Engaging the Diaspora: An “Untapped Resource” for Wellness: Recommendations
Diaspora Philanthropic Organizations have been helpful in enhancing family independence, sustaining communities and pre-empting stressors associated with conditions of poverty. They can do the same for mental health. The IMF recently noted that Guyana needs to make a serious effort to build human capital by improving the education and healthcare sectors with input from the diaspora. The activities of Hometown Associations (HTAs) include a history of sending remittances, helping with self-care and enhancement of peoples’ capacity to develop their communities. Mental health professionals attached to organizations such as Caribbean Voice have been instrumental in the areas of prevention, treatment and rehabilitation, including natural disaster counseling. Workshops conducted by Lesley University/ Guyana Program and the Center for Multicultural Global Mental Health promoting public awareness and practitioner training, exemplify valuable diaspora contributions. The Caribbean American Social Workers Association based in New York has conducted workshops on domestic violence and mental health, drawing from the local field research of University of Guyana Lecturer Dr. Paulette Henry, who found that families are traumatized by guilt from their inability to prevent a suicide. She also warned that the media must cease sensationalizing acts of murder/suicide. Indications are that HTAs and individuals in the diaspora, are willing to partner with local non-profit entities and the government to provide funding and other resources to streamline and expand services.
Medical outreach spearheaded by diaspora teams have played a role in providing vital medical interventions in the form of treatment, coordination of service, donating equipment and training. They have rendered free medical care in various geographic regions, albeit mostly in physical medicine. However, continuity of care in a timely manner has been a major problem. Commenting on the lack of proficiently connecting needs and resources and “disjointed” intervention, one diaspora medical practitioner refers to “the healthcare crisis” in Guyana. She observed that despite the medical advancements gradually coming to the nation, the needs of underserved communities are not adequately addressed. She laments that those who are unable to obtain medical care often wait for excessively long periods to be seen again.
One diaspora public health professional who has volunteered his services warned, “We have a system that doesn’t promote a coherent strategy to target specific issues. It’s usually piecemeal… Since the new oil finds, social welfare has been put on the back burner. How can we benefit from the fruits of prosperity without a healthy nation? There has been a disappointing, inconsistent record of follow-through of engagement efforts by several administrations to the dismay of volunteers from the diaspora. Apparent hesitancy to fully commit to a Diaspora Engagement Policy and Strategy has been a major setback. However, the recent announcement by the Ministry of Foreign Affairs of a Skills Mapping Exercise of the Guyanese Diaspora is promising, especially if the intended goal is to actively engage the diaspora in developmental efforts.
Fortifying mental health training programs with the recent establishment of the Behavioral Studies and Research Center at the University of Guyana is also a promising development. A report by overseas-based Guyanese Psychologist Dr. Nathalie Caldeira spearheaded a funded project for more evidence-based research, education and training for successful response to mental health as a national concern. It would have increased knowledge, extent and nature of the problem, elevate psychological well-being and expand the population’s capacity to reach its full potential. That program report was presented, but unfortunately not implemented. Such research would help to determine why some interventions are successful in some communities and fail in others. The variation may be based on differences in demographic make-up, the extent of adherence to traditional practices or attitude toward “outsiders.” The National Mental Health and Suicide Action Plan of Guyana calls for enhancement of opportunities for integration, sustainability and capacity building with other services for strengthening mental health care and treatment services. Hopefully, those “other services” will include education (academics, arts and sports), job training, child rearing techniques and cultural sensitivity protocols.
The government is advised to seize the opportunity to make the most of diaspora knowledge transfer and skills-building through its partnering with local practitioners, reaching and treating as many people as possible. Re-establishing confidence in the government’s commitment to embrace the diaspora’s role in health care and other social and technical services would be a galvanizing force. Collabora-tion with the Ministry of Health has ensured life-saving services when initiated, funded and delivered by diaspora organizations. However, lack of “follow-up” by local counterparts causes serious lapses in care. Hopefully, the latest government-promised initiative to “re-align mental health services and tap into the diaspora” will benefit civil society, especially the underserved. There is reportedly an abundance of Psychiatrists, some voluntary from the diaspora, but a shortage of Social Workers, Psychologists and other mental health practitioners. Paucity of professionals decreases the opportunity for vital patient-centered “talk therapy” and coordination of critical, individualized aspects of care, while increasing dependence on psychotropic medication, “assembly line” queues and lapses in follow-up treatment.
Recommendations: Resources, Training and Approach
1. Earmark adequate funding for mental health care, including increased salaries, improved working conditions and other ways to incentivize practitioners.
2. Expand preventive programs such as Child Link and Family Awareness, Consciousness & Togetherness (FACT) and continue the Guyana Well-Being Conference series.
3. Share information about communities in which efforts to provide services have succeeded or failed. Document the reasons for the disparity to augment enduring mental health care and not perpetuate a “band-aid” approach.
4. Help stakeholders to recognize behavioural and physical symptoms. Done with respect, professionalism and non-imposition will overcome fears, myths and taboos based on customs and beliefs. These must be informed by community practices and traditions that contribute to mental distress, as well as those that enhance wellness.
5. Solicit the role of Religion. Informed faith-based programs can help improve emotional stability and coping ability, but are not to be seen as a “cure” for mental illness.
6. Essentialize the role of the University of Guyana in research and training of social workers and psychologists, in collaboration with the Ministry of Health and Human Services, internships and field work placement. This will normalize practitioner-to-counselor ratio.
7. The guardian/practitioner relationship must be a partnership, not adversarial.
8. Provide information about confidential crisis counseling and promote the therapeutic value of culture through public education and on-line forums.
9. Conduct preventive and treatment services in schools and correctional facilities.
10. Intervene through congruent behaviours, approaches and policies consistent with established protocol and respectful of community values and traditions.
11. Establish mobile mental health crisis teams, extending to hinterland communities through the Ministry of Indigenous Affairs with input from Toshaos.
12. Decriminalize attempted suicide and establish a Suicide Hotline managed by civilian counselors and replace the term “committed suicide” with “death by suicide”.
13. Establish a telehealth system for suicide prevention and mental health connections.
14. Engage diaspora knowledge, skills and other resources for mental health care.
Summary and Conclusion; Sounding the alarm
This article examines a neglected dimension of nation building. Good mental health is a prerequisite for improved human capacity. A healthy society is the foundation of development, since there is arguably a correlation between psychological well-being and labour force participation. Clearly enough has not been done to ameliorate this critical dimension of the national healthcare system in Guyana. The government must be less reticent. More than a tepid response is needed to make children, adolescents and seniors in particular, less vulnerable. Guyana’s former Acting Chief Medical Officer, Dr. Jeetendra Mohanlall argues that mental health is everybody’s business and communities should be vigilant with regard to changes in their love-ones’ wellness. He clearly understands the total needs of families, communities and the nation.
The reaction to people with interpersonal and societal distress must not be characterized by disdain, stigmatization, impatience, punishment, force and ridicule. Neither should they be treated with indifference nor mass institutionalization, but rather with compassion, understanding, cultural sensitivity and informed intervention. Ignoring the nation’s mental health and well-being must not be a price for sustainable energy. It is essential that all Guyanese benefit from the spoils of new energy sources. If a “transformative trajectory” of Guyana is to be realized as promised by the President, stakeholders must be in good emotional health and feel motivated. There is a dark side to the rewards and gains from new oil and gas money which requires vigilance, adequate redistribution of resources and mental health care. The government is urged to harness psychological insecurity, but also respect the rights to a clean, healthy environment. If not, economic development and the prosperity of current and future generations will be encumbered. Decreasing the pervasiveness of mental distress would stymie human and economic costs. Unabated, inimical mental health planning leaves the youth in particular, at risk of psychologically vulnerability, affecting interpersonal relationships and educational performance. Consequently, education, awareness and identifying precipitating causes of mental distress must be emphasized. Political discord, ethnic tension, as well as preoccupation with anticipated wealth, undermine health and wellbeing.
Hopefully, this analysis which seeks to bring into focus the breadth of the mental health crisis, will inform policy as Guyana navigates opportunities, change and challenges. Deliberative action will provide solace to those whose productive capacity has been hindered by interpersonal or socio-economic stress. It will bring attention to the “invisible” who see life without a purpose, and uplift those who have been left behind in a society planning for an economic windfall. These considerations should motivate those who champion both human and natural treasures of Our Dear Land.
