…as Ministry prepares to craft new Strategic Plan
The adequate collection of information has long been recognised as a challenge in addressing issues related to health
care. Moreover, this shortcoming is one that especially stands out when dealing with conditions of a Mental Health nature – that is, conditions that affect behaviour, mood and thinking, and can range from depression and anxiety to schizophrenia and eating disorders, even addictions.
This state of affairs was emphasised by Chief Medical Officer (CMO), Dr Shamdeo Persaud, as he made a presentation during a recent Mental Health consultation spearheaded by the Ministry of Health in collaboration with the Pan American Health Organisation.
At the forum held at the Ocean View International Hotel, Liliendaal, East Coast Demerara, on Wednesday last, Dr Persaud disclosed that “I don’t think that in our previous surveillance system, for example, we were routinely collecting all the information that we need. “ According to him, the health sector had instead relied on intermittent studies and rapid assessments to provide required data in order to effectively plan.
But even as efforts are being made to put in place a new Mental Health Strategic Plan, the CMO is convinced that more efforts will have to depend on a more efficient form of data collection, as he pointed out that the former limitation “has been a major challenge for health generally, but more so for mental health.”
“We are all excited about the new strategy…but we can look at how we can build integrated surveillance systems with our health information systems so that we can collect the kind of data that we need,” Dr Persaud explained.
He pointed out that the information on suicide for instance is based purely on the mortality database maintained by the Ministry of Health. However, other vital database statistics are not similarly maintained, as according to Dr Persaud, “a lot of the times even the General Registrar Office refers to the Ministry of Health to provide information.”
Alluding to the local suicide statistics, Dr Persaud noted that there is a likelihood that there will be a difference in records kept by the Police Force, the Ministry of Health and what can be found at the office of the General Registrar. And there is a plausible reason for this, based on an explanation offered by the CMO.
He disclosed for instance that the recording of different periods of death could in fact have a bearing on this state of affairs. This is in light of the fact that some persons may ingest poison (or carry out an intended act of suicide) but do not die immediately, a process that could see them being admitted to hospital first then being sent home before succumbing.
“This is especially because of some of the (poisonous) chemicals that we have…and those (subsequent deaths) don’t get recorded by the police as a suicide death,” said Dr Persaud.
For this reason, he noted that the country’s deaths database may not always be reliable, a situation that is compounded by the fact that it is often one or two years behind, because of the complexities of coding and efforts to ascertain the accuracy of the information provided.
“A lot of times we receive death registration forms that just say pesticides poisoning and I am at a loss to decide whether this was an accidental exposure or if it was an actual suicide event,” Dr Persaud asserted.
As such he informed that the Ministry has employed officers who are tasked with “going back to the homes (of the deceased) and finding out whether the (respective) cases were intentional suicide or accidental. A lot of the time they actually did drink the poison voluntarily, but in few cases there are some questions as to whether the person took the poison or was given the poison, which are issues we usually have to resolve,” the CMO explained.
Reiterating the need for efficient data collection, he pointed out that when the Ministry had in 2005 introduced an earlier Mental Health Strategic Plan, efforts were made even then to revise the surveillance system with a view of incorporating mental health conditions.
Dr Persaud however lamented that such conditions are often not efficiently recorded at the primary health care level – that is, at the various community health facilities spread across the country.
“When persons come in and they complain of anxiety or depression or any other mental health condition, they are treated very causally for headaches, they are given some sleeping pills and then they are sent home, which might not be an adequate way of first of all addressing the problem, and secondly, it does not provide the kind of information that would give us enough data so that we can go ahead and plan effective programmes,” Dr Persaud stated.
Inefficiency from the community level, according to him, could by extension even limit Central Ministry’s efforts to procure medicines for this purpose.
It is the view of PAHO Resident Representative, Dr William Adu-Krow, that while all persons do not have severe psychiatric conditions, most are subjected to some level of mental health disorder.
Based on available statistics, at least 70 per cent of the Latin America and Caribbean population has had conditions that warrant psychiatric care. According to Dr Adu-Krow, conditions such as anxiety and depression also fall under the category of mental health disorders, all of which require health care.
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