Guyana: mental illness, witchcraft, and the highest suicide rate in the world

THEGUARDIAN.COM

At a staggering rate of 44.2 suicides per 100,000 people (the global average is 16 per 100,000) the small nation of Guyana in South America has the highest rate of suicide in the world. And with fewer than 10 full-time psychiatrists in the country, a shortage of social workers or psychologists and no operating crisis hotline, there are limited options for those seeking help.

No one factor can explain Guyana’s shockingly high suicide rate. Health workers have pointed to the deep poverty in rural areas, the prevalence of alcohol abuse (which is notorious for its contribution to successful suicides) and the ease of access to deadly substances. Some scholars have theorised that exposure to certain herbicides and pesticides used on the island makes farmers more prone to suicidal behaviour.

Because of a strong stigma and a lack of resources in Guyana, suicide as a public health issue has fallen by the wayside. Efforts by the ministry of health in the last few years have been nominal, and those interventions that have taken place seem misguided at best.

    Mental illness is misunderstood on the island, with symptoms often mistakenly attributed to witchcraft

Savitri Persaud, a doctoral candidate at York University who has done extensive research on mental illness in Guyana, highlighted the inadequacies of one recent government initiative.

One of the most frequently used suicide methods on the island is the ingestion of pesticide. As many people are farmers, pesticides are readily available and contribute significantly to the high suicide rate. In response, the government distributed storage cabinets with locks to farmers who won a lottery, with the aim of limiting accessibility and encouraging safe usage. In the initial stage, 10 farmers received cabinets, with the total number distributed said to be only 150.
“That is not suicide prevention. That is not proactive, that is reactive,” says Persaud. “We need to think twice about our knee-jerk responses.”

Restricting access to potentially lethal means, such as firearms, ropes or poisons, is a necessary part of prevention but is not of itself sufficient. Effective suicide prevention involves intervention on an individual level – psychologically and physiologically – and also in the wider community.
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In Guyana, Persaud notes the powerful effect of stigma and the importance of grassroots intervention. Mental illness is misunderstood on the island, with symptoms often mistakenly attributed to witchcraft (known locally as obeah). Communities often ostracise sufferers, and on occasion have physically assaulted them, at times with the endorsement of religious leaders, who are highly respected figures.

“Guyana is a place where most people live in villages and rural areas, so those who people tend to reach out to are religious leaders,” says Persaud. “In some ways religious leaders become first responders.” Taking into account Guyana’s specific culture with religion, she says, “we have to take into consideration the way mental health symptoms can be interpreted certain ways by religious leaders”.

The Guyana Foundation, a private philanthropic institution tackling Guyana’s social problems, has taken on the problem of suicide at the ground level. Anthony Autar, the managing director, spoke about the multiple ways in which the foundation has approached suicide prevention.
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The foundation has reached out to police, family and survivors in rural areas to educate them about suicide and suicidal behaviour. In additional, it conducted training sessions in Georgetown, the country’s capital, for religious leaders, social workers and representatives from NGOs. It also launched an information campaign in local newspapers to challenge misconceptions about mental illness.

The foundation is currently trying to partner with international agencies, such as those in Canada, to route calls from those in need to crisis lines abroad. “Guyana just doesn’t have the capacity,” says Autar, “so we’re doing our best to become creative in seeking solutions”. They’re seeing success. Autar reports that large companies are requesting more information on suicidal behaviour and intervention for their employees. When the foundation offered to connect citizens with mental illness to professionals, they received 50 phone calls in a fortnight. “It shows that people are recognising they can get help and are willing to reach out,” says Autar.

Persaud herself encourages a multi-sectoral approach, saying: “The medical community needs to be actively involved, the church needs to be actively involved, community members need to be actively involved.” In a sentiment echoed by professionals worldwide, Persaud says a comprehensive approach should apply not only to Guyana: “The problem is cross-cultural. We can’t call certain countries advanced just because they use the medical model.”
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In the region overall, the issue is gaining attention. The Pan-American Health Organisation (PAHO) has recognised suicide as a major problem, and is focusing special effort on raising awareness and implementing changes in government policy and in public health services. Between 2010 and 2013, PAHO launched region-wide initiatives to address treatment gaps in mental health, and has integrated mental health in its strategic plan for 2014 to 2019.

Efforts have seen some success. According to a report released in 2014, only six countries and territories in the region do not have mental health policies established. (Simultaneously, much work remains to be done, as only eight countries have established targeted, up-to-date mental health laws.)

While top-down interventions are beginning to show results, with psychiatric care moving from psychiatric hospitals to communities and more legislative action on mental health, most Caribbean countries are still struggling to fight the stigma of mental illness at grassroots level. Jamaican blogger Brandon Allwood, one of the few to share his experience of mental illness and suicidal feelings publicly, recounted how the most resistance came from his family and friends. “I understand, now, that my mother and most Jamaicans are of the ‘help-yourself-nuttin-nuh-wrong-wid-yuh’ ilk.”
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Allwood concludes: “This is not a call for the government; it is a call for us all to seriously look at our attitudes towards mental illness. How we support our children, siblings, parents, friends and colleagues who are affected by the gamut of mental ailments. It is about us, as a people, being more open to the idea that sometimes we actually do need help.”

Indeed, while psychiatric facilities can keep those in crisis safe, medical intervention alone is not enough. Effective suicide prevention comes from a holistic approach – taking more than the individual or the attempt into account, but also the communities in which they live, the cultural attitudes towards mental illness, and the awareness of the issue of suicide. Globally, there needs to be more open discourse about suicide. For those at risk, there are still significant obstacles, both cultural and logistic, in seeking treatment. Suicide prevention has simple, but proven measures for countries to implement. Putting it on the agenda for 2015 has the potential to save thousands, if not hundreds of thousands, of lives.

Health workers have pointed to the prevalence of alcohol abuse in attempts to explain Guyana’s shockingly high suicide rate. Photograph: David Preutz/Alamy