ELEVENTH PARLIAMENT OF GUYANA – FIRST SESSION (2015-2016) NATIONAL ASSEMBLY NOTICE PAPER NO. 46
Member Giving Notice: Dr. Vindhya Persaud, M.S., M.P.
MOTION: CURBING THE RISE OF SUICIDE RATES IN 2016
WHEREAS the incidence of suicide has been consistently increasing in Guyana in 2016 with the younger members of the population taking or attempting to take their lives;
AND WHEREAS for the last decade a person takes his life every 1.8 to 2.4 days in Guyana; in the United States of America there is a suicide every 13 minutes and, sadly, there is a suicide every 30 seconds somewhere in the world. Suicide accounted for 1.4 per cent of all deaths worldwide in 2012, making it the 15th leading cause of death. Among the age group of 15 to 30, anywhere in the world, suicide is among the top 3 causes of deaths;
AND WHEREAS in Guyana’s case suicide has ranked in the top 10 causes of death for the last several decades. In the age group 15 to 24, suicide ranks between 1 and 3 in terms of the top causes of deaths. In the 1980s, suicide deaths were about 200 to 250 per year. In the last decade it has been between 150 and 200 cases per year;
AND WHEREAS it is estimated that there are between 1500 to 2000 attempted suicide cases each year, or about one attempt every 5 hours in Guyana. Around the world, it is estimated that there is one suicide attempt almost every second;
AND WHEREAS while Guyana has done no such studies, it is estimated that suicide costs the Health Ministry conservatively about $600M to $900M annually excluding the loss of life, family income and emotional and psychological anguish for the surviving family members;
AND WHEREAS the majority of suicides occur among people suffering mental health conditions and illness such as depression, bipolar disorders and schizophrenia, social issues such as alcohol abuse , poverty and unemployment also contribute to the growing number of suicide cases;
AND WHEREAS the current economic situation in the agricultural communities due to falling rice prices, loss of income and consequential foreclosures on loans in the banking sector coupled with the state of the sugar industry where jobs are under threat, and, the unemployment of thousands of people in the last 9 months in the public service and general society, are leading to a state of despair and hopelessness which are factors contributing to this rise;
AND WHEREAS whilst there are cultural, religious, class and other prejudices that inhibit people from seeking help for mental health problems, the mental health services are inadequate to meet the demand with only 3 full time psychiatrists (based in Georgetown and New Amsterdam), insufficient hospital beds and trained personnel in the National Psychiatric Hospital, and no day treatment or community residential facilities, and, inadequate numbers of counsellors, to help and treat patients;
AND WHEREAS there are insufficient counsellors in the educational system, both private and public, to provide support to students of all ages;
AND WHEREAS the availability and easy accessibility of poisons especially in rural agricultural communities contributes to making this the easiest method of committing suicide in Guyana;
AND WHEREAS suicide is still a crime in the statutes thereby posing serious challenges for social, health, law enforcement and prosecutorial services;
AND WHEREAS there is at present no infrastructure in place for follow-up for persons who have attempted suicides even though there is high risk of a reattempt unless treated;
BE IT RESOLVED: That this National Assembly calls on the Government to implement the comprehensive 2014 Mental Health Strategic Plan and the National Suicide Prevention Plan 2015 – 2020 which were crafted under the PPP government;
BE IT RESOLVED: That this National Assembly calls on the Government to take urgent action to reduce the impact on the rice farming communities by negotiating with the commercial banks to reschedule their debts;
BE IT RESLOVED: That this National Assembly calls on the Government to reverse its decision to close Wales and LBI Sugar Estates and to work towards alternative options to save the industry;
BE IT RESOLVED: That this National Assembly calls on the Government to ensure that funds are allocated to provide the financial, human, technical and physical infrastructure needed to treat mental health and level of suicides as a national health priority;
BE IT RESOLVED: That this Nationally Assembly calls on the Ministry of Public Health to resuscitate the National Suicide Prevention and Control Committee with regional committees, comprising both professionals from health, education, academics, law enforcement and broad- based representation from civil society including the religious community to update the National Strategy to Prevent and Control Suicide within 3months of its appointment, monitor and evaluate the data on suicide, lead a national education and awareness campaign to help individuals and their families to seek help, and make recommendations to government;
BE IT FURTHER RESOLVED: That this National Assembly agrees that a nondenominational National education and intervention campaign be crafted with the technical support of PAHO/WHO with emphasis on the value of life, self-esteem and practical approaches to problem solving and coping mechanisms, anger management, and depression to be introduced into the schools, work places and communities;
BE IT RESOLVED:
That this National Assembly calls on the Ministry of Public Health to train health care providers – GMOs, nurses, medex, Community Health Workers as first responders at the primary health care level, emergency rooms, etc., to use the Depression Suspicion Index in recognising and diagnosing depression and to refer the individuals to GMOs and psychiatrist for further evaluation;
BE IT FURTHER RESLOVED: That this National Assembly calls on the Government to urgently establish a special scholarship programme to fast track training of 100 health care providers and counsellors in mental health over the next 5 years to improve the availability of properly trained personnel to address suicides and other mental health issues;
BE IT FURTHER RESOLVED: That the Ministry of Public Health re-establishes a 24 hour Mental Health Hotline with health care providers manning it and referring individuals to appropriate facilities;
BE IT FURTHER RESOLVED: That this National Assembly calls on the Ministry of Public Health to resuscitate community support through partnership with Faith-based and Community Based Organisations, experienced Non-governmental organisations in the Gatekeepers, Alcohol and Substance Abuse Programmes and Pesticide Safety Programmes;
BE IT FURTHER RESOLVED: That this National Assembly reviews and amend legislation to decriminalise suicide;
BE IT FURTHER RESOLVED: That the Government will submit a Report to the National Assembly by August 2016 with regard to the actions taken.
(Notice Paper No. 46 (M40 Opp. 7) published on 2016-04-29)
Date Received: 2016-04-21
Date for Order Paper: 2016-05-10
Suicide Motion Presentation by Dr. Frank Anthony
I rise to make my contributions to this motion on suicide. As we have heard suicide is a global problem accounting for approximately 800,000 deaths per year according to the WHO. We were all alarmed when the WHO report “Preventing Suicide, a Global Perspective” came out in 2014.
• In that report using age standardized rates per 100,000 Guyana was ranked the top suicide country in the world with 44.2 per 100,000. The global average is 11.4.
• Globally, 15 men per 100,000 commit suicide, in Guyana it is 70.8 per 100,000.
• Women globally 8.0 per 100,000 while in Guyana it is 22.1 per 100,000.
World Health Organization guidelines recommends that each country reduce suicide by 10% by 2020. The National Suicide Prevention Action plan also recommends this 10% reduction by 2020, but given the specifics our situation, we may need a more ambitious target for us to relinquish this inglorious title as the world’s top suicide country.
The causative factors for suicide in Guyana are many and include:
• Gender – males are four times as likely to take their own life as females;
• Age – people aged 10 -24 it is the 2nd leading cause of death
o For the 15 to 44 age group it is among the top three causes of death.
• Mental illness (depression)
• Substance abuse (alcohol and drug misuse).
• Physically disabling or painful illnesses including chronic pain; and
Stressful life events can also play a part. These include:
• The loss of a job/ loss of income/ loss of a means of livelihood.
• Living alone, becoming socially excluded or isolated;
• Family breakdown and conflict including divorce and family mental health problems.
Cultural factors such as religion can play a significant role in suicide. In several local studies there is a correlation between suicide and religion.
Using these causative factors, a number of high-risk groups were identified:
• Young and middle-aged men in particular Hindu males.
• People who have been or still are physically or sexually abused.
• People with untreated depression
• People with a history of self-harm
• People who misuse drugs and alcohol
• People who are vulnerable due to socio/ economic circumstances, unemployed or who has job insecurities.
• Farmers who have high rates of depression, job stress due to economic pressures, social isolation and access to pesticides.
If the government is smart it would prioritize its interventions to focus on these high risk groups. It should also pay attention to the geographical location of the problem. The government’s plan has rightfully identified Region 2 as having the highest suicide rates (52.7 per 100,000), followed closely by Region 6 (50.1 per 100,000) and Region 3 (37.3 per 100,000). Yet, the governments suicide interventions have been a one size fit all, instead of a custom made solution base on the regions peculiarities and specificities. This must change, to obtain meaningful impact.
Some efforts have been made to establish a mental health unit, with responsibility for suicide. The unit is housed in the dilapidated building in Quamina Street. The conditions under which this unit is working is posing a challenge to their mental well being, very little furniture, no computers, inexperience personnel with no formal budget to implement the propose suicide prevention action plan. If this is happening centrally, imagine what it is like on the periphery. The primary health care system seems overwhelmed, and for all the talk, very little mental health services let alone suicide prevention services, are offered by these facilities.
Another bothersome trend is the medicalization of suicide. Suicide is not just a health problem. It is a societal problem. It therefore requires a multi-sectoral approach; a good starting point would be the establishment of a National Suicide Prevention Commission with its attendant Regional Committees to oversee the implementation of the regional suicide prevention plan.
With such a multi-sectorial approach there is need to partner with faith base organizations such as Guyana Hindu Dharmic Sabha and Non Governmental Organizations such as the Caribbean Voice. The government should provide resources to these organizations, for them to expand their current programs.
There is need for ministerial committees on suicide prevention that ensures that the ministries are implementing the strategies that have been recommended by the National Suicide Prevention plan.
For example, 63.7% of cases of suicide were caused by the ingestion of a pesticide or herbicide.
Sri Lanka had a similar problem, they develop and implement a Hazard Reduction Model. Some key elements of this model are:
1. Using pesticides that are least toxic to human health.
2. Placing restrictions on importation of dangerous chemicals into the country.
3. Restricting the availability of agro-chemicals by ensuring they are stored safely in locked boxes in rural households.
4. Disposing empty containers properly.
5. Restricting the sale of agro-chemicals only to licensed premises.
6. Monitoring licensed premises to ensure that agro- chemical are stored properly.
7. Educating farmers and others on the safe handling, use, storage and disposal of agro- chemicals.
8. Improving medical management of pesticide poisoning.
These simple interventions help Sri Lanka to reduce the cases of suicide by 19, 800 from 1996 -2005 using a 1986 to 1995 baseline. A reduction of more than 50%. This Hazard Reduction approach can be easily adopted in Guyana, because many of these measures are already in the Pesticide Act, what is needed is proper monitoring and enforcement by the Ministry of Agriculture and the Poison and Pesticide Board.
Many patients are lost, when there is uncertainty about the poison ingested, the availability of antidotes etc. One way of improving medical management of poisoning is to ensure that doctors have information of the various pesticides, herbicide and other dangerous chemicals. The way to do so is the establishment of a National Poison Control Center with a database of information on all toxic chemicals and poisonous substances used in Guyana, and the recommended protocols for medical management of these cases. The Center must at all time housed the appropriate antidotes or be able to source them in a timely manner to assist persons in need. A Center like this operating on 24/7 basis, will help to save many lives. This is not in the current plan, but this is an intervention that can make a real difference.
The government needs to establish a small unit, that will maintain a database on suicide victims. After each known case of suicide, they should conduct a psychological autopsy with next of kin, relatives and friends to discerned what were the factors that drove this person to take such a fetal step. By understanding these factors, it would help the team to formulate better preventative programs.
For every case of suicide, they many more people who attempt it. The National Suicide Prevention Plan, has estimated that in Guyana for every case of suicide there are 20 to 25 attempted suicide. Actual suicide in Guyana vary from year to year but it is estimated that there are about 180 to 200 cases per year. That would mean that they are 3,600 to 5000 cases of attempted suicide every year.
This I contend is quite high. The truth is I don’t think the Ministry of Public Health has real numbers and this is just a guesstimate. To prevent this from happening in the future, the Ministry of Public Health or some other relevant part of the government need to establish an attempted suicide registry.
As we should be aware, attempted suicide is the strongest predictor of suicide. Therefore, by documenting the cases, and offering support and treatment to these persons, we would be working with the most vulnerable group and this would have a significant impact.
I wonder however, if such a straight forward measure will be difficult to implement because our current law criminalizes attempted suicide.
In the Criminal Law Offences Act section 96, it states that “everyone who attempts to commit suicide is guilty of a misdemeanor and liable to imprisonment for two years.”
The criminal prosecution and the imposition of custodial sentences on those who attempted suicide is an affront to human dignity. In many cases, the suicidal attempt is typically a symptom of psychiatric illness or is an act of psychological distress, indicating that the person needs assistance, not punishment by imprisonment.
In countries that have retain and implement these penal sanctions, studies have shown jailing people will only serve to exacerbate suicidal persons’ risk for depression, anxiety, and repetitive suicidal attempts. Decriminalization is more enlighten and humane way of dealing with the problem.
I therefore call on my colleagues for us to urgently repeal Section 96.
Additionally, by repealing this law and establishing an attempted suicide registry, it will improve the collection of epidemiological data on suicidality.
The World Health Organization estimates that every minute there is a suicide, and every three seconds there is an attempted suicide globally. We can help reduce these horrific numbers if we reduce the amount of suicide and attempted suicide in Guyana.
The government needs to get serious, target the more vulnerable groups, target the most vulnerable regions, create a broad base suicide prevention coalition, create safety nets for those in financial desperation, provide adequate funding for suicide prevention programs, implement the Hazard Reduction Model, establish a National Poison Control Center, repeal Section 96 of the criminal offenses Act, and work with Faith Base, NGO’s and Community Base organizations to reach the most vulnerable and provide support for the bereave families. These and other measures will certainly have an impact on the reduction of suicide in Guyana.
The government need to move, from lip service to real service.
Only then we will get progress.
I therefore support this motion.
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