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Guyana Helplines & Hotlines

Phone: 223-0001, 223-0009, 600-7896, 623-4444.

What's App: (592) 600-7896 or 623-4444.

Cell: 600-7896 (toll free from Digicel phones), 623-4444

Email: guyagency@yahoo.com

Bbm pin: 2BE55649, 2BE56020

Twitter: @guyanaagency

 

Serenity Seekers Al-Anon Family Group: Nicky - 600-0832, Joanne - 619-4835

Help & Shelter: 227-3454 or 225-4731

Guyana Foundation: 608-6902

Monique's Helping Hands: 225-9263

SASOD: 225-7383 or 623-5155

Crossroads Suicide & Mental Health Awareness Services: 667-2692

Mental Health Unit, Ministry of Health: 226-7400

Georgetown Public Hospital Psych Ward: 226-7210,226-7214,226-7216, 226-7217,226-7219,227-2240

National Psychiatric Hospital:

 

 

Guyana Suicide Overview

Guyana was ranked first in suicides per capita worldwide, with 44.2 suicides per 100,000 persons, according to the World Health Organization’s (WHO)5 2014 report. However, based on investigation carried out by The Caribbean Voice, this figure turned out to be incorrect, as WHO claimed that it had factored in the globally unreported suicides estimated at 25%, which is not a usual adjustment made by WHO. Once that 25% was factored out, the actual rate turned out to be 32.15, still a very high rate.

The WHO 2017 (the latest available with figures as of March 2015) report placed Guyana at number four with a suicide rate of 30.6 per 100,000. However, given that globally, an estimated 25% of suicides go unreported, the actual figures would be about 320 suicides in Guyana, although empirical and anecdotal evidence in Guyana, indicate that unreported suicides are higher than 25%. Thus actual suicides could well be higher than 320 annually.  Also, at a globally estimated 25 attempts per suicide, Guyana would have almost 8,000 attempted suicides a year, even though it is estimated that suicide attempts in Guyana are higher as these too are significantly under-reported.

Suicide is the leading cause of deaths among young people ages 15-24 and the third leading cause of death among persons ages 25-44, while in the 15-19 age group, it is the leading cause of death among females and the second leading cause of death among males.

In 2000, a landmark study – "The Shadow of Death: A Recent Study of Suicides in Guyana, Incidence, Causes and Solutions" - reported that the majority of those dying by suicide were young males below the age of 35 years. They were likely to be poorly educated, employed in low-income occupations, reside in the same community all their lives and be less likely to have children. A ‘suicide cluster’ was identified in Black Bush Polder, a community in East Berbice, Administrative Region Six. However, over the last three years or so, Administrative Region Two has had more suicides than any other geographic area. As well, suicide has been found to be extremely high among hinterland and riverrain communities, mostly inhabited by Guyana’s indigenous citizens.

Additionally, between 2009 and 2015, data published by the Guyana Police Force, showed that 22 murder-suicides happened over the period significantly in the 20 -49 age group.

Also, in a recent study on the murder-suicide incidents in Guyana, the findings showed clear evidence of an increasing trend in the number of murder-suicidal incidents during the same 2009-2011 period. Even more revealing, were Guyana Police Force records of suicide deaths for the 2009-2015 period, that showed rising trends in the number of murder-suicide deaths, which peaked in 2013, with 2010 recording the lowest number of murder-suicide cases during this period.

It was further predicted that the number of murder-suicide deaths for the 2016-2030 period, would be around 76 over the 15-year cycle. This means a consistent increase of approximately one dual fatality between the years 2016 to 2019, and two between the years 2066-2030. This finding further confirms Henry (2015) whose projection points to an increase, of which murder-suicide will add to this projection. (Henry, P (2015): “Agrochemicals, Suicide Ideation and Social Responsibility”; Issues in Social Science, 3(2).)

In Guyana almost all suicide deaths are the result of ‘hanging’ and ‘poisoning’.  Death by poisoning was said to be 36% of all reported suicide deaths while hanging comprised 41% of such incidents from 2009 to 2015. Poisoning was perceived as the ‘preferred’ method due to the easy availability of pesticides and other agro-chemicals and related substances. One researcher (Henry, 2015) noted that increase of pesticides availability in the ten Administrative Regions in Guyana, with “very limited controls for procurement,” could be one of the contributory factors to such a preferred method of choice. This is compounded by storage that leads to easy accessibility in homes where such pesticides are used as well as easy accessibility at places of sales as there are no stringently enforced conditions of purchase.

The studies, analyses and other research have concluded that, prone to copycatting, a practice referred to as the Werther Effect, suicide ideation is the result of depression and/or anxiety6 triggered by helplessness, hopelessness, powerlessness and loneliness. These triggers are catalyzed by low levels of self-acceptance and/or feelings of inadequacy/low self esteem, (and to a significantly lesser degree psychosis, bipolar disorder and some other mental illnesses) (Schmidtke A, Häfner H (1988). "The Werther effect after television films: new evidence for an old hypothesis". Psychol Med. 18 (3): 665–76) as a result of abusive and dysfunctional relationships; lack of empathetic communication, teenage affairs and pregnancy; rape and incest; an inability to deal with problems (lack of coping skills) and/or unbearable pain – physical or emotional – poverty, unemployment and alcoholism.

Against this background, suicide prevention activists have referred to the Guyana situation as a suicide contagion, which has gone beyond copycatting (Scutti, Suss: “Suicide Rates Highest In Guyana, May Be Explained By Clustering Effect”, Medical Daily USA, Oct 14, 2014). It would seem that suicide has been normalized, not only as an answer to challenges and problems but also as an option to deal with those challenges and problems. In effect suicidal ideation is now a regular part of the behavioral landscape.

 

Myths & Misinformation

on Suicide in Guyana

Since The Caribbean Voice launched its suicide prevention campaign, we have been appalled by the biases, prejudices, misinformation and disinformation that character attitudes towards suicide. In fact we have arrived at the distinct understanding that suicide prevention can only be effective when attitudes become more enlightened and sympathetic.

When a post was placed on a Facebook page requesting contacts to help organize the Black Bush Polder outreach, one commentator wrote, "All the names I want to give you have all committed suicide."

And when his comment was pointed out to be in bad taste, he responded that he was not joking but trying to emphasize the magnitude of the problem. This lack of sensitivity is perhaps the number one misguided attitude. Also, based on feedback, it seems that sensitivity creeps in only when someone has been personally affected by suicide.

Furthermore we receive a lot of comments to do with God, religion and temples. Yes, faith-based counselors and individuals with deep religious convictions do believe that faith in God can help. In fact, one commentator posted, "Stop begging and send them to church to pray to God."

So yes, we are certain that some suicidal individuals might have been brought out of that mindset by faith-based counseling. But faith-based counseling does not work with all, is not available to all and faith-based leaders are not generally equipped for clinical counseling.

Besides, people who deeply believe in God, still commit suicide. So while we endorse faith-based counseling as a strategy that may work for some, we believe that there must be a range of strategies and access so all can be reached.

Furthermore, a number of individuals also simply dismiss suicide as the victim's personal choice and business, and feel there is no need to get involved in suicide prevention since nothing can really be done. Yet there is a tremendous body of literature and shared experiences that prove that something can indeed be done and that suicide is preventable.

So as we move forward, it becomes important to dispel some of the prevailing myths and misinformation about suicide. For too long suicide and factors the drive this crisis have been viewed as 'taboo' and not an appropriate topic to be discussed in public. That taboo must now be laid to rest.

Myth # 1:  People who commit suicide want to die.

Fact: Suicide is seen as a way to end the pain. A suicidal person does not see any other option but those who have survived attempted suicide say they never wanted to die.

Myth #2: People, who talk about killing themselves, are just looking for attention and won't do it.

Fact: If someone is talking about suicide, regardless of how it is expressed, it must be taken seriously.  That person is in pain and crying out for help.  If you're in doubt, keeping talking to the person and listen carefully. Unless this is done that person could end up carrying out the threat.

Myth #3: If people are determined to kill themselves, then nothing is going to stop them.

Fact:  Various studies indicate that showing someone you care and giving that person just five minutes of your time has proven to reduce suicidal attempts. A person's urge to kill him/herself, regardless of the reason, is only temporarily. A study of those who survived the jump from the Golden Gate Bridge stated they would not have jumped if someone had just spoken or even smiled at them during their period of crisis.

Myth #4: People who commit suicide never tell or show any signs of distress.

Fact: In various studies it was noted that up to 80% of victims leave clues, either verbally or through their change in behaviors. That is why, it is important to learn about and become familiar with the warning signs.

Myth#5: Discussing suicide with someone will put the idea in his or her head.

Fact: Talking about suicide lets the person knows you care and that he/she is not alone. It gives a sense of relief and promotes a greater chance that the person will unburden himself/herself.

Myth #6: Only Indo-Guyanese commit suicide.

Fact: Guyanese of all ethnic backgrounds commits suicide.

Myth #7: Only the poor commit suicide.

Fact: Suicide does not discriminate and it can affect the lives of anyone regardless of social status or financial background, as has been seen over and over.

Myth #8: Telling someone to cheer up when he/she is depressed will stop him/her from acting crazy.

Fact: Telling someone to cheer up will cause more distress because it will appear as if that person's feelings do not matter and the person is not being taken seriously.

Myth #9: People commit suicide on impulse or a whim.

Fact: People do not commit suicide on an impulse. Those who end their lives would have thought about it over and over in their mind; it's this process that allows them to carry out the act.

Myth #10: Only cowards commit suicide.

Fact: It's not a question or being a coward or being brave. The reality is that it is difficult to imagine the agony someone goes through before committing or attempting the suicide.

Myth #11: If you go to church you will not commit suicide.

Fact: Regular church attendance, by itself has not stopped individuals from committing suicide. And while belief and faith based counseling may help some it takes more than that to help others.

Myth #12: Only people who drink commit suicide.

Fact: Alcoholism or being under the influence of alcohol is not a reason for suicide, but may provide Dutch courage to the already suicidal.

Myth #13: People who commit suicide are selfish.

Fact: Actually its almost the opposite - people commit suicide because they think they are saving their loved ones from having to disrupt their lives to deal with the own pain and agony of the suicide victim.

Myth #14: People who commit suicide are stupid.

Fact: Stupidity has nothing to with it.

Myth #15: All the barrels and money sent by overseas relatives to their Guyanese families cause the families to become lazy and drink a lot of rum. This then lead to suicide.

Fact: As pointed out above alcohol is not a cause of suicide. Nor is laziness or the combination of the two.

Myth #16: Too much cell phone use cause users, especially the young to maybe be depriving them of opportunities to 'offload' their problems in face-to-face communication, making them more vulnerable to suicide.

Fact: Cell phones do play a part in suicide bu there is no research or evidence to support this contention.

In the final analysis please remember that 'Suicide Prevention is Everybody's Business' and if each of us plays a part, we can save lives and enable potential to flower. Also do remember that suicide is never an answer, no matter what the problem or issue is; suicide simply leaves too many unanswered questions. Finally suicide does not eradicate pain, it leaves behind a circle of agony that embraces those left behind.

 

Empathetic Communication

for Suicide Prevention

An inability to communicate empathetically has been identified as a factor that catalyzes suicide.

What is Empathic Communication?

• Also know as active communication or reflective communication, empathetic communication is a way of listening and responding to another person that improves mutual understanding and trust.

• It enables the listener to receive and accurately interpret the speaker’s message/words, and then provide an appropriate, non-threatening, affirming response.

• Through empathic communication the listener lets the speaker know, “I understand your problem and how you feel about it. I am interested in what you are saying and I am not judging you.”

• The benefits are as follows:

1. Builds trust and respect  2.   Enables the person to release hidden emotions

3. Reduces tension/conflict  4.   Encourages free exchange of information

5. Creates a safe environment that is conducive to collaborative problem solving.

Guidelines to Empathic Listening:

Do’s:

• Be attentive. Be interested. Be alert. Create a positive atmosphere through nonverbal behavior.

• Be a sounding board-allow the speaker to bounce ideas and feeling off of you while assuming a non-judgmental , non-critical manner.

• Act like a mirror-reflect back what you think or hear the speaker is say and feel.

• Provide brief, noncommittal acknowledgment responses, e.g., “I see,” or  “Uh- huh.”

• Give nonverbal acknowledgements, e.g., head nodding, facial expression matching the person, eye contact and a relaxed body posture.

• Invite the person to say more, e.g., “tell me more about it,” or “I’d like to hear more about that.”

Don’t’s:

• Don’t discount the person’s feeling by saying, “it’s not that bad “ or “you’ll feel better soon.”

• Don’t let the person “hook” you. This can happen if you get angry or upset, by allowing yourself to take sides and or pass judgment on another person.

• Don’t ask a lot of questions. That can give the impression that you’re being “fas” or intrusive.

• Don’t interrupt or attempt to change the subject being addressed by the person.

• Don’t give advice, teach or rehearse how you will respond to the person.

 

What is Self-Acceptance?

• It is being able to embrace all facets of one’s life, not just the positive. Each person must recognize his/her own specific weaknesses, limitations, and foibles but this awareness should not prevent full understanding of oneself as a person. Remember everybody possesses these qualities also.

• Accepting the person you are is the first step. This enables you to identify with your great qualities - things that make you unique – as well as the not so good parts and can help alleviate feelings of guilt, lack of self-esteem and unhappiness.

• It helps to stop you from comparing yourself to others, which brings about a sort of inner peace, lightness and happiness in your life and prevents continual dissatisfaction, disenchantment and frustration.

Practical Approach:

➢ Set an intention-move from the world of blame, doubt and shame, to one of tolerance, acceptance and trust.

➢ Forgive yourself-everyone makes mistakes; view it as lesson learned.

➢ Consider the people around you-focus on those who are a good influence in your life.

➢ Create a support system- those who want better for themselves and can help you be better; network and reach out.

➢ Quiet your inner critic-we can be our own worst enemy; learn to ignore doubts, be less self-critical.

➢ Celebrate your strengths- identify them; write them down, use them, build on them.

➢ Perform charitable acts-when you give to others, it helps you to value what you have, to accept who you are, to develop additional skills and inner satisfaction.

➢ Be kind to yourself-embrace everything that is you (the good, bad and ugly) and remember you’re unique, not lesser than anybody else.

➢ Grieve for lost dreams- sometimes what we want out of life is not possible, mourn the loss but don’t obsess over it, then get back to the life you have and move forward.

➢ Set realistic goals for you- 3, 6, 9 and 12 month goals, celebrate them.

➢ Take time to know you- set aside a few minutes a day for yourself to introspect, enjoy who you are as a person and celebrate your strengths and achievements.

 

What is Self-Esteem?

Self-esteem is your opinion of yourself. High self-esteem is a good opinion of yourself, and low self esteem is a bad opinion of yourself. The way we feel about ourselves has a huge affect on the way we treat ourselves, and others, and on the kinds of choices we make. it affects how we think and act and how we react to challenges. It has a direct bearing on your happiness and wellbeing.

HOW TO ENHANCE YOUR SELF-ESTEEM:

Here are some things you can do to protect, raise, or reinforce your self-esteem.

• Spend time with people who like you and care about you.

• Select god role models

• Ignore (and stay away from) people who put you down or treat you badly.

• Focus on your achievements rather than on your failures.

• Prepare thoroughly for any task so that you can be sure you are ready.

• Focus on who you are and what you like about yourself. Why do your friends like you?

• Do things that you enjoy or that make you feel good.

• Do things you are good at.

• Reward yourself for your successes.

• Develop your talents.

• Be your own best friend - treat yourself well and do things that are good for you.

• Make good choices for yourself, and don't let others make your choices for you.

• Take responsibility for yourself, your choices, and your actions.

• Always do what you believe is right.

 Be true to yourself and your values.

• Respect other people and treat them right.

• Set goals and work to achieve them.

 

Self Esteem (SE) Test

Circle your choice:

1. Other people are not better off or more fortunate than me.

     True   False

2. I accept myself as I am and am happy with myself

     True   False

3. I enjoy socializing.

     True   False

4. I deserve love and respect.

     True    False

5. I feel valued and needed.

     True    False

6. I don’t need others to tell me I have done a good job.

     True    False

7. Being myself is important.

     True    False

8. I make friends easily.

     True    False

9. I can accept criticism without feeling put down

     True    False

10. I admit my mistakes openly.

     True    False

11. I never hide my true feelings.

     True    False

12. I always speak up for myself and put my views across.

      True    False

13. I am a happy, carefree person

      True    False

14. I don’t worry what others think of my views.

      True    False

15. I don’t need others’ approval to feel good

      True    False

16. I don’t feel guilty about doing or saying what I want

      True    False

 

TEST SCORE:

Total number of TRUE answers giving EACH ONE POINT:

15-16 Points – You have a high level of self esteem!

12-14 Points – Not bad but room for you to improve

8-11   Points – Low self esteem is holding you back

Below 8 Points – Your esteem is drastically low!

May we point out that is just one of many self esteem test available. Others include the Rosenberg Self Esteem Scale, Psychology Today Self Esteem Test, Positive Self Image and Self Esteem and Sorensen Self-Esteem Test.

 

Suicide Prevention Strategies

The following are strategies for suicide prevention.

What is Self-Acceptance?

• It is being able to embrace all facets of one’s life, not just the positive. Each person must recognize his/her own specific weaknesses, limitations, and foibles but this awareness should not prevent full understanding of oneself as a person. Remember everybody possesses these qualities also.

• Accepting the person you are is the first step. This enables you to identify with your great qualities - things that make you unique – as well as the not so good parts and can help alleviate feelings of guilt, lack of self-esteem and unhappiness.

• It helps to stop you from comparing yourself to others, which brings about a sort of inner peace, lightness and happiness in your life and prevents continual dissatisfaction, disenchantment and frustration.

Practical Approach:

➢ Set an intention-move from the world of blame, doubt and shame, to one of tolerance, acceptance and trust.

➢ Forgive yourself-everyone makes mistakes; view it as lesson learned.

➢ Consider the people around you-focus on those who are a good influence in your life.

➢ Create a support system- those who want better for themselves and can help you be better; network and reach out.

➢ Quiet your inner critic-we can be our own worst enemy; learn to ignore doubts, be less self-critical.

➢ Celebrate your strengths- identify them; write them down, use them, build on them.

➢ Perform charitable acts-when you give to others, it helps you to value what you have, to accept who you are, to develop additional skills and inner satisfaction.

➢ Be kind to yourself-embrace everything that is you (the good, bad and ugly) and remember you’re unique, not lesser than anybody else.

➢ Grieve for lost dreams- sometimes what we want out of life is not possible, mourn the loss but don’t obsess over it, then get back to the life you have and move forward.

➢ Set realistic goals for you- 3, 6, 9 and 12 month goals, celebrate them.

➢ Take time to know you- set aside a few minutes a day for yourself to introspect, enjoy who you are as a person and celebrate your strengths and achievements.

 

Suicide Prevention Mechanisms

• We appeal to all stakeholders to join in on organizing walks and rallies in various communities in collaboration with other stakeholders. Regional administrations, NGOs, regional health institutions and community-based organizations, religious institutions and schools can take the lead in his respect. We want to emphasize that that any accompanying address should not focus on awareness (since there is hardly anyone in Guyana who is not aware) but rather on coping skills and prevention strategies, collaboration and ongoing activism.

• We urge the media to be more responsible and sensitive in reporting suicide so as not to foster copycatting on the one hand and to become more proactive in providing coping information and suicide prevention strategies as well as to publicize all the efforts taking place to tackle suicide. Also the media must keep pushing the government to transform all their talk into action.

• Also we urge the government/Ministry of Healthy to restart the Gatekeepers' Program. We believe that media can help to bring this on stream by continually focusing on this need. Additionally we strongly suggest that there be a standard training manual provided to all entities that engage in this kind of training so that the right information and strategies are provided and so that any possibilities of myths and misinformation being included in the training are eliminated.

• The Minister of Education had announced that counselors would have been placed in schools by February 5th. The deadline came and went and so we appeal to the Ministry to please get going on this promise. Here again we strongly believe that the media can help to bring this on stream.

• Meanwhile laud the self-esteem workshops done in some schools in Berbice by the New Jersey Arya Samaj Humanitarian Mission and the Peace Corp with the blessing of the Ministry of Education. We believe that these workshops should be taken nation wide and we urge other NGOs, as well as schools themselves, to establish the requisite partnerships to get this done. Furthermore we strongly urge that the right focus is placed regardless of which entity/individual engages students – self esteem, self worth, self acceptance, coping strategies, how to access help – useful, practical, pragmatic, concrete information and strategies that can actually be used.

• Also we urge the all high schools to follow the lead of Queens College students and set up mentoring programs. Perhaps the Ministry of Education can take the lead in this endeavor.

• We appeal to all businesses everywhere to include suicide awareness messages and prevention strategies in their advertisements, especially outdoor billboards. Even local businesses and other entities can join in this by creating heir own ‘suicide prevention’ billboards within their various communities, such as was done recently in Essequibo.

• We emphasize collaboration, and holistic approach that must include focus on related issues such all forms of abuse, sex crimes and drugs and alcoholism.

• Also we urge MOH and MOSP (Health and Social Protection) to map all that is happening so that an overview can be in place, duplication can be avoided and the gaps can be plugged. And to ensure this mapping perhaps a stakeholders' committee should be set up.

• We also appeal to farmers and users of agro chemicals to safely and securely store, use and dispose of agro chemicals and their containers and to ensure that only responsible persons buy and handle these chemicals. We know that Pesticide Board has distributed 150 cabinets and plans to give out another 150 but this amount is woefully inadequate. So we urge all farmers and other users of these pesticides to create your own cabinets/strong boxes or to collaborate with others in doing so.

• As well we appeal to sports in general to include suicide prevention awareness and coping info in their various plans and events. We know that at least two sports competitions have already taken the lead in this respect and we believe that sports is a very critical avenue to create awareness and foster prevention.  But so too is culture and so we implore entities and individuals who organize cultural events and programs to also include coping skills suicide prevention strategies within these endeavors.

• Finally we appeal to the phone companies to add awareness messages and prevention and coping info to the messages they send out to their cell phone subscribers on a daily basis.

 

Suicide Impacting Factors

The following are critical factors for suicide prevention.

Warning signs:

➢ Talking about: wanting to die or to kill oneself; being a loser; wanting to end it all or give up; having no reason to live, being a burden to others and the like.

➢ Feeling hopeless, helpless, trapped, frustrated.

➢ Feeling unbearable pain – physical, mental or both.

➢ A sudden increase in use of alcohol or drugs.

➢ Sleeping too little or too much.

➢ Being withdrawn or feeling isolated.

➢ Showing rage or talking about seeking revenge.

➢ Displaying extreme mood swings.

➢ Visiting many people all of a sudden and seeming very friendly/happy.

➢ Seeming to be lost but denying that there’s a problem.

➢ Suddenly giving away or selling off personal items and wastefully spending money.

Risk Factors:

• Sexually transmitted disease.

• Abuse (sexual, physical and mental).

• Mental illnesses (depression is a key factor) and associated taboos.

• Previous suicide attempts and/or family history of suicide/suicide attempts.

• Teen pregnancy, incest, rape.

• Relationships: dysfunctional, triangular, teenager. separations, break ups.

• Alcoholism and drug abuse.

• Alternative sexual lifestyles – gays and lesbians.

• Problems that seem insurmountable - poor socialization and coping skills.

• The Werther Effect – copycatting

• The Bollywood Effect – cultural sanction

Preventative Factors:

• Do not sit on a problem; find someone you trust to talk to – family member, priest, teacher, close friend or relative, village elder…

• Never see suicide as the answer…think of your dreams and all you can achieve in life. Remember things will get better; they usually do.

protective Factors:

• If you observe suicidal warning signs, take action and get the person help…suicide prevention is everybody’s responsibility.

• Communicate in such a way to build trust and show that you care. Don’t judge harshly and drive people away or make them feel alone, unwanted, unloved.

• Always safely secure pesticides and poisons with access granted to the most responsible family member.

 

Shri Lanka’s Hazard Reduction Model: Suicide Drop by 50%

According to Guyana’s Chief Medical Health Officer (CMO), Dr Shamdeo Persaud, the Ministry of Health will set up Poison Control Centers throughout the country to provide immediate, free and expert treatment, advice and assistance over the telephone in case of exposure to poisonous or hazardous substances. The CMO explained that the operations of such centers across the country can help curb the issue, or at least, reduce the amount of successful suicides by providing immediate life-saving information for suicide attempts.

However, The Caribbean Voice hopes that Dr. Persaud is aware that information by itself, is useless, unless it is acted upon. So we look forward to the unfolding of other measures aimed at ensuring that information disseminated by the Poison Control Centers is utilized to the fullest, that utilization is monitored, and that follow up is mandated. In this context we would like to point out again, that Shri Lanka’s Hazard Reduction Model relating to agro-chemicals, has proven to be highly successful in reducing suicide in that nation. In fact, the total number of suicides in Sri Lanka fell by 50% from 1996-2005 compared to 1986-1995 – a reduction of approximately 19,800 suicides, after this model was introduced.  There is no such proven track record for Poison Control Centers.

The Shri Lankan model encompasses:

1. Introducing a minimum agro-chemicals list restricting the use of pesticides to a smaller number of pesticides least dangerous to humans.

2. Placing import restrictions to ensure that more dangerous chemicals do not enter the country.

3. Restricting the availability of agro-chemicals by ensuring they are stored safely in locked boxes in rural households, along with all equipment with which these pesticides are used.

4. Ensuring that empty containers are safely and effectively disposed of.

5. Restricting sale of agro-chemicals only to licensed premises and to licensed farmers.

6. Implementing administrative controls to ensure that sales outlets safely store all agro-chemicals.

7. Implementing an ongoing safe use policy to educate people about safe handling, use, storage and disposal. Concurrently, for small-scale farming, non-chemical methods, including organic farming, should be encouraged.

8. Improving medical management of pesticide poisoning: an important facet of control because better management will reduce the number of deaths. Requirements are the better availability of antidotes (both in central referral hospitals and ideally in peripheral health units) and ventilation facilities, better training, and better evidence for interventions.

9. Constantly monitoring all measures to ensure ongoing conformity, including random home visits to check for locked box storage and field visits to ensure that only licensed premises and licensed farmers have access to chemicals and that safe handling, use, storage and disposal are in effect.

Given that in Guyana, the vast majority of suicides result from ingestion of agro-chemicals, it would seem logical for the Ministry of Health, in collaboration with the Ministry of Agriculture (and related other agencies), to implement (with necessary modifications) a suicide reduction model that has been tremendously successful, rather than a measure that is nebulous at best. Besides this innovation should cost less than poison control centers. The most difficult part would be regular enforcement but, given what is at stake, surely the resources should be employed accompanied by political will to ensure success.

 

Abuse Overview

Although reliable national statistics are not readily available, it is well accepted that Guyanese women continue to be subject to widespread violence that prevents them from enjoying other constitutionally ensured rights. "Guyana’s Second Periodic Report to Committee on the Elimination of All Forms of Violence Against Women  (CEDAW) concludes that, “Violence against women is widespread in Guyana,” and cites a 1998 survey of 360 women in Greater Georgetown as evidence. The survey found that, “Out of more than 60% of women who were involved in a relationship or union, 27.7% reported physical abuse, 26.3% had experienced verbal abuse and 12.7% experienced sexual violence. Approximately half of the surveyed women responded that one of the likely causes of partner’s abuse was jealously (55.4%) or “hot temper”. Nearly four of every five respondents perceived violence in the family to be very common in Guyana (76.8%). More than one in three knew someone who was currently experiencing domestic violence (35.5%).

According to the Stabroek News (Jan 17, 2012), “… domestic violence, and particularly the abuse of women by their male partners, is among the most common and dangerous forms of gender-based violence. Women become targets by virtue of their relationship to the male abuser and the violence is inflicted on them usually, but not exclusively, within the home”. Media reports also place the domestic violence rate as anywhere between 50% and 66% but some activists argue that it could even be higher and that a significant percentage of abuse never gets reported. With respect to child abuse, The United States (US) Country Reports on Human Rights Practices for 2007 indicates that in Guyana the "vast majority" of cases of child rape and abuse are not reported.

Effectively, this means that gender inequity has enabled the proclivity towards gender-based violence and abuse, in which children often end up being victimized. That corporal punishment in and out of schools is still the practice in Guyana, and considered a necessity in the socialization process, also compounds the existing problem and related issues associated with societal violence overall.  Traditionally, domestic violence in Guyana is still perceived as a personal, private or family matter. Its reasons and consequences are often hidden, with this type of abuse being frequently portrayed as justified punishment or discipline in what is still a male-centric dominated society, and one in which children are still considered ‘to be seen and not heard’.

Tragically too, both spousal and child abuse exists, irrespective of ‘victims’ ethnicity, status, social standing and other persuasions. The prevalence of abuse seems to convey the distinct impression that among sections of the Guyanese populace, this represents a ‘normative pattern of behavior’. Of course, when matters reach crisis proportions, only then is there a sense of introspection or reflection on the causative factors for such behavior.

A report, published on the economic and social situation in Guyana, analyzed cases of homes and families where children suffer as “witnesses of domestic violence and as victims of child abuse and neglect” (UNICEF Regional Office for Latin America and the Caribbean, 2006). The long held perception that women were frequently victims of domestic violence, has changed over the past decade or so, with ‘main victims’ now “extended to boys and girls of all ages”. Between 2011 and 2013, the Crime and Social Observatory (CSO) from the Ministry of Public Security registered over 9,200 different types of domestic violence cases in Guyana, with 65% of them involving assault.

Further, the nature and type of incidences associated with domestic violence could also be validated according to age groups of Guyanese of all genders and social strata. These trends are symptomatic of the varying causative factors that interplay in the levels of suicide (deaths) officially and or unofficially reported.

A few years ago, one of the United Nations agencies, undertook a ‘situation analysis’ comprising children and women in Guyana (Guyana Situation Analysis of Children and Women, UNICEF, July 2016 pp 143-146). The report highlighted the plethora of domestic violence across age groups – from Guyanese as young as under18 years to the elderly, 65 years plus. The study attributed much of this to varied domestic and external factors.  These included cultural and faith traditions, poor relationship, lack of communication between spouses and partners (including cohabiting ones), money ills, material poverty, low attainment levels, health issues and other environmental pressures.

Significantly, the ‘distribution’ age of the ‘victims of domestic violence’ was (and still is) a vital consideration in modern times. This causative factor illustrates, in the main, that domestic violence can no longer be perceived as merely ‘an age-limitation’ issue, but that it has now extended across all-age ‘frontiers’.

 

Drugs & Alcohol Overview

According to the WHO, on average, Guyanese consumed more than eight litres (17.5 grams daily) of pure alcohol in 2010 compared to the global figure of 6.2 litres (13.5 grams daily).  That is, alcohol consumption in Guyana in 2010 was equal to 8.1 litres of pure alcohol consumed per person aged 15 years or older (15+). However, the average drinker in Guyana consumed more than 3.5 gallons/13.7 litres or 29.76 grams daily.

About 15.2% of male drinkers (10% of the population aged 15+) engaged in heavy episodic drinking, that is, consumed at least 60 grams of pure alcohol at least once per month. Also, 8.6% of males and 5.9% of all Guyanese aged 15 and older were classified as having alcohol use disorder, with 3.9% and 1.9% respectively classified as alcoholics.

The alcohol death rate for Guyana is 1.6 per 100,000.

There are no reliable statistics on the amount of persons using illegal drugs or those described as addicts. However, a Guyana Government 2003 Behavioural Surveillance Survey, found that 11% of out of school youth use drugs, as do 8% of in school youth. Other users included 17% of Guyana Sugar Corporation (GUYSUCO) employees, 45% of female sex workers, 74% of male sex workers and 12% of members of the armed forces. Since then, there has been a steady increase in the number of persons observed on the streets coupled with those who engage in the use of illegal drugs in social environments. The illegal drugs of choice in Guyana today are marijuana, crack cocaine, cocaine and to a limited extent, ecstasy.

It is also noteworthy that Guyana is increasingly becoming a drug transshipment point and the media is replete with the innovative ways in which drugs are shipped out of Guyana (US 5 Mar. 2013; Freedom House 2013; SAS 2012, The US Department of State's 2013 International Narcotics Control Strategy Report) According to OSAC (US Bureau of Diplomatic Security) 2014 report, “Drug trafficking organizations are prevalent and pose the biggest challenge to law enforcement in Georgetown. Airport security and custom officials frequently detail and arrest individuals attempting to smuggle drugs to the USS or other destinations. Apprehension of drug “mules” often US citizens perceived to be able to travel easily with their US passports, have increased this past year.”

This suggests a culture of drugs as an economic activity and quite clearly indicates that drugs are thus easy to access. In fact, empirical and anecdotal evidence gathered by The Caribbean Voice, indicate that in almost every community there are well known drug pushers, and that every community has drug addicts who engage in odds and ends work to support their habits. Also similar evidence suggests that a significant percentage of deportees, especially from North America, have developed drug habits.

 As well, even though stats for Guyana are not available, alcohol and drugs do have an overall economic cost to all nations and take a toll on workplace productivity. In fact, alcoholism has been identified as a major reason for absenteeism in the sugar industry. The Guyana Human Development Report (1996) points out that “there appears to be an association between drug use and mental illness and the transmission of the HIV/AIDS virus,” that prostitution is linked to drug use and that many of the street children are into drug use.

 Other substantial costs to society include property damage and job loss and health service costs. As well alcohol and drug abuse have many potential consequences including accidental falls, burns, drowning, brain damage, impaired driving resulting in accidents, deaths and injuries, poor school performance, work productivity loss, sexual assault, truancy, violence, vandalism, homicides, suicides, lower inhibitions, increased impulsivity, risky sexual behavior, early initiation of sexual behavior, multiple sexual partners, pregnancy and STDs.

 

SEXUAL CRIMES OVERVIEW

Sexual violence and crimes against women in Guyana is escalating: a rise of one-third in rape reports (from 117 to 154) occurred between 2000-2004 and a 16-fold rise in statutory rapes (from 2 to 34). The rape rate in 2010 was 15.5 per 100,000 which translated into 124 rapes for that year – an almost four fold increase over 2004 figures. Also, from January to September 2014 there were more than 140 reported cases of rape, while from January to July 2013, there were 179 reported cases. And the Guyana Police Force recorded a 68% increase in rape (243 reported cases) during the period January 1 to July 31, 2015 with most of the offences being perpetuated against underaged girls. In fact, statistics show that law enforcement officials receive reports of sexual violence almost on a daily basis.

Also, Guyana has the second highest rate of teenage pregnancies in the Caribbean with an estimated 97 teenage girls, aged 15-19, out of 1000 becoming pregnant each year. Of the more than 60% of women involved in a relationship or union, 12.7% experienced sexual violence ‘Challenging Sexual Violence: Some considerations’, Stabroek News, 3 April 2017).

A 2007 report by the Guyana Human Rights Association (GHRA) analyzed sexual crimes between 2000 and 2004 and found that 92% of all rape victims were females, 43% were in the 12 - 15 age group, and 26% were in the 1 - 12 age group. It also found that Amerindian girls between 12-16 years were the most vulnerable group nationally. And, over the last three years or so there have been at least eight reported cases of elderly women found murdered with all of them after being raped. Also it should be noted that while these figures are alarming, most rape cases go unreported because of the stigma and discrimination attached to it in Guyana where rape is still considered taboo, too shameful to be made publicly known and a significant percentage of rapes is incestuous. Besides, the 2007 GHRA Report found that more than two-thirds of sexual assault crimes occurred in the homes of the victims while three out of four perpetrators were known to victims and one in every five perpetrators were related to their victims. As well, fathers, stepfathers and father figures are responsible for over 67% of family-related sexual violence. Use of condoms was reported in only 3% of cases.

Against this background of increasing sexual violence and crimes, there has been an average conviction rate of 1.4% in rape cases compared to rape reports originally made to the police. Additionally, as of 2016, there were no convictions for sexual offences since 2011. Factors impacting this include lack of rape kits at hospitals, flimsy evidence, an inefficient jury system, shoddy prosecution of such cases, reluctance of victims to give witness and discontinuance of cases owning to unwillingness of victims to pursue.

Amidst all of this, emerge very disturbing trends. The rape/murder of the elderly is one such trend. Another is the rape, resulting in serious injuries, to small children less than 10 years old and as young as a few months old. A third trend is the rape of teenagers, many of whom end up pregnant, forever changing their lives and often times putting an end to dreams and aspirations.

With respect to teenagers, in most cases victims are coerced into consenting but the reality is that sex with anyone under 16 is statutory rape. As well, empirical and anecdotal evidence indicate that in many cases the victims are bought off, with police often fostering the ‘deal’ for commissions. Sometimes families are also bought off after being intimidated, especially if the rapist is politically connected or comes from a family with status and influence.

In effect, in Guyana, issues such as poverty and complicity involving law enforcement officers also impact both the under reporting of rape and the conviction of rapists. Furthermore, the Sexual Offences Act is still to be given teeth and too many police still do not enforce the provisions of that act; in fact sensitivity training with respect to provisions of the Sexual Offences Act, is still to be widely implemented. Given these realities, there is really very little protection against rapists for communities across Guyana.

 

Suicide Costs

The research does not seem to exist for Guyana, or if it does, is not easily accessible, but suicide does take a tremendous toll beyond the lives lost. Such costs are usually referred to as direct costs – costs associated with suicide and its aftermath. There are also the indirect costs – costs associated with productivity or earnings loss or projected earnings losses, and intangible human costs – pain, grief, suffering, lost quality of life, lost opportunities and values associated with what life would have offered.

Usually also there is a total financial cost computed by adding direct and indirect costs. For example in the US, these costs have been estimated to be $1,061,170 per suicide. For Guyana it could well be millions, per suicide, especially given the low worth of the Guyana dollar, which trades at over $200 per US$1 dollar.

The Guyana press quoted former Guyana Minister of Health Dr Leslie Ramsammy, who referred to the ‘shocking statistics on suicide’ in this way: “The loss of lives are tragic, but there are also staggering social and economic costs. In the US, studies have shown that suicide costs the US about $US40B. While Guyana has done no such studies, we had estimated that suicide costs the Health Ministry conservatively about $600M to $900M annually in 2002 when I was Minister of Health, in hospital costs and other medical costs and loss of family income and for other necessary procedures, like autopsies.” (Stabroek News, January 16, 2016).

A survivor of suicide is a family member or friend of a person who dies by suicide. Surviving the loss of loved one to suicide is a risk factor for suicide. (Brent, 2010; Brent et. al., 2006). Additionally, surviving family members and close friends are deeply impacted by each suicide, and experience a range of complex grief reactions including, guilt, anger, abandonment, denial, helplessness, and shock (Jordon, 2001; AAS, 2008). And while no exact figure exists, it is estimated that a median of between 6 and 32 survivors exist for each suicide, depending on the definition used (Berman, 2011). In Guyana it would be conservative to estimate that approximately 50% or more of the population knew someone who die of suicide in any given year and can be considered survivors.

Official figures indicate that over 1,000 victims have taken their own lives between 2011 and 2014. At this rate, the nation may lose 1,000 or more lives to suicide every three years, even factoring the reduction in rate from 2012 to 2015. And indicators do not provide any comfort in this respect. A 2014 poll conducted by INEWSGUYANA clearly explained the feelings of isolation, neglect and depression being experienced by youths between the ages of 15-24. How long before many give in to the feelings of total despair and hopelessness that will lead to suicide as an escape from their present living conditions given rising overall crime, rising youth unemployment and increasing youth alcoholism and drug use? Already, almost all of the suicides from this age group seem to be the result of lack of coping skills and low self-esteem.

This loss to suicide becomes more profound when its impacts on outward migration are considered. In 2011, Guyana’s emigration rate was tagged at 33.5% or one out of every three Guyanese, with an estimated two out of every three skilled Guyanese leaving. In 2013 the birth rate was 16.31 births per thousand while the death rate was 7.18 per thousand, which means that the overall increase to the population should have been 9 per thousand or an increase of 7,200 per year.

Effectively, despite the net birth rate that indicates an annual increase in the population, migration movement has ensured that the total population remains constant for the last three decades or more. Furthermore, this migration has also fueled the brain drain, which has catastrophic consequences for financial, intellectual, social and technical capital resources, all of which are imperative for national development. Now with suicide depleting the ranks of the younger population, replacing such precious resources necessary for development, would indeed be difficult to reconcile, more so manage. The effect on development and the economy could only be more debilitating.

 

Health Problems Associated With Suicide

A "2008 World Health Organization Report" on Guyana states that, “75,000 to 112,500 Guyanese suffer from mental disorders and require some level of mental health care services. Of these, approximately 22,500 to 37,500 would be expected to suffer from severe mental illness”.  And as counselors and suicide prevention activists know so well, the correlation between suicide and mental illnesses is direct and significant.

In fact, in Guyana, 4 in 10 persons with mental illness or neurological disorders attempt suicide. Mental illnesses affect nearly one in four people, with women, the unemployed and young adults accounting for over 60 %. Less than 10% are being treated. (Kaieteur News Editorial, Feb. 8, 2017).

Research also indicates that among suicide victims who have killed themselves, many have experienced depression, anxiety, psychosis, bipolar disorder or other forms of mental illness. In fact, up to one in 10 people affected by mental illness kill themselves but in Guyana this figure could be significantly higher given the extremely limited mental health care system. The nation’s main hospital, the Georgetown Public Hospital Corporation’s psychiatry ward, has six beds while conditions at the 200 plus bed, National Psychiatric Institution, has been described by health care activists as inhumane. Among the problems listed are supplies of poor and sub-standard quality; an inoperable canteen; an acute shortage of basic items in the kitchen; leaky roofs; no fans in the wards; shortage of beds; dysfunctional washrooms; and a deplorable laundry facility, including shortage of clothe-lines, a huge, unfenced gas tank next to the kitchen, lengthy delays in processing purchase orders, the constant flooding of the compounds.

Add to this, the prevailing myth that dealing with counseling and the psych ward or the psychiatric institution means someone is ‘mad’; a significant resistance to counseling among Guyanese; the fact that the counseling landscape does not elicit total trust and confidence; benign neglect of persons with mental illnesses, including drug and alcohol addicts; the common misunderstanding that victims of domestic and sexual abuse do not need counseling and a laissez faire attitude among some counselors in a situation of woeful shortage of psychologists, psychiatrists and clinical counselors and the picture of the mental health landscape become somewhat frightening.

As well, it has been pointed out in the local media that, “Mental illness is the major contributor to displacement of the children…It explains the growing band of young criminals who seem to have no regard for life or limb.” It was also reported that, “Mental health related illnesses account for more morbidity than HIV/AIDS, tuberculosis and malaria combined”.

As well, there is the correlation between a nation’s mental health and its economic growth. WHO indicates that the positive impact that health has on growth and poverty reduction occurs through a number of mechanisms, such as a reduction of production losses due to fewer worker illnesses, the increased productivity of adults as a result of better nutrition and lower absenteeism rates and improved learning among school children. This relationship also allows for the use of resources that had been totally or partially inaccessible due to illnesses. Finally, it allows for an alternative use of financial resources that might normally be destined for the treatment of ill health

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