By Savitri Persaud
Dr. Savitri Persaud is a Postdoctoral Fellow and Qualitative Research Lead at the University of Toronto in the Department of Health and Society and previously the Dalla Lana School of Public Health. Savitri was born in Guyana and spent part of her childhood in the farming community of Moblissa, located along the Soesdyke-Linden Highway; and in Belle Vue, West Bank Demerara. Sections of this article are reproduced from Savitri’s doctoral dissertation, which examined how mental health is experienced and understood in Guyana, specifically analyzing the competing and complementary discourses, perceived causes, and diverse practices employed by Guyanese to address and ease distress.
On August 23, Stabroek News reported that the decomposed body of Oscar Angel, 65, of Number 53 Village, Corentyne Berbice, was discovered by his neighbour. The article states that Angel was a pensioner “who suffered from epilepsy and mental illness.” Villagers only noticed Angel’s disappearance after the odour of his decomposing body began to emit from his home. It was reported that Angel died between August 17 and August 21. Foul play was not suspected, though it was difficult to determine given the advanced state of corpse decomposition. While it is assumed that there was no element of criminality involved and no individual contributed to his death, this tragic incident is a reminder of how government mental health interventions may not reach those who need them the most. Furthermore, Angel’s death poses questions about the state’s obligation to its citizens in upholding their constitutional right to healthcare and the nature of the government’s responsibility to adequately provide said care to all Guyanese and Guyanese, like Angel, who experience mental health challenges and other compounding health issues.
If we look to the President’s New Year’s Day addresses, many promises have been made year after year, including assurances to tackle issues related to the provision of mental health care in the nation. There is no denying that some important strides have been made to address aspects of the nation’s archaic mental health system, including the repeal of the Mental Hospital Ordinance of 1930, a colonial piece of legislation informed by the British lunatic asylum model; the long-awaited decriminalization of suicide; and the enactment of the Mental Health Protection and Promotion Act (2022) and the Suicide Prevention Act (2022). The enactment of these laws is the ethical first step, but it is ultimately the operationalization of these laws and the material change experienced on the ground by everyday Guyanese that is the measure of legislative effectiveness, which remains to be seen.
One of the promises made by this government and previous governments is the deinstitutionalization of mental health care, with the aim of taking a more decentralized approach through primary and community care instead. Indeed, what initially prompted this article was the announcement on September 17 that the National Psychiatric Hospital (NPH) in Berbice is slated to close in the future. The timeline for this promised closure was not indicated. What should be of paramount concern following this announcement are the present conditions and provision of care received by in-patients at the NPH at this very moment. What about these patients? What meaningful and concrete care plans are operative or being put in place for these in-patients today?
My doctoral fieldwork in Guyana – which comprised of research trips to and observations at the NPH and interviews with doctors, nurses, and social service providers – tells me that it is the in-patients at the National Psychiatric Hospital who bear the greatest burdens of risk, harm, and violence. Between April 2009 to June 2021, the NPH failed to prevent the deaths of five patients under its care. Please, reader, I implore you to Google the 2009 murder of Harriram Nauth; the 2015 murder of a patient identified only as “Eda”; the 2019 assault and death of Stephan Francis; the 2021 assault and death of Ryan Sunthgolam; and the 2021 post-fire death of an unnamed patient. Also ask yourself: how many politicians – across the board – have visited and witnessed the conditions at the National Psychiatric Hospital, or the “Mad House” as most Guyanese so casually call it? How many have seen first-hand the dilapidation of this institution, which is a monument of deprivation and colonialism? We need to do better for the in-patients at the National Psychiatric Hospital now – scratch that, yesterday.
The goal of deinstitutionalization is an admirable one that is yet to be realized, especially given the primacy and institutional centrality of the National Psychiatric Hospital. When headlines tout state plans for deinstitutionalization – which has been promised for years and has yet to be comprehensively actioned – what is largely unmentioned and made invisible in this type of reporting are the oppressive, institutional conditions that in-patients are forced to languish in at the NPH. Over the last few decades, patient deaths and the horrific conditions at the Hospital tend to initially trigger a series of promised government action and grand statements of intent for institutional reform. These promises, as historically demonstrated, appear to be predictable and Pavlovian responses of virtue-signalling that ultimately expose themselves as inaction when little or no substantive change is delivered and yet another harmful or fatal incident occurs to spark public outrage and restart the carousel of purported government concern. These promises function to launder a long history across administrations of state ineptitude and institutional violence; to whitewash, or what I call psy/psych-wash, the tragedies that elicited them – patient murders and deaths for which the state appears to abdicate responsibility. Over time, these proposals often prove themselves to be meaningless or principally serve to maintain the status quo.
At present, the picture of deinstitutionalization in Guyana is a grim one, based on reporting from a Guyana Times article on April 10 (“Mental health patients languish in health-care system for years – Health Minister”). This article outlines how the NPH will discharge in-patients to the custody of random relatives without any notice informing the family, and how discharged patients may also go missing as a result: “Just a few days ago, a man who was discharged from the National Psychiatric Hospital; was dropped off in custody of a minor and is now missing.” The teen relayed her account to Guyana Times: “I was in the hammock and saw the bus stopped and a girl and a boy came out and they walked in the yard and the girl asked for my mother and I say she just gone out on the road. She asked me if I know this man and I told her that I know his face… Then she just say that he get discharged and he is not mad. He needs to come out from there and take his medication.” The family was unable to care for this patient, and his whereabouts are currently unknown. This is not deinstitutionalization. This is neglect.
Furthermore, what these promises also gloss over are the difficult circumstances experienced by individuals with mental health challenges who reside (semi-)independently in their communities, like Oscar Angel, but are not provided adequate and liveable resources to care for themselves with dignity – any Guyanese pensioner understands this. Also, what about the families of those who are struggling to care for a loved one currently experiencing mental distress, and who do not have the necessary supports to provide continuity of care? What about these Guyanese? Wrap-around and comprehensive support services must be provided in any push for deinstitutionalization; otherwise, any such promise is made in vain.
Please, reader, I ask you to see beyond the political promises; to examine your day-to-day living conditions; to make demands of your government in the here and now; and to hold their feet to the fire at every step.