system is key to planning, delivery and outcomes. The intersectionality of multicultural norms, shaped by introspection and respect for others can be transformative and represent a unifying force yet to be fully realized. These elements are at the core of psychosocial well-being. Respecting cultural values, community inclusiveness, and cultural sensitivity help to overcome fears, myths and taboos. Counseling Educator Heather Vinner found that Caribbean adults are reluctant to seek help due to lack of understanding, stigma and shame. They value discussing cultural issues, but tend to prefer practitioners who are similar to them in ethnicity/race, culture and gender.
Mental health advocate Annan Boodram argues that there is no ethnic impetus for domestic abuse, which is often triggered by psychological stress. His position reinforces the rejection of culturally biased causes of socio-economic and family deficiencies as a factor in family violence. Families need help in responding to mental health challenges, which are often a causal factor in disputes. The inability to recognize or denying symptoms could lead to confusion and hesitancy to engage remedial efforts.
Parents are generally familiar with children’s routine mannerisms and acceptable habits. However, at times behaviors may be symptomatic of a mental health problem, signaling the need for alertness and healthcare education to guide effective intervention. It is often difficult to distinguish between non-threatening “acting out” behavior or suppressed feelings, signaling symptoms of a mental health crisis. Families need help identifying and responding adequately. A parent may say: “Duh boy really bad ah tell yuh…two lashes gon fix ‘e good” or “Don’t worry wid duh lil gyrl…she always hiding in dee corner, she like being by she self”. Helping professionals should be vigilant in assisting caregivers to accept the inevitability of having to make changes and adjustments without seriously compromising respect for cultural values and practices. Relative to this matter, Caribbean parents tend not to see corporal punishment as abuse. Notably, in diaspora communities where child abuse laws are judiciously enforced, Caribbean immigrants have endured penalties for violations. Adjustment problems, characterized by tenuous attachments and traumatic reunions are often the source of emotional schisms within immigrant families as they try to resettle in the host country.
An intercultural approach ensures an inclusive perspective to problem-solving. Understanding the ripple effect of vulnerabilities, how certain groups in society become targeted and how intangible and indirect pain are generated, understood and experienced cross-culturally, are all important. These factors affect interpersonal relationships and family life in many ways. When we consider “social problems” we think about economic inequality, poverty, unequal access to vital resources, discrimination based on race, ethnicity, gender, sexuality, ability, political affiliation and age. Do we seriously think about those more invisible, but persistent sources of personal and social pain, and insecurities some Guyanese grapple with? We need to carefully ponder such realities which are often skirted. They affect people in so many ways. Seriously addressing mental health seems crucial within the context of all the earnest talk about development and anticipated riches.
Psychologist Dr. Sharla Khargi posits that it is important to pay attention to changes of behavior in self and others, particularly in times of crisis, such as the COVID Pandemic or when the society is experiencing economic and institutional transformation.
Having the infrastructure to cope with stress in a transforming, multicultural nation is crucial. Indications are that there is no comprehensive strategy to address mental health. There seems to be little uniformity in services and methods of delivery. Instead, intervention tends to be haphazard and customer service is often non-committal. Communities react to these deficiencies differently. Some residents may be ambivalent about asking for help due to their formal education level, susceptibility to rumors, or influenced by embedded community norms, which may be a catalyst for what may be viewed as acceptable or imposed intervention. Yet it is important to understand the unique/ specificcharacteristics of each community. Deep-rooted religious rituals and “indigenous cures” can be a challenge to conventional mental health care, but must be factored in assessment.
Part 2 of this essay will focus on Engaging the Diaspora: An Untapped Resource and Recommendations
