Now available! Handbook for community mental health resilience

The ARCLIGHT project has published a practical handbook for creating community mental health resilience drawing together lessons learned through the project’s research. It has relevance to many communities facing adversity and it intended primarily for health and social care practitioners. Download the handbook here!

The handbook is the result of the research team’s work alongside three very diverse communities facing adversity in Guyana, South America, led by Dr Helena Ann Mitchell of the Open University. The issues the communities faced included climate change impact, domestic abuse and economic downturn. A common factor was that limited resources for dealing with the mental health issues were available. This makes the guiding handbook relevant to communities facing similar issues in developed as well as underdeveloped countries.

The handbook can be widely used by health and social care professionals for developing community resilience where adverse circumstances affect mental health. For instance, Covid-19, employment loss and domestic abuse are common factors world-wide. In the current climate the handbook should prove a valuable tool for anyone needing to address community mental health.  The handbook is released under a Creative Commons licence (CC BY-NC-ND 3.0), and we welcome ongoing discussions about its future use. If you  have any questions, please contact ann.mitchell@open.ac.uk

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Introducing ARCLIGHT

Over one billion people globally struggle with issues related to mental health, including depression, substance abuse and self-harm. Lack of research in implementation and policy change is further impeded by stigma, capacity shortages, and fragmented service delivery. In collaboration with Guyanese communities and stakeholders, and funded by the British Academy[1], Dr Ann Mitchell (Lecturer in Mental Health Nursing, The Open University, UK) will lead ARCLIGHT[2], an ambitious new research project which will develop, implement and evaluate a capacity building and intervention programme for addressing the challenges of mental health in Guyana. The project will also be supported by Dr Tania Hart (Associate Professor in Mental Health and Learning Disability, de Montfort University), Dr Andrea Berardi (Senior Lecturer in Environmental Information Systems, The Open University), Mark Gaved (Lecturer in Learning Futures, The Open University), Dr Deirdre Jafferally (Research Associate, Cobra Collective), and Gareth Davies (Research Impact Evidence Manager, Research and Enterprise, The Open University). Kerese Collins is our highly qualified project manager.

Guyana is consistently ranked within the top five countries in the world with the highest suicide rates[3]. Mental health services are barely functional, with Guyana’s public health minister describing the country’s national psychiatric hospital as “not fit for human consumption”.  Guyana is also one of the most vulnerable countries in the world with respect to climate change impacts. Increases in extreme weather events, such as heatwaves, floods, droughts and wildfires, and vector-borne disease epidemics such as malaria and dengue, will inevitably exacerbate mental disorders. These disruptive effects will also increase pressures on public services, infrastructure and the wider economy, straining social functioning within families, communities and organisations, thus further deteriorating Guyana’s capacity to mitigate and adapt to climate change and its multiple development challenges.

The research will identify, record and share successful local practices for building community mental health resilience that have evolved to cope with challenging cultural, organisational and environmental conditions, and devise mechanisms to promote these in low resource settings within Guyana and worldwide. What makes this initiative innovative is how it will promote the collection and sharing of positive community stories through freely accessible local communication networks. Building on The Open University’s global leadership role in distance learning, the key outcome will be to establish a BSc honours degree in Mental Health Nursing in Guyana, which has gained enthusiastic support from the Guyanese government, the higher education sector, and civic society. Organisations supporting the project include the University of Guyana, Association of Guyanese Nurses and Allied Professionals, the Cobra Collective, and De Montfort University. The 18-month project started on the 1st of February 2019 and will conclude on the 30th of July 2020.

[1] This research project is funded by the British Academy’s Knowledge Frontiers: International Interdisciplinary Research Projects Programme.

[2] ARCLIGHT stands for ‘Action Research Community Led Initiative Guyana Health Team’.

[3] World Health Organization (2018) World Health Statistics data visualizations dashboard: suicide. (updated 04/05/18). URL: http://apps.who.int/gho/data/node.sdg.3-4-viz-2?lang=en [accessed 24/08/18]

 

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Reflections of my experiences with women who have encountered domestic violence

by Ann Mitchell

Meeting with a group of women who had encountered physical and sexual abuse from early childhood was rather daunting. This was due to uncertainty as to how they would react to me as a researcher engaging them in collaborative research. That first meeting was important for outlining the rationale of the project together with a list of sessions that would be conducted over a two-week period. I emphasised the collaborative nature of the approach being adopted to ensure the women felt fully involved in the research process. As it promotes self- discovery, Participatory Action Research (PAR) has been adopted as the intervention methodology for the ARCLIGHT project. Researchers are encouraged to research alongside the participants as co researchers driving the research process rather than attempting to impose predetermined actions or activities. It meant as a team we needed to be sensitive to the needs of the women and to be flexible with the approach as they gave voice to the stories and other experiences that they wanted to share.

The focus of the project was to undertake and develop co-production of community mental health resilience resources with three case study communities: the Yupukari, an indigenous community in the interior; Enmore, a rural coastal community that is primarily Indian with other ethnic groups now residing there and a community refuge for abused women.

This reflective account aims to capture positive examples of resilience for the urban coastal community refuge. This group of women faced extreme levels of domestic abuse and lived in a refuge. Some members had recently left to embark on a new chapter in their lives and were now living in their own home environment, with their children, in communities away from the refuge. I appreciated that they were all willing to participate in the sessions and share their experiences with each other.

See two drawings from the women below that depict abuse.

 

I felt humbled, as well as uncomfortable, as I listened to the content of their stories. I realised that the women had faced intolerable situations which they felt they had had no control over. They felt powerless and ill equipped to change things in their lives. The refuge acted as a place of safety for them as they all expressed that it was a supportive and safe community environment for women who experienced violent and aggressive situations in their home lives. Whilst they recognised it was a transitory one, they knew that they could return if similar issues arose. They accepted the need to return to their own respective communities elsewhere. However, staying in the refuge enabled them to build relationships and friendships as they sought new ways of caring for themselves and their children. They spoke fondly about the refuge community; the support provided by the managers, the counsellors and being given a place to live when they had nowhere else to go.

On reflection they showed resilience which was not couched in those words but more about coping with hardships, struggles, problems, adversity. They showed their hidden strengths as they used craft items to illustrate their feelings, told stories openly about their experiences of abuse, their wishes and hopes during the sessions. I was totally amazed at the pictures drawn by all of them, but particularly two women who experienced problems with reading and writing.

An example of a drawing is shown below.

Surprisingly they wanted to share their stories with fellow women experiencing similar issues associated with violence as they expressed graphic details of the violence and abuse they had encountered. I thought they might not have agreed to upload their pictures, stories and other images onto the MAZI zone being used as a learning tool and to share information with others. We explained the purpose of the MAZI zone which is based on a digital device whereby users can communicate and share information with others without connecting to the internet. It is therefore useful where an internet connection is non-existent or inadequate as can occur in Guyana. They were all in agreement in using this platform as long as their personal information and identity remain anonymous. We agreed to them using the names of fruits eaten in Guyana as pseudonyms.

Together we produced resources that reflected the women taking control of their lives by making decisions to improve their situation in terms of seeking employment and accommodation. I was surprised to see how much the sessions meant to them and the value they placed on being involved in the groups. They all commented on that they felt they had been listened to, developed knowledge about the ‘r’ word that stood for resilience and skills they were totally unaware of. Learning had taken place which was slowly impacting on their change of behavior. They became more articulate as they voiced their opinions about domestic violence and started to make subtle changes to their current lives by planning to find jobs, accommodation and forging new relationships with family members.  The group decided to call themselves ‘Flavours of Hope’ and to have T shirts printed to advertise the effects of domestic violence.

I believe we provided a culturally supportive environment that empowered the women to consider the many challenges that they will face as they plan to provide a caring and nurturing home for them and their children. Listening to stories of abuse on many levels and the experiences of hardship and poverty is difficult especially when you consider that your own home environment and a way of life is a direct contrast.  Yet these women showed zest, determination and courage to change their lives. They wanted to champion the cause for more workshops about domestic violence across Guyana.

Examples of the resources produced by the women

Finally, an example of a Christmas card produced by one participant who made cards to raise funds to care for the family. She developed this skill as part of the research study .

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CALRG2020 talk: Taking participatory action research approaches in a time of pandemic

Mark Gaved

The covid-19 pandemic has impacted ARCLIGHT – researchers have not been able to work alongside communities in the final months of the project, and our workshop to gather stakeholder feedback, planned for Georgetown, has had to be moved online. We’ve moved rapidly to respond and have come up with a set of pragmatic responses, working online and via telephone.

Some research contexts enable substitution or support through alternative techniques that enable remote engagement, such as videoconferencing instead of face-to-face interviews. However taking a participatory action research approach implies building trust with participants and nurturing close collaborations and remote engagement can lead to a sense of emotional as well as physical distance, risking a failure of partnerships and less equitable processes and outcomes. Alternative methods must ensure that key methodological principles are upheld.  This is particularly problematic when engaging in low resource settings, where reliable or affordable access to network-based alternative techniques dependent on internet or mobile phone connectivity cannot be assured and where other environmental factors may come into play (e.g. political instability, movement restrictions).

As we’ve worked through a set of pragmatic responses, in ARCLIGHT we have also been mindful of seeking to keep to the spirit of a participatory research approach, ensuring all stakeholders’ voices are heard and ensuring equitable participation. Mark Gaved presented our approach at the recent Open University’s Computers and Learning Research Group annual conference (CALRG2020) – which itself was held online as a result of the pandemic.

You can view the slides online in Slideshare.

 

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Reflections of Enmore Community

Enmore used to be a village in the Demerara-Mahaica region of the Guyana coastal belt but is now described as a town. It is about two square miles (5.1 km2) in size and protected from the Atlantic Ocean by a large concrete wall. Enmore has a population of around 3,000 (Census 2012). Currently 90% are Indo-Guyanese but it is gradually becoming  more multi-ethnic with the introduction of Chinese and Indigenous groups.

Enmore was the third community studied as part of the ARCLIGHT project. I spent two days here visiting places of interest and collecting data by interviewing medical and nursing staff in the Polyclinic and the headmistress of the nursery school. As I reflect on my experiences of meeting and having conversations with different members of this community, I recognised a once thriving community was going through change that was impacting on their health and mental health. The sugar estate provided well paid employment for many of the community’s inhabitants and the estate compound provided social facilities that kept them engaged and interested. Closure of the estate impacted on all of them as family income was reduced with many experiencing personal distress and hardship as they sought new ways of obtaining an income.

The crime rate increased amongst the young because they felt there were limited social and recreational activities available to them. I was surprised to hear about crime as the police station occupies a central position in the town, yet there were reports that the police failed to respond to the many crimes.

As I walked around the town there were still pockets of affluent living and several shops lined the main street including supermarkets and internet café. There is also a selection of places to worship for example church, mandir and mosque as the various religious practices are well represented.

The polyclinic has been described as one of the best examples in Guyana. I was heartened by the positive healthcare staff who gave me their valuable time to discuss the health and social issues in the community. One of the nurses highlighted the plight that many families faced as they relied on the sugar estate for ‘their survival’.  Patients come to the clinic depressed but failing to recognise the symptoms. As a consequence, they turn to alcohol or suicide without getting treatment.  From the dialogue with health care staff, it was evident that more health care resources were sorely needed. A social worker has been employed to work with families but the team realised they needed more members of staff to meet the changing needs of the community.

Yet there were examples of positive changes in the community. Families were taking on various jobs regardless of type and income in order to provide for their children. Women were becoming more assertive and roles were changing as they too sought jobs to contribute to the family’s finance. Families were still considered to be ‘traditional’ where the wives were expected to stay at home to care for their children.

Education was considered key as families recognised that it was a route out of their poverty situation. The headmistress at the Gandhi’s nursery school described the modern techniques used with the children by offering IPADs and other tablets to disadvantaged children who could not get these at home. I found this to be a very positive environment that showed displays of the children’s work on the walls and enthusiastic teachers who use a blended approach with children who have mixed abilities.

As I reflect on my experiences with this community, they were resourceful, friendly, approachable and willing to share their stories with me. As a community they showed resilience as they strived to not only improve their current lives but those whom they cared for. They all identified the need for more resources in all aspects of the community but they work with what little they have to make a difference to their lives. I feel humbled when considering what we have available in the UK and Europe. These communities are coping with very difficult circumstances and showing great resilience when they have so little compared to us.  Many in this community believe the discovery of oil in Guyana will bring prosperity for all but that itself will bring new challenges.

Dr Helena Ann Mitchell

Researcher

 

 

 

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Responding to the global pandemic

As the ARCLIGHT work continues, we have found ourselves in globally extraordinary times with the emergence of the Covid-19 pandemic.  Our participatory action research approach has empowered and enabled change to take place within hard to reach communities, in some cases giving participants a voice for the first time to articulate their views and opinions.  However, social distancing has meant we are having to rely even heavier on the participants to express their voice through the remaining channels of communication.

Importantly we recognise that we are not alone, nor alas are the first to reflect and respond to such challenges. For example, Deborah Lupton has edited a collection “Doing fieldwork in a pandemic” drawing on colleagues’ experiences in facing Ebola and SARS amongst other situations, and we are considering this amongst other resources to plan our route forwards.

These challenging times have forced us to reflect on our own community mental health resilience as we grapple with the relative value of the different options available to us to complete the project. We seek equitable channels of communication, in line with our ambition to remain participatory and open in our approaches. As we evolve our response, we will report on how we are responding

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A five step framework for encouraging community engagement with networking tools

Central to ARCLIGHT is the idea of introducing low-cost, offline networking hubs (our Raspberry Pi computers running the MAZI software) to enable community members to collect, share, and read positive mental health stories. These enable stories to be gathered and viewed over time, via participants’ own personal devices (smartphones, tablets, or laptops).

Initially it was challenging to introduce the MAZI to participants so to build their confidence without overwhelming them, one of the researchers, Andrea Berardi produced a “ five step method”. This method consisted of five distinct steps: each requiring increasing levels of sophistication with regards to community use. The steps outlined below were used with the communities in the ARCLIGHT project.

Step 1 – Engage. The first step is to encourage curiosity and a willingness to engage with a MAZIzone, and to see this as a useful mechanism for connecting with the ARCLIGHT aims and processes. Activities could involve supporting community members to read local stories through the MAZI website (using WordPress), and to read and even contribute to brief social exchanges on the message board (‘Guestbook’). This is a key part of the necessary ‘free, prior, and informed consent’ process allowing participants to familiarise themselves with the project and its key communication platform.

Step 2 – Inform. This step involves participants accessing the MAZIzone for more in-depth knowledge acquisition. Community members are encouraged to explore existing multimedia assets stored on the MAZI on wellbeing, resilience, community owned solutions and positive deviance, alongside more practical tips on storytelling using different forms (text, drawings, photos, video). These will comprise short introductory materials uploaded on the file sharing tool (Nextloud, an open source tool similar to Dropbox) providing examples and explanations so that participants build their understanding of the concepts and the techniques underpinning the project, and gain confidence in accessing a MAZIzone to view existing content.

Step 3 – Debate. This crucial step supports participants in their reflections of the initial project aims, concepts and techniques, and raise queries, concerns, ideas, and ultimately, enables then to decide how to proceed.  WordPress can be used for community leaders to create discussions that participants can then respond to. A more open-ended conversation might either be recorded (annotating a face to face discussion for later reviewing or amending), or carried out through the simple collaborative writing tool deployed on MAZIzones, Etherpad.

Step 4 – Create. Here, participants are encouraged to produce and upload their own assets on the MAZIzone. This is anticipated to be primarily achieved by participants contributing their own community stories of resilience, but also with a license to co-develop, with project researchers, new assets to describe the project aims within the community, and expand on, modify, and contribute new concepts and techniques. MAZIzone tools that could be used include: WordPress, Etherpad, and NextCloud.

Step 5 – Manage. Participants are encouraged to produce a timeline of who is doing what, when and how, and the emerging result of the intervention. Ultimately, if the MAZIzone deployment is to serve as the ‘digital collective memory’ for building community mental health resilience, this social memory needs to be in the form of an engaging and captivating story. A WordPress blog could be the best tool to integrate and ‘manage’ the disparate assets on a MAZIzone.

All of this also implies a parallel activity, “Maintain”: the development of local community expertise in running and maintaining the MAZIzone itself. This has both technical and social aspects: ensuring the hardware and software are running well, and also facilitating and moderating participants’ use of the digital tools. For a number of the participants, they will not only require technical guidance and confidence building but also social and cultural guidance in how to contribute to shared discussions. As with any collective communication space, there is always the possibility that well-meaning contributions might accidentally offend instead of enhancing conversation.

 

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Evidence Cafe: insights from experts

UPDATE: with the current Covid-19 virus crisis, this workshop has been postponed until further notice. We are considering whether we can run an online version in the future

With the project well underway, the ARCLIGHT team is seeking to widen our understanding of the challenges both faced by the particular communities in which we are working alongside local people, and also across Guyana nationally. To gather insights from experts, the UK based team members will be hosting an Evidence Café in London in March.

An Evidence Café is a hands-on workshop where experts from different backgrounds and practices come together with academics to consider a challenge, and share their perspectives. In our case, we are asking: “How do we build community mental health resilience in Guyana?”. We will be inviting experts from a range of fields, including drawing from the strong network of the Association of Guyanese Nurses and Associated Professionals. During the day, we will consider where the knowledge lies that can answer this question, and how we can move forwards in solving this important societal challenge. As an outcome, participants insights will be drawn together into a report that we will make available to inform practitioners, researchers and policy makers.

Get in touch with our Principal Investigator, Dr. Ann Mitchell, if you’d like to find out more.

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Presentation at The Open University

Mark Gaved presented the progress of the ARCLIGHT project at this year’s 40th anniversary CALRG conference at The Open University (‘Computers And Learning Research Group), 17th June 2019. Mark described the background context – challenges in supporting mental health in Guyana, and drawing from the ARCLIGHT team’s expertise, and the participatory approach to research we are taking.  He discussed how we were exploring the use of digital technologies to help capture stories, building on prior Open University work both in Guyana and in the EU funded MAZI project. There was strong interest in the project’s use of a combination of smartphones as familiar tools for the participants, and ‘offline networking’ Raspberry Pi’s running MAZI software to enable us to collectively gather and reflect on stories in community settings.

Audience members were interested to hear about the diverse range of participant experiences and challenges across Guyana, and how smartphones and networked technologies might be used to support learning  in places where internet connectivity couldn’t be assured. There was lively discussion around how to best support learning with technologies where there were heightened sensitivities to be taken into account: both personal subject matter, and ethical considerations to ensure participants weren’t put at risk. Evaluation was also discussed, and Mark explained how we were using the 6P’s framework developed by The Open University to ensure the impact of co-creation with participants also informs the impact of the developed learning resources.

A live ARCLIGHT MAZIzone was running in the room, and several members of the audience logged in and explored the tools the project is deploying.

Presentation: ARCLIGHT: offline networked tools for collecting positive mental health stories in Guyana

Authors:  Andrea Berardi, Kerese Collins, Gareth Davies, Mark Gaved, Tania Hart, Ann Mitchell

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Reflections on Mental Health in Guyana

Reflections from Kerese Collins, ARCLIGHT Project Manager

I first became aware of issues around mental health in Guyana around 2012. I had just returned home to Guyana after completing studies in Trinidad, and for reasons that now evade me I began to pay keen attention to the incidences of suicidal attempts among our people. As far as I was concerned, I had felt that 1 suicide was one too many. Eventually, I began to compile a list of the headlines in an effort to identify any trends I had noticed.

A few days later, my list-making project was interrupted when the WHO released their statistics, declaring that Guyana was the country with the highest suicide rate per capita. Suddenly, there were conversations, conferences and social media posts. Mental health came into view.

I was not surprised, but I do remember thinking, “Did we really need an international body to make this declaration before realizing what was happening in our own backyard?”

One of the challenges we face in Guyana is that of a heavy dependence on “outside” influences. We assume that anything from outside must be true, trustworthy and superior, whether or not its value has been tested. The result – we often feel there is not much we can offer.

But I have always believed that there is deep wisdom to be uncovered in the hearts of the Guyanese people. We have lived through diverse challenges, tragedies and disadvantages, spread over decades and for some reason, we just keep going. We just need to figure out how to tap in to that wisdom and learn from our past so that we could pioneer a better future.

This is why I appreciate Participatory Action Research (PAR). PAR embraces collaboration, rather than imposition of values and theories. It seeks to engage with those experts who live at the community level to learn from them. A result is the emergence of an empowered people, whose internal skills and history are among their most valuable assets. This is what I am most excited about.

What if we are more resilient than we ever dreamed possible? What if we could solve our own problems by being open about our common struggles? What if we focused on our stories of victory and success? What if there was more to our common experiences than pain and shame and doom?

The possibilities are endless.

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Reflections on a Guyana visit

Dr Tania Hart, from De Montfort University reflects on her visit to Guyana in May 2019

The World Health Organisation have identified 10 key threats to world health in 2019, one of which is weak primary health care systems (WHO, 2019).  WHO clearly sums up the benefits of good primary health care by stating it is the most efficient method of improving health outcomes, advancing universal health and achieving the United Nations sustainable development goal 3: of ensuring healthy lives and promoting well-being and better health for all ages. A good primary health care system, as seen in many high income countries, does not only prevent disease by managing vaccination programs, supporting the chronically ill and promoting better  palliative care, but most importantly, it  can also successfully empower people and communities by placing a greater emphasis on promoting and preventing better health and detecting early health care problems. This focus on empowering individuals to promote their own well-being and resilience is ARCLIGHT’s key emphasis.

In 2008, Guyana’s laid out its mental health sector strategy in a World Health Organisation commissioned document. This document stated that Guyana’s number one priority at the time should be, promoting better mental health and the need for movement of mental health care into the primary health care system. It also stated improvements in mental health can only come about through prevention (WHO Aims Report, 2008 Pp7). I would agree that this is where the focus should be. Having visited Guyana, however, I have seen firsthand, the complexity, of introducing a primary care system that places some of its focus on mental health. This is because despite Guyana’s small population of approx. 773,000, its primary mental health services are literally non-existent.  Non-Government organizations (NGO’s) are presently filling the gap as much as they can when it comes to mental health care. Plus stretched hospital services and a handful of qualified mental health practitioners, including psychiatrists, psychologists, psychotherapists, counsellors and general nurses, are trying their best to promote the mental health of the population, however services remain fragmented and not all inclusive.

This blog therefore outlines some of my key reflections, after visiting and talking to people who play a central role in operationalising and strengthening the primary care provision in Guyana’s capital of George Town and beyond.  These people, being university lecturers developing  training programmes in nursing and psychology and nursing officers overseeing nursing services throughout the 10 regions in Guyana. (The photo is taken outside the Nursing School in George Town, and standing between ARCLIGHTS project team members, at the very centre of our picture, is the Deputy Nursing Matron who spoke to us).

I feel the University of Guyana will undoubtedly be one of the most important players in strengthening Guyana’s primary health care provision. This is because at present there are only a small number of professionally qualified mental health workers. Presently their School of Health train general nurses and medics, but it does not run a pre-registration mental health nursing programmes, nor does it run post registration programmes which focus on mental health and wellbeing.  There are however plans, with the Building of  UG’s impressive School of Behaviour Sciences, to begin promoting more proactively a new psychology programme, which aims to ensure Guyana has a larger pool of psychology and counselling graduates who can be utilised to help develop Guyana’s mental health service provision from primary, secondary and tertiary care delivery. Thus psychology graduates will have an important role in promoting better mental health in Guyana, breaking down the taboos and stigma associated with mental health and detecting and treating mental illness.

My concern, however, as a nurse, is it is nurses and midwives that make a substantial contribution to health-delivery systems in primary care, acute care and community care settings and that new workforce development is good, however, it is nurses who are best placed to lead strategic and operational health development. Once suitably qualified in mental health they will have the expertise to offer holistic care and because they are at the front line of health care delivery are arguably best placed to help promote, protect and manage health care problems across populations. I come to this conclusion from speaking to Guyana’s nurse academics and nurse matrons who at the forefront of health care management and learnt the following from them:

  1. Post graduate modules related to mental health and primary care are much needed in Guyana. Presently there are no nurses qualified in mental health nursing. Neither are their school nurse training programmes or health visiting programmes that focus on the promotion of wellbeing, child and family mental health.
  2. The Guyanese trained nurses are well appraised because they are taught to a high level clinically. This is because they cannot rely on other allied professionals to do things, like take blood, pass nasal gastric tubes etc. so they are trained to an advanced clinical level. Mental health, however, is an aspect presently overlooked in their repertoire of skills and it is the mental health skills and health promotion skills that have the potential to advance their practice yet further. Possibly making them some of the best qualified nurses in the world.
  3. Concerning, however, is a present shortage of nursing staff in Guyana. Low pay often means nurses are going abroad to work in better paid jobs. Plus private hospitals in Guyana often pay higher wages than public institutions. This brain drain therefore means there are very few well qualified and experienced nurses available to lead strategic workforce changes or operationalise new ways of working and policy around mental health.

The Deputy Nursing Office travels to many of the remote areas of Guyana, ensuring the quality of nursing is assured. The key challenge she faces is finding staff to work in the remoter areas of the country. This she said was mainly due to young newly qualified nurses not wanting to relocate to places where life is quieter. I could not help reflect on the fact it is perhaps the vast, sometimes impassable, geographical terrain that will be Guyana’s real challenge, when it comes to strengthening their primary health care mental health care provision. This is why, Dr Andrea Berardi’s work exploring the resiliency of people living in the very remote areas of region 9 of the Rupununi will be invaluable. Arguably Digital technology (an aspect of our own ARCLIGHT project), will have to play a key part in the promotion of mental health, (as it is beginning to do so in the UK for different reasons associated with the growing aging population and health care capacity). It is technology, which has the potential to enable geographical divides to be crossed and nurse consultation to happen more easily. For example ensuring the availability of digitally available self-help materials as well as ensuring the accessibility of telehealth consultations, all of which will be invaluable. Teleconferencing however is still the technology of tomorrow in extremely remote areas of the world like in some parts of Guyana.

WHO do, however, place an emphasis on the urgency of digital technology development in order to tackle today’s health care challenges, stating:

 “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies, for the exchange of valid information for diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, in all the interests of advancing the health of individuals and their communities”.

(World Health Organization, 2010)

The ARCLIGHT project is using innovative digital technology in the form of a Raspberry Pi computer. This very small computer creates its own Wi-Fi zone, termed a MAZIzone. This means people in remote areas, who do not have access to conventional Wi-Fi, can up load materials, from any SMART device, to the Raspberry Pi and also download any materials stored on the device. For instance we will upload self- help materials and our research participants will upload materials they wish to share. Notably the Open University are presently using this type of technology to distribute training guides in the form of PDF’s via a MAZIzone document sharing NextCloud tool (the equivalent of a Dropbox).

In summary I am of the firm opinion it is the nursing workforce who can be utilized to help develop Guyana’s mental health primary care system, both strategically and operationally, as they already have developed a nursing infrastructure which ensures even those in the most remote communities have some way of accessing nursing support for physical problems. Therefore the next step is to ensure they have access to training so they can offer accessible mental health provision and this training should not only place an emphasis on managing mental illness but also equip nurses to promote resiliency, wellbeing and positive mental health or ‘brain health’ more widely via for example school wellbeing programmes or community well-being projects..

It is ARCLIGHT’s goal, through action research methods and participatory approaches, that are encouraging co-produced knowledge, to explore more about how Guyanese people cope with adversity, how they bounce back from hardship, what they draw upon when faced with difficulties and how they understand mental health, both positive mental health and negative mental health and what they need in their communities to promote better brain health. By exploring this in more detail we hope to utilise such information in the development of a mental health educational programme which places an emphasis on primary care provision that better promotes, prevents, detects and treats Guyanese people.

References:

WHO AIMS Report on Mental Health in Guyana (2008) Available at: https://www.who.int/mental_health/guyana_who_aims_report.pdf

WHO information related to primary health care available at:

https://www.who.int/primary-health/en/

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