Anxiety, loss of energy, feelings of guilt or hopelessness, thoughts of self-harm or suicide, these are all symptoms of depression, known globally as the most common mental health condition. Fortunately, the Government of Guyana, through the Ministry of Public Health and the Mental Health Unit has implemented a holistic approach to target and treat persons silently working through mental health challenges.
In a brave first for Government in Action, Ms. Shama tells us her story of recovery from an isolating depression that she, at first, did not realise she was struggling with.
Disclaimer: For confidentiality purposes, the true identity of Ms. Shama has been withheld.
From diagnosis to recovery
Ms. Shama: “I met Dr. [Tomica Daniels-Williamson] when I started coming to the clinic… I’m a diabetic, so, I joined the clinic [and] I had suffered [a] stroke about six years ago and from then I just [felt] down… I didn’t consider myself a depressed patient. I didn’t think it was depression [that] had me. I thought [it was the] the stroke that had me down, but it wasn’t… It’s not something to be ashamed of.”
Were it not for her doctor’s attentiveness to her case, Ms. Shama might have gone undiagnosed.
Ms. Shama: “She [said] that I have many symptoms of depression, so, she started treating me for that… She prescribed some tablets for me, one every night… Now I’m more outgoing. Before I [did not] want to go anywhere. I [did not] want to see people, but now, when my daughter tells me, ‘mommy, let [us] go [for a walk,]’ I would go. Before… I never used to go. I never wanted to go… [Depression] is real, yes… without Dr. [Daniels-Williamson telling me] that I had depression, I might have continued living the same way and being the same type of person.”
Ms. Shama encouraged those who recognise a change in their behaviour to be open to a diagnosis, which, after all, only properly categorises what a person is feeling and maps the way forward to recovery.
Ms. Shama: “I consider myself well-recovered from it… It’s not something to be ashamed of. It’s a real sickness, but take your medication and you will survive it. There was a time in my life where I was feeling down, down, down, but after medication, I don’t feel that way… I started coming to this clinic about three years [ago] and the first doctor I saw was Dr. [Daniels-Williamson] and she was very patient with me. That, I have to thank her for. When Dr. [Daniels-Williams] told me about the depression, I wasn’t ashamed of it.”
Advocates for mental health
Family Medicine Specialist, Dr. Tomica Daniels-Williamson diagnosed and treated Ms. Shama and while this case is considered a triumph, Dr. Williamson explained that, sadly; some persons exhibit symptoms of depression and other mental health conditions, but avoid seeking out treatment because of negative stigma.
“Generally… mental health is usually associated with stigma and discrimination and I think the whole Guyanese population [thinks] if you have [a] mental health condition, automatically it means that you’re mad, failing to realise that mental health encompasses a whole variety of conditions. It could be anxiety, bipolar disorder, depression… So, I think the whole barrier to persons coming to talk about mental health issues is that they’re afraid of the stigma attached [to] mental health conditions. They’re afraid of being cast aside by society, even by their own family members. They’re afraid of losing their jobs,” she said.
Dr. Daniels-Williamson refuted the misinformation that mental health patients are not deserving of human rights.
“So, the change needs to start, first, with us. We need to educate the public that these persons, they’re still humans. They still have rights. Just like how I have a right to work and learn. I have a right to an education. These persons have the same rights. So, that’s a very important barrier, I think, the stigma and the discrimination linked to mental health conditions,” she said.
Dr. Daniels-Williamson has also participated in the World Health Organisation’s (WHO) Mental Health Gap Action Programme (mhGAP), which trains medical professionals to better handle mental health conditions in countries where resources are sometimes scarce. The specialty-specific education, she says, allows her and her staff to welcome all patients without judgement.
“Since [I’ve been] here, we’ve been edifying staff. We do health talks frequently. I address this topic frequently, so, my staff is well aware. Some of my staff were also trained under the mhGAP programme so persons are aware and they’re encouraged to be an advocate for these individuals. They understand that these persons can come and they understand the peculiarities that are associated with these mental health conditions. So, we make no hesitations to see these persons. I’m a key person here at the [Grove] Health Centre that deals with these issues. Whenever I’m available… I deal with them right away. So, there are no issues with seeing these [patients],” she said.
While the Ministry welcomes increased treatment and recovery of mental health patients, institutionalisation is the last option. Head of the Mental Health Unit, Dr. Util Richmond-Thomas explains the Unit’s vision for mental healthcare in Guyana.
“My role [includes] governance and standard setting and surveillance of all the mental health programmes that are going on in the country. We [also] have to create our own programmes according to the needs of the population and also according to the international standards,” Dr. Richmond-Thomas said.
Community-based care, she explained helps the patient maintain a sense of normalcy.
“At the moment we’re in the process of transitioning from institutional care to community-based mental health. So, it means that we have to beef-up the capacity of primary healthcare and the community facilities to take care of patients at the primary healthcare level in an adequate fashion rather than hospitalising them at the National Psychiatric Hospital. Worldwide, countries are moving away from that kind of model because we find that it is a waste of resources and more than 70 per cent of the patients can be managed at the primary healthcare level on an outpatient basis and it is much better for the patient because there are better patient outcomes. Their lives are not disrupted… and they do much better when they are closer to their family and friends that they love and they can go to work, go to school… We’re moving toward that level,” she said.
Dr. Thomas stressed that early diagnosis is crucial in preventing the mental health conditions from progressing to a level where institutionalisation is necessary.
“Right now, the Mental Health Unit is training the doctors in primary healthcare to treat all the major and most common mental health issues. So, when the patient presents to primary healthcare, these doctors are there and they are diagnosing and they are managing those patients and they are getting them in the very early stages. We have seen a lot of progress there because even as we speak, the admissions to the psychiatric ward at the Georgetown Public Hospital [have] decreased significantly. So far, we’ve trained more than 300 healthcare workers and more than 150 doctors. So, they are out in the communities at their various posts and… detecting and treating mental illnesses in their early stages,” she said.
Strength in unity
The Unit’s robust awareness campaign can be particularly helpful in the classroom setting. For example, in the past, students struggling with mental health conditions, like Attention Deficit Hyperactivity Disorder (ADHD) had been seen as ‘bad’ students. With the right instruction however, educators can learn the symptoms of these conditions and begin helping their students, rather than punishing them.
In a push to catch mental health patients at the community level, the Mental Health Unit, in collaboration with The Wellness Centre and S.A.V.E Guyana, has begun training support group leaders, who will target persons struggling with self-harm and substance abuse throughout the country. This initiative, Dr. Richmond-Thomas says, will be up and running by mid-July.
Ms. Shinelle Bayrd of the Wellness Centre, which is providing financial support for the workshops, created the organisation with the intent of raising mental health awareness.
“The figures that I… received from the Mental Health Unit as it relates to the youth mental health is startling. So, I needed to create something to help fix that problem. Being a youth myself… I said that that would be the perfect thing for me to get into,” she said.
Ms. Bayrd also posited that the mental health advocates need to be deliberate in their attempts to shatter the stigma.
“People in Guyana, they really and truly don’t understand mental health. The minute you say you have a mental health illness, they immediately label you as mad or crazy, when, in fact, it’s much… deeper than that. So, I think we really and truly need to break that barrier [and] end that stigma… We can’t just talk the talk, but we need to walk the walk in terms of providing the support. So, yes, we’re raising the awareness, but we’re also backing it up by helping those [who] truly need [help] and the support groups are, in my opinion, the perfect way to start that process,” she said.
There is help available for those to whom symptoms described and stories told in this week’s edition of Government in Action sound familiar. The Government of Guyana, through the Ministry of Public Health and the Mental Health Unit has come alongside all Guyanese to uplift those who are quietly combating mental health conditions. You too are deserving of the good life promised to all Guyanese, which includes sound mind, body, and spirit.
The Mental Health Unit is a sub-department of the Ministry of Public Health. They are located at 252 Quamina Street, South Cummingsburg, Georgetown and can be reached via telephone at 226-1405 and 226-1407.
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