Category: Health

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Prisoner Health, Human Rights and Social Recovery

By Martin Halliwell

On 21 October 2011, at a summit in Rio de Janeiro, the World Health Organization (WHO) released the Rio Political Declaration on Social Determinants of Health, its strongest statement yet of the need to tackle health inequities within and between countries. Focusing on the WHO’s commitment to health as a fundamental right rather than a privilege, the Rio Declaration recognised that to eliminate inequities would require the sustained ‘engagement of all sectors of government, of all segments of society, and of all members of the international community’. By viewing social determinants in both economic and psychosocial terms, the declaration made three policy recommendations: ‘to improve daily living conditions; to tackle the inequitable distribution of power, money and resources; and to measure and understand the problem and assess the impact of action’. The World Health Assembly’s adoption of this policy framework in 2012 was an effort to embed what the Rio Declaration called ‘an intersectoral approach’ to analysing how social groups are classified with respect to quality of life, comorbidities and access to health care.

A decade on from the Rio Summit, the governance role of the WHO is more critical than ever to ensure that economic pressures, polarizing ideologies and faltering international accords, which we have witnessed globally in the 2010s and early 2020s, do not compromise the ideal of health as a fundamental right. Despite this stated imperative, the WHO has been slow to attend to the psychosocial needs of prisoners, especially those incarcerated in the Global South. This sluggishness is despite a growing body of research across the humanities, social sciences and life sciences that shows how incarceration is itself a ‘chronic health condition’, with ‘social, biological, and psychological elements’ which are both ‘poorly documented and poorly addressed’. [1] As an April 2022 School of Oriental and African Studies (SOAS) workshop on the colonialities of incarceration makes clear, this trend not only privileges Euro- and US-centric analyses but it can lead to an exceptionalising (and sometimes racializing) of human rights abuses in the Global South.

The WHO’s Health in Prisons Programme
While heeding the warnings of the SOAS workshop, it is important not to overlook the ways in which WHO has addressed prisoner health, albeit with a largely European focus. We can pinpoint 1995 as a breakthrough year for WHO, with the formation of its Health in Prisons Programme (HPP) across eight European countries, with the aim of sharing good practice and raising national standards, as embodied by the Declaration on Prison Health as Part of Public Health. This 2003 WHO declaration states that economic pressures and social challenges faced by a nation state cannot excuse a government’s failure to uphold their duty of prisoner care, including ‘effective methods of prevention, screening, and treatment’.

This ideal is shared by NGOs, such as Penal Reform International (PRI), established in 1990 to raise global standards in prisons and share best practice, with a particular focus on prisoner support in Africa, the Caribbean and South Asia. In its worldwide emphasis, PRI highlights human rights violations, noting that reducing overcrowding and meeting (or exceeding) the UN Standard Minimum Rules for the Treatment of Prisoners (also known as the Nelson Mandela Rules) are ‘vitally important components of a prisoner’s journey’. [2] Nonetheless, as Katherine McLeod and colleagues have recently argued, there remains ‘a critical lack of evidence on current governance models and an urgent need for evaluation and research, particularly in low- and middle-income countries’. [3]

A case in point is the European focus of HPP. Despite its growth from an initial eight to forty-four national members, the 2014 HPP publication Prisons and Health acknowledges that incarceration falls disproportionately on poor and vulnerable communities, at a time when researchers across a span of disciplines were calling for attention to the health needs of women and older prisoners on a global scale. [4] Despite its Eurocentrism, Prisons and Health develops the insights of Good Governance for Prisoner Health in the 21st Century (2013), with the aim of facilitating ‘better prison health practices’ with respect to human rights and medical ethics; communicable and noncommunicable diseases; oral health; risk factors; vulnerable groups; and prison health management’. [5] Calling for prisoners to receive an equivalent standard of health care to other citizens, Prisons and Health defines the ‘prisoner as patient’ with the same rights as all other patients. We might take issue with the power dynamics of the ‘prisoner as patient’ concept, especially the implication that patients are powerless (or have only limited agency) in the face of diagnostics and interventions. Yet the report focuses as much on governmental responsibility as on ensuring that prisoners have basic health rights and benefit from prison health services that are integrated ‘into regional and national systems’, within and beyond their experience of incarceration. [6]

Clinical Recovery and Social Recovery
Estimating that 40 per cent of prisoners encounter mental health problems during their jail time (some reports suggest this percentage is much higher), not only does Prisons and Health highlight the multiple determinants and co-causalities of mental ill health, but it points to the psychosocial needs of prisoners, noting that ‘clinical recovery’ and ‘social recovery’ are two distinct processes with differing timelines. [7] One of the missing factors in assessing these recovery arcs, as medical anthropologists Johanna Crane and Kelsey Pascoe argue, is that often appraisals of prisoner health fail to engage with what prisoners themselves identify as their needs. Crane’s and Pascoe’s research in Washington State is closely informed by interviews with prisoners who often describe a ‘slow erosion of their well-being over the course of their imprisonment’ due to ‘a frustrating mix of regimentation and unpredictability that derailed their ability to transition to life beyond prison’. [8] This mix is particularly acute for prisoners who experience solitary confinement or who feel locked-in by an aggressive course of medication administered to manage erratic or psychotic behaviour.

Yet ‘erosion of well-being’ can also result from overcrowding, unsanitary conditions, prisoner-to-prisoner violence, mistreatment by prison staff, or health needs that might be either undiagnosed or overtreated. Not only are these realities in tension with the goal of ‘social recovery’, but they evoke what sociologist Erving Goffman calls a conspiratorial form of ‘secret management’ practised by social institutions beyond the prison, where wounds continue to be inflicted on ex-prisoners via tacitly aligned systems that collude with overt forms of carceral management. [9] The WHO’s reminder of health as a human right is pivotal to ensure this kind of collusion does not occur. However, this may not be enough to offset rights violations that can lead to long-term erosion of selfhood, which, in turn, may lead to further offences or to debilitating mental health experiences that jeopardise rehabilitation.

PAHO and Culturally Congruent Research
A related issue is the lack of regional and cultural specificity in these kinds of overview studies, even though PRI’s 2019 edition of Global Prison Trends provides brief case studies from Thailand and Australia to offset the Eurocentric focus of HPP. The dearth of regionally sensitive studies on prison health is particularly relevant for the Caribbean, as University of West Indies psychiatrists Frederick Hickling and Gerard Hutchinson have argued. [10] Although WHO and the Pan American Health Organization (PAHO) have raised awareness and standards of best practice for prisoner health care, their publications tend to ignore both the historical legacies of slavery and colonialism and the ‘clash of cultures and ideologies’ that cut across national identities. [11] At a basic level, in many PAHO publications, the Caribbean is often overshadowed by a Latin American focus on Central and South America, or where Anglophone and Francophone distinctions within the Caribbean are overlooked.

This need for culturally congruent studies is vital, but it is also important to recognise that PAHO has played a major role since the 1990s in working with national governments across the Caribbean to combat health conditions arising from poverty, ranging from pan-regional studies, including the 1998 survey Health in the Americas, through to country specific reports, such as the 2012 Guyana: Faces, Voices and Places in Guyana. These interventions include improving health surveillance; increasing epidemiological capacity; expanding the pool of trained health officials; tackling environmental health; promoting healthy lifestyles; and highlighting co-morbidities in prisons, especially around mental health and addiction. PAHO continues to advocate for good health-care practice and improving public health communications, but its reports tend to be oriented towards disease surveillance and, when they deal with mental health, fail to give a holistic account of what clinical and social recovery might mean within (and beyond) a carceral environment.

Faced with this regionally uneven advocacy and policy landscape, our ESRC-funded project, ‘MNS Disorders in Guyana’s Jails: 1825 to the Present’, shows why it is equally important to account for the long arc of colonialism in the Caribbean and to attend carefully to the intersectoral factors that exacerbate ‘the pains of imprisonment’. [12] Since 2019, we have witnessed the collaborative efforts of the Guyana Prison Service and Guyana’s Ministry of Health to improve systems and governance, including the adoption of holistic health care, with the aim of transitioning ‘from a penal system to that of a correctional facility’. [13]

Nevertheless, as our project publications show, the shadow of the colonial penal system still looms large in Guyana’s prisons. Not only do health screening procedures for new prisoners need improving, but overcrowding, unsanitary condition and inadequate care continue to jeopardise UN standards intended to safeguard prisoner health. [14] Intensified WHO and PAHO collaboration will enable Caribbean national governments to share best practice, but ministries also need to improve prison infrastructure and to facilitate a meaningful shift of discourse from ‘management’ towards ‘care’ and a reorientation from eroded to positive identities. A sharper emphasis on ‘social recovery’ may prompt officials to think about prison as a transitory phase within a life-journey rather than a defining experience from which it is difficult to recover. Not only it is crucial to recognise the multiple determinants of prisoner health, but to remember that it is the collaborative task of government, prison and health care officials to uphold human rights and prepare the ground for released prisoners to ‘lead meaningful and contributing lives as active citizens’. [15]

Martin Halliwell is Professor of American Thought and Culture in the School of Arts, University of Leicester. He is the author of American Health Crisis: One Hundred Years of Panic, Planning, and Politics (University of California Press, 2021) and his co-edited volume The Edinburgh Companion to the Politics of American Health will be published by Edinburgh University Press in August 2022. He is grateful for feedback while preparing this blog from Professor Clare Anderson, Dr Tammy Ayres and Dr Dylan Kerrigan.

[1]. Johanna Crane and Kelsey Pascoe. ‘Becoming Institutionalized: Incarceration as a Chronic Health Condition’, Medical Anthropology Quarterly, 35(3), 2020, 2–20.

[2]. Penal Reform International, Global Prison Trends 2019, ‘Healthcare in Prisons’ supplement: https://cdn.penalreform.org/wp-content/uploads/2019/05/PRI-Global-prison-trends-report-2019_WEB.pdf. On prison overcrowding, see also Morag MacDonald, ‘Overcrowding and its Impact on Prison Conditions and Health’, International Journal of Prisoner Health, 14(2), June 2018, 65–8.

[3]. Katherine E. McLeod et al., ‘Global Prison Health Care Governance and Health Equity: A Critical Lack of Evidence’, American Journal of Public Health, 110(3), March 2020, 303.

[4]. See, for example, Seena Fazel et al., ‘Mental Health of Prisoners: Prevalence, Adverse Outcomes and Interventions’, Lancet Psychiatry, 3, 2016, 871–81.

[5]. Stefan Enggist et al., Prisons and Health (Copenhagen: WHO Regional Office for Europe, 2014), i.

[6]. Enggist et al., Prisons and Health, 1–2.

[7]. Ibid., 87–8. See also David Pilgrim, ‘“Recovery” and Current Mental Health Policy’, Chronic Illness, 4, December 2008, 295–304.

[8]. Johanna T. Crane, ‘Mass Incarceration and Health Inequity in the United States, in The Edinburgh Companion to the Politics of American Health, ed. Martin Halliwell and Sophie A. Jones (Edinburgh: Edinburgh University Press, 2022), 520.

[9]. Erving Goffman, ‘The Insanity of Place’ (1969), in Relations in Public Microstudies of the Public Order (London: Penguin, 1972), 415.

[10]. See, for example, Frederick W. Hickling and Gerard Hutchinson, ‘Caribbean Contributions to Contemporary Psychiatric Psychopathology’, West Indies Medical Journal, 61(4), 2012, 442–6. 

[11]. Daniel Nehring and Dylan Kerrigan, Therapeutic Worlds: Popular Psychology and the Sociocultural Organisation of Intimate Life (London: Routledge, 2019), 29.

[12]. ‘Mental Health in Guyana’s Prisons: A Direct Legacy of the Country’s Colonial History?’, Stabroek News, 16 April 2021.

[13]. Guyana Prison Service, 2020 Annual Report (Georgetown: Guyana Prison Service, 2021), 1, 5.

[14]. See ‘Offender’s Mental Health Prior to Incarceration must be Assessed’, Guyana Chronicle, 28 August 2021.

[15]. Jerry Tew, ‘Recovery Capital: What Enables a Sustainable Recovery from Mental Health Difficulties?’, European Journal of Social Work, 16(3), 2012, 360. See also Jerry Tew et al., ‘Social Factors and Recovery from Mental Health Difficulties: A Review of the Evidence’, British Journal of Social Work, 42, April 2011, 443–60.

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Alcohol, Alcoholism and Mental Health in British Guiana, Part 2

By Deborah Toner

At the inaugural meeting of the Caribbean Conference for Mental Health (CCMH) in 1957, delegates described alcoholism as the single biggest mental health issue facing Aruba, where the conference was held, and amongst the biggest problems across the region. As part 1 of this post established, heavy alcohol use had featured prominently in psychiatric explanations of insanity during the late nineteenth-century period of asylum reform led by Dr Robert Grieve at the Public Lunatic Asylum in Berbice, British Guiana. Grieve and other physicians typically used the term ‘alcoholism’ to describe the physiological and neurological effects of alcohol consumption that led to different forms of insanity and used some combination of theories about inherent racial difference, the impact of social dislocation, and environmental factors to explain the varying prevalence of mental illnesses amongst the colony’s ethnically diverse population.

By the time the Caribbean Federation of Mental Health (CFMH) was formed in the 1950s, to spearhead the first cross-Caribbean project to improve mental health at a population level, medical and psychiatric professionals around the world increasingly viewed alcoholism as a mental illness or physiological disease in its own right. As a result of the influence of organisations like Alcoholics Anonymous (AA), the term had also become part of everyday language in discussing problem drinking, defining alcoholism as a particularly destructive, out-of-control pattern of drinking. The early conferences of the CFMH explored these ideas and adapted the AA model of alcoholism to incorporate, as part of alcoholism’s causation, the psychological and social legacies of colonialism and ongoing processes of rapid socio-economic change in the Caribbean.

The Emergence and Spread of the ‘Alcoholism Movement’

From the late nineteenth and up to the middle of the twentieth century, an increasingly global community of researchers, practitioners, temperance advocates and policy makers discussed the social, economic and health impacts of alcohol consumption at major international conferences known as anti-alcohol congresses. By the middle of the twentieth century, the “disease” model of alcoholism dominated medical, psychological, and social work approaches to understanding and treating problem drinking. Organisations like Alcoholics Anonymous, the Research Council on Problems of Alcohol and the Yale Centre for Alcohol Studies, all founded in the United States between 1935 and 1943, helped to popularise the idea that alcoholism was a sickness to which some individuals were more susceptible than others. There was ongoing debate about the aetiology of this susceptibility – as a physiological allergy to ethanol; as a psychosexual disorder; or as more environmentally influenced. But all agreed that alcoholism should be treated as a public health problem (Tracy 2021; Tracy 2005).

            Treating alcoholism as a public health problem, these organisations promoted mass public awareness campaigns, alongside new models for treating and rehabilitating the individual alcoholic. The most influential was the Alcoholics Anonymous Twelve Step programme, “a set of principles for achieving sobriety and personal transformation through self-reflection, mutual aid, good works, and surrender to a higher power” (Tracy 2021). The AA model for treating alcoholism spread around the world quite quickly, with branches opening in Mexico in 1940, Ireland in 1946, Scotland in 1848, France in 1960, and Japan in 1963 (Toner 2021, 18). In the Caribbean, a report commissioned by Aruba’s Department of Social Affairs in 1951, led to the foundation of an Alcoholics Anonymous group and the Aruba Society Against Alcoholism in 1955. Both these organisations fed into the establishment of the Aruba Society for Mental Health that hosted the first Caribbean Conference on Mental Health in 1957 (CCMH Proceedings 1957). While research into a wider range of records is needed to map the spread of AA across the Caribbean more systematically, proceedings of the 1959 Virgin Islands conference suggest that it quickly became established. In discussing tensions between different government departments about who should be involved in improving mental healthcare and how it should be funded, Trinidadian delegates commented that Alcoholics Anonymous ‘could be relied upon to go along’ without public funding, indicating that AA was already an established presence in the Caribbean by the end of the 1950s (CCMH Proceedings 1961). Certainly, delegates at later conferences reported that AA branches had been established in Grenada in 1961 and Antigua in 1962, and joining AA had become a formal part of the treatment programme operating in St Ann’s Hospital, Trinidad by 1963 (CCMH Proceedings 1965).

Alcoholism at the Caribbean Conferences for Mental Health: Definitions and Causation

American speakers were influential in moulding discussions of how to define alcoholism at the Caribbean Conferences for Mental Health. In 1957, Dorothy M. Johnson, Supervisor of Psychiatric Social Work at the State of Florida Alcoholic Rehabilitation Program, followed the Yale Center of Alcohol Studies in defining an alcoholic as a person who drinks ‘alcohol in an uncontrolled and self-destructive manner’, such that their drinking causes serious detrimental impact on their health, personal relationships and/or work. Johnson further highlighted that alcoholism was often linked to difficult transitions or traumas in a person’s life. Another colleague from the Florida Rehab Program implicitly defined alcoholism as a male condition, saying that wives often caused their husbands’ drinking problems by infantilising and emasculating them. The secretary of Aruba’s AA branch, comprised of 150 members at this time, defined an alcoholic as ‘a person who has a physical allergy to alcohol and is at the same time emotionally immature’, echoing the way in which AA as an organisation typically combined a specific physiological predisposition with the influence of social and psychological factors in explaining individuals’ alcoholism (CCMH Proceedings 1957).

However, in applying the AA definition and treatment model to rehabilitation programs in the Caribbean, mental health professionals typically emphasised broader sociological processes, some relatively recent, others with long historical roots, in explaining alcoholism in their communities. A social worker from the Aruba Department of Social Affairs, which had kickstarted sustained investigation into alcoholism in the early 1950s, highlighted as a central cause, the ‘mental tensions’ that had resulted from rapid development of the island’s oil industry, via American investment, in the previous two decades. In the capital port city, the higher wages and social influence of a large influx of ‘unsettled foreigners’ apparently led to increased incidence of alcoholism. In more rural regions, alcoholism was attributed to the longer-term pattern of young men from Aruba migrating to Cuba for work on sugar plantations, where they often developed habits of heavy rum consumption, combined with psychological feelings of inferiority stemming from intergenerational poverty (CCMH Proceedings 1957). The dislocating effects of rapid socio-economic change across the 1950s and 1960s, often as a result of migration and tourism, continued to be important themes in explaining the psychology of alcoholism, and mental health problems more broadly (CCMH Proceedings 1961; CCMH Proceedings 1965).

            Conference delegates often pointed to the psychological and social legacies of colonialism in producing the emotional immaturity, or feelings of emasculation and powerlessness, that organisations like AA posited as being central to the psychology of alcoholism (CCMH Proceedings 1965). Discussion following papers presented by personnel from the Florida Rehabilitation Program in 1957 highlighted that the Caribbean experience of alcoholism was bound to be different from that in the US because of the legacies of colonialism and slavery (of course, the US had its own legacies of slavery and colonialism, but the early alcoholism movement in America, and Alcoholics Anonymous in particular, overwhelmingly catered to white people). Delegates argued that instability of family life in the Caribbean was a source of emotional immaturity and emasculation, rooted in the ‘break up of family patterns among negroes when they were taken from Africa into slavery in the New World’ and that feelings of powerlessness were pervasive because of how colonial governments (still in control of most Caribbean countries at this time) meant that Caribbean people were ‘not master in [their] own home or own country’ (CCMH Proceedings 1957).

            Reports from both St Ann’s Hospital, Trinidad and Fort Canje Hospital, British Guiana in 1963 suggested that alcoholism was more common amongst patients of East Indian heritage. Heather Pinto, Senior Occupational Therapist at St Ann’s Hospital, stressed the psychological and social legacies of colonialism in explaining this. While she followed the AA disease model in stating that some predisposition in the individual was necessary for broader factors to lead to alcoholism, the main causes that explained a higher rate of alcoholism amongst East Indian people were: the psychological legacy of indenture and separation from a distant homeland; the trauma of marginalisation due to ethnic, linguistic and religious difference; and cultural traditions that embedded alcohol in social and family life. By contrast, she stated that Black people were ‘not so inclined to be bogged down by memories of slavery’, but where they did develop alcoholism this was because they used alcohol as a ‘tranquiliser’ for feelings of inferiority compared to Europeans they worked with in the oil and sugar industries. Europeans who developed alcoholism in the Caribbean, meanwhile, were likely to do so because of ‘too much money and lack of suitable activity which constitutes boredom and depression’. While Pinto concluded that alcoholism was fundamentally rooted in emotional immaturity, in line with a core tenet of AA’s definition of alcoholism, this emotional immaturity was understood to be the product of historical and social forces that shaped the experience of different ethnic groups in the Caribbean (CCMH Proceedings 1965).

This conclusion was broadly in line with the wider ethos of improving mental health at population level with which these CFMH conferences were imbued. Specific innovations in institutionalised and outpatient care were implemented to treat individuals, in the context of a broader understanding that it was really major social inequalities arising from Caribbean histories of colonialism that needed to be addressed. You can see our working paper, “Changing Approaches to Mental Healthcare in the Caribbean Conferences on Mental Health” for more on this broader context, and await publication of our article on the relationship between intoxication, insanity, migration and intoxication for more on how these relationships played out in British Guiana across the whole colonial period.

Deborah Toner is an Associate Lecturer in the school of History, Politics and International Relations, University of Leicester.

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Mental Health and Covid-19 Protocols in Guyana’s Prisons

By Queenela Cameron

Interviews conducted at the Georgetown and Lusignan prisons in 2019 as part of a collaborative research on the topic of “Mental, Neurological and Substance Abuse disorders in Guyana’s Jails – 1825 to the Present Day” revealed that a number of mental health challenges (diagnosed and undiagnosed) are experienced by both prisoners and prison staff, with depression seeming to be the dominant one. Depression in the context of Guyana’s prisons, is exacerbated by several factors; limited recreational activities, poor or limited work and education rehabilitation programmes, and an absence of, or limited contact with family members to name a few.

Image: Lusignan Prison 2019, Professor Martin Halliwell, University of Leicester

The Covid-19 pandemic and the measures taken (from March 2020 to early January of this year) to prevent and manage its spread in the prison environment, played additional roles in further alienating prisoners from the already limited activities which aim to contribute to their rehabilitation. It stands to reason, that an absence/suspension of these activities and programs (for approximately two years) as well as the pandemic itself, likely intensified feelings of stress and depression amongst prisoners.  Prison staff who too were subjected to strict Covid-19 guidelines including prolonged periods of confinement in the prison environment likely experienced increased levels of stress on their mental well-being.

Among the measures taken was the suspension of all religious activities and training programs within the prison. One of the key findings unearthed during the interviews conducted in 2019, revealed that religion is one of the biggest coping mechanisms utilized by prisoners, as attending religious services gives them comfort and relieves feelings of stress, depression and hopelessness. These findings are not unique to Guyana’s prison environment, as several studies conducted in other jurisdictions point to the effectiveness of religion in positively impacting the mental health of prisoners. Bradshaw and Ellison 2010, and Ellison et al, 2008 for instance, note that “Participation in religious activities can impact inmate mental health by promoting social support. Attendance at religious services has consistently been shown to be protective against mental distress.” 

The suspension of this vital stress-reliever and depression-combatant implies that many prisoners were likely to become withdrawn, easily agitated, disruptive, fight amongst themselves, experience appetite loss, and harbour escape and/or suicidal thoughts.

Given that the number of daily Covid-19 positive cases, both outside of and inside of the prison contexts of Guyana has drastically reduced from its peak of 1,558 on January 17 of this year to 5 cases as at March 25, 2022 (WHO), and also given that there is already inadequate mental help support in the form of counselling and therapy for convicted prisoners and that no such service exists for prisoners on remand, it is recommended that religious activities should be resumed, albeit in the contexts of social-distancing, sanitizing and mask-wearing guidelines. Conscious of the limited spacing available for religious worship due to massive overcrowding, small groups could be accommodated at various intervals in order to fulfil the right of prisoners to religious engagements which is vital to prisoners’ mental well-being as well as their rehabilitation.

With respect to training activities, those too were suspended for approximately two-years. However, between January 12 and 15 of this year, all of the Guyana dailies and Newscasts reported that 861 prisoners housed at the various prisons graduated in what is being referred to as “ground-breaking” training courses offered at the various prisons. The programs, prison officials’ note, aim to prepare inmates for life outside of the prison and to assist with their reintegration into society. The inmates had the opportunity to participate in a number of different training areas such as entrepreneurship, anger management, carpentry and joinery, family reconciliation, tailoring, culinary arts, art and craft, cosmetology, barbering, crops husbandry and veterinary sciences. The courses were extended to all prisoners including those on remand and also those who were convicted with several high-profile and special watch inmates taking the opportunity to rehabilitate themselves with the courses. (HGP Nightly News. January 15, 2022). Further, the “Fresh-start” program launched just last month by the Guyana Prison Service with similar programs and more, are all aimed at preparing prisoners for productive life outside of prison. (Stabroek News. February 18, 2022)

These programs must be commended for their role in fostering prisoners’ rehabilitation and likely reducing rates of recidivism as “the impact of education goes well beyond the walls of the prisons themselves, extending into the home communities of the incarcerated.” (North Western University Prison Education Program). Their importance in assisting the mental health of prisoners whose time would have been more than likely spent on unproductive activities which contribute to depression, anxiety, stress and other mental ailments cannot be overstated. Further, the inclusion of these programs to prisoners on remand must also be applauded for its progressiveness given that the current laws do not extend those privileges to remand prisoners, many of whom sometimes spend several idle years behind bars before sentencing or release.

Another of the measures taken was the suspension of the (external) work rehabilitation program. Prior to the pandemic, some prisoners were able to capitalize on work rehabilitation programs which not only helped in the provision of financial resources for them to supplement their prison-provided supplies, but also contributed to their families’ upkeep, occupied their time, helped provide meaning in their lives by providing them with something to focus on, and prepared them for post-prison productive life. North Western University Prison Education Program notes that work rehabilitation aids in preparing prisoners for life outside of prison as “reentry is far smoother and more successful for those who took classes in prison, especially insofar as gainful employment is one of the defining features of successful reentry.” The suspension of this privilege likely impacted the mental health of prisoners in a negative way.  Existing literature suggests that “inmate boredom caused by the lack of work and absence of recreational activities could be linked to depression and aggressive behavior.” (Tartoro and Leaster, 2009). Such behaviors could spread among the prison population thereby leading to prison riots, fires etc., all of which could make the work more challenging for an already thinly-stretched and over-worked prison staff.

The suspension of family visits was another measure implemented to prevent and manage the Covid-19 pandemic in Guyana’s prison setting. During the interview sessions with prisoners in 2019, many bemoaned the lack of/limited visits form their family members, while others were in praise for supportive family members who visit often and supplement their supplies. The complete removal of this social support privilege (though replaced by electronic means using the “Google Hangouts app” and/or telephone) likely increased feelings of depression and other mental health issues amongst prisoners. De. Claire Dixon, 2015 notes that “Visits help offenders to maintain contact with the outside world, promoting successful reintegration back into society and reducing recidivism. This scarcity of social support might make adjustment to prison more difficult, risking the use of maladaptive coping strategies.”

A further measure taken was the suspension of actual (face-to-face) court hearings, and the establishment of virtual courtrooms. While this measure must be lauded for its role in respecting the rights of prisoners to a trial within a reasonable time period as well as the possible reduction of time spent on remand, the positive mental-health benefits of actually leaving the confines of the prison environment for a trip (however temporary), to be in a setting with non-prisoners, to perhaps have a moment to socially interact with family members and their attorney, cannot be ignored.

While most of these measures impacted prisoners, their impact on the mental-health of prison staff cannot be ignored. Prison Officers were already in-line due to the prolonged March 2020 elections and they were forced to remain in-line (for time frames as long as two weeks) as a precaution against bringing the virus into the prison environment.  Devoid of the vital social interaction of family, being forced to work long hours in an overcrowded setting in the face of a massive human resource deficit, fearful of contracting a deadly virus in the contexts of agitated, violent, dangerous and scared prisoners are all factors which likely intensified the stress levels of prison staff.

It should be recalled that a number of undiagnosed prisoners, specifically those on remand, complained of experiencing bouts of depression and anxiety as a result of their incarceration. They also bemoaned the absence of competent mental health personnel on whom they could unburden themselves. Similar sentiments were expressed by officers and other prison staff who, like most prisoners, also use religion as a coping mechanism.

In light of the foregoing, and in the context of the almost- completed “modern” prison and proposed new prison headquarters at Lusignan, it is hoped that this facility would be equipped with a modern mental health facility and staffed by competent metal-health personnel, including therapists and counselors to assist prisoners (including remand prisoners who do not benefit from existing arrangements) and prison staff.

Such facility would greatly augment prisoners’ rehabilitation, prepare them for life outside of prison and ultimately reduce the rates of recidivism. For Prisons Officers and other staff, working in both one-on-one and group sessions with a therapist could help them cope with the challenges associated with a highly stressful, time-consuming, low-paying, and sometimes under-valued profession.

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Research during Covid: The three Rs (Reflexivity, Resilience and Rum)

By Members of the Research Team

Research never goes to plan. As academics, we all know this. It is also a fact we constantly share with our students as an expected part of academic research. Whether it is a failure to gain access, or find enough people willing to participate, we all face research challenges. Like most things however, Covid has added a new set of challenges to academic research (as well as opening up new opportunities), which our research team recently faced on a trip to collect data in Guyana. This reminded us all about the importance of the three Rs – Reflexivity, Resilience and Rum (rum is used to emphasise the importance of relaxation and researcher self-care as well as the importance of looking after each other when out in the field, something that is to commonly forgotten about in research). Subsequently, this blog outlines how Covid recently impacted upon our data collection plans and how we, the team of three (the three musketeers), responded to the challenges they faced, illustrating the importance not only of the team – its members, relationship, reflexivity, and resilience – but also of building the networks of support that became an invaluable source of help on this trip. Although often over-looked, networks of support – academic as well as practitioner – are invaluable as we travel the globe in person or virtually undertaking research and delivering research papers at conferences.

Covid-19: The Challenges

We have all had to face new challenges arising from the global Covid pandemic, and this includes research. The ever-changing requirements for travel alone can be a minefield especially when multiple destinations are involved. Do you need a PCR test? A lateral flow? A vaccine record? Although the team joked about the possibilities of Covid negatively affecting this research trip as we completed the usual research risk assessment form, we did not for one minute think that this would become our reality. As we navigated the various government requirements for travel to Guyana, and as transit passengers (currently there is no direct flight from London to Georgetown), we quickly became all too familiar with the challenges when these documents expire. Three days prior to travel our connecting flight was cancelled; due primarily to the knock-on effects of Covid the carrier was required to consolidate some of its existing flights. This delay in being able to fly to our final destination meant that our existing Covid PCR tests (taken in the UK before departure) became invalid while we were in transit. As a result, two hours before we were due to leave for the airport, we had to retest, and then found ourselves faced with the unenviable decision of whether to abandon the research trip as one of us tested positive. Despite the UK being only days away from dropping all restrictions the rules of quarantine in our transit destination, as in many areas of the Caribbean, remained in full force. After a frantic hour of rearranging hotel rooms, contacting our colleagues, updating the insurance provider, and ensuring the Covid patient had the basic necessities for a possible ten-day stay in isolation, the remaining two members of the team apprehensively continued on with the trip.

Reflexivity

We reflect on a daily basis in both our personal and professional lives, and the importance of being reflexive when undertaking research is well documented.  It facilitates self-awareness and allows researchers to respond to unexpected challenges and situations in appropriate and ethical ways. It also allows researchers to improve and build on instances of good practice as well as to learn from their mistakes. Thanks to Covid we had to revisit and alter our itinerary for the trip. This was mainly owing to the fact that as a team we were now lacking in the expertise required for certain elements of data collection, namely the interviewing of prisoners and a focus group with their families. The added scrutiny that this placed on our planned activities ensured that we worked together, albeit remotely, to create a workable plan. As a result, two of the most invaluable research tools on this trip quickly became Zoom and WhatsApp, as we adapted to the circumstances to ensure the trip was a success. This technology enabled us to further refine our research questions and aims as we prepared for the interviews with our colleague in isolation. Due to the circumstances, we also made the decision to employ a local researcher with experience of working with prisoners and their families. In addition to helping with the language barrier (many speak a variation of English known as Guyanese Creole) this also had the unexpected benefit of producing more in-depth data as the prisoners connected with the interviewer over their shared experiences of living in the same country. Furthermore, where possible one of our key activities – a session in which we co-created a new tool that will enable the Guyana Prison Service to gauge the experiences of prisoners and officers – was moved to an online session. This had the added benefit of enabling officers, and members of our team, from a wider geographical area to take part. This reflexivity not only ensured we were able to successfully carry out our designated activities, it also strengthened our relationships with our partners, both in Guyana and the UK, as we worked together to overcome difficulties.

Resilience 

Although not a fan of the word resilience – which seems to have become a contemporary buzz word – it best describes the reaction of the team members to the situation they found themselves in during this research trip. Instead of letting it get them down they did their best to make the best out of a bad situation (thanks to being reflective), which actually resulted not only in a very productive data collection trip, but also one that contained some genuine moments of comradery, good humour and bursts of hysterical laughter despite the adverse and at times disappointing situation that faced us. As Charles Darwin exclaimed/outlined: ‘It is not the strongest of the species that survive, not the most intelligent, but the one most responsive to change’. Sentiments that stand true for the recent predicament we, the research team, found themselves in and how we chose to respond to it.

We had always planned for Covid, in that we decided that three persons would go on this trip, so that in the event of sickness and isolation the others could complete the research activities. Despite our pact that if one of us tested positive for Covid then the team would carry on without them, like many plans in life, you never really expect them to happen so, the reality and its accompanying shock was somewhat overwhelming and definitely unexpected. In fact, the first 5 minutes after the initial news of the positive test was spent asking the medical team if they were joking, as is often the way in the Caribbean. It was however no joke. One of us had tested positive and was going to have to stay behind in transit and in quarantine in a different country on their own, while the remaining two went on to Guyana. This is when true teamwork and collegiality really come into play as everyone (bar the infected who had to stay outside) pulled together to rectify/address the situation in the 2-hour window before everyone was due to fly. A team member in the UK liaised with our travel agent. We called and discussed the situation with our partners, and later on the British High Commission in Guyana, with whom we have built excellent working relationship over the past few years.

Once the initial shock of one of us testing positive for Covid had worn off the team revisited their itinerary and data collection plans for the forthcoming week to ensure everyone was still involved where practically possible/needed. Despite the initial disappointment, and the frustration of not being able to go and collect data in Guyana, the Covid patient endeavoured to come up with an exit plan until they heard from the Ministry of Health. The idea was to rest up, clear the virus and follow the team on after 5-days. However, this was not to be. Instead, the Ministry made it quite clear that the minimum isolation period was 10-days, although the patient was given a hotline number to call. After a frustrating day with 7-hours spent just redialling but being unable to get through on the telephone number provided by the Ministry of Health, the Covid patient also explored other avenues of help/support to ascertain the situation. It was at this point that the importance of networks was emphasised: the team was in touch with the High Commission of Guyana, and it was willing to help. Once the Covid patient knew that they were quarantined for 10-days and the research team had created a new itinerary for the trip, it was easy to plan their time and make the best use of the situation both to recover but also to catch up on some of the background project reading, reading the interview transcripts and coding frames as well as numerous other tasks that often get postponed.

The team debriefed every morning and/ or evening where practicably possible not only to catch up on the day’s progress but also to relax, and jolly each other along. The daily debriefs with their colleagues in Guyana, including meetings where the Covid patient Zoomed in, also helped to ensure that they felt part of the project and part of the team. It also kept them busy and helped the time to pass quickly, with some days feeling quite busy despite not leaving the hotel room. We had a job to do, and Covid was not going to stop us. We just had to get on with it.

Rum

Undertaking research in the Caribbean is challenging. Although, Guyana is often seen by many as a desirable research location, many often fail to consider the subject matter of our project, the political/cultural sensitivities, and the fact that despite being a desirable destination, our time is often spent in old colonial prisons – some of which have been deemed to violate the United Nations Minimum Standards for the treatment of prisoners – talking to prisoners, staff, communities and families about often upsetting and traumatic experiences, which the research team then have to process and deal with. It is in this context that the importance of self-care and looking after each other comes into play. Although there are more formal channels of support offered to everyone working on the project, there are also informal support practices that have been an integral part of this research project, which is also reflected in the relationship of the team.

The research team on this project are very close, familial like even – but without much of the negativity associated with families. We all genuinely support each other. There are no egos. There is no competition. Instead, there is clear leadership, collegiality and care. Whether it is coffee and cake or catching up over a meal, regular debriefs, relaxation and humour have always been an important part of the team’s R and R, emphasising the importance of relaxation and researcher self-care as well as the importance of looking after each other when out in the field, something that is to commonly forgotten about in research. It was this which got us through what one of the researchers described as the most difficult situation in their 25-year career. With pride, we returned to the UK together, having completed all our planned activities and with our research team stronger than ever before.

Acknowledgements: The Covid patient would like to thank their two travel/research companions, as well as the team in Guyana, and everyone that looked after them, especially the High Commission in Georgetown in Guyana, and the Chief Medical Officer of the transit country, who went above and beyond in their support.

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COVID-19 in Guyana’s Prisons

By Clare Anderson, Mellissa Ifill, Remi Anderson & Shammane Joseph-Jackson.

All over the world, the COVID-19 pandemic has impacted on prisons, particularly where institutions are overcrowded. In Guyana, where prison capacity hovers at around 125%, until 15 September 2020, no prisoners were known to have had the virus, but on that day two prisoners at Lusignan Holding Bay tested positive. COVID-19 quickly spread in the prison, and by the end of the month 218 inmates had returned positive tests. To date, the overwhelming majority of infections in the prison system are in this location (around 70%). This is due to the fact that Lusignan is the main prison for new admissions, which accounts for the majority of new cases.  The others were mainly split between Timehri and Mazaruni, with smaller numbers in New Amsterdam and Georgetown (Camp Street). Up to now, October 2021, one prisoner has died at Mazaruni, though following the Lusignan infections a hunger strike and attempted outbreak led to the death of two inmates who were shot dead whilst trying to escape.

In the current pandemic, Guyana’s prisons have attracted even less than normal attention and resources. With the exception of public statements by the Guyana Human Rights Association, civil society has largely been unresponsive to the plight of prisoners in COVID-19. It has recommended that all sentences for possession of marijuana or other secondary category drugs be commuted to time served, all remand prisoners for non-violent crimes be reviewed and bail reduced, all prisoners whose sentences are within three months of completion be released early, and all women prisoners for non-violent offences be commuted.

Pandemic prison guidelines were initially developed from the more general guidelines issued by the Ministry of Public Health and National COVID-19 Task Force, and also influenced by best practices yielded from the 2020 International Conference for Prison Services in Latin America and the Caribbean. Guidelines included the establishment of isolation and quarantine areas, early release of some inmates, setting up of virtual courts, suspension of prison visits, new staff work schedules (14 days on/ 14 days off, to reduce ingress and egress), and new sanitation and cleaning practices. Since last autumn, these were augmented with the mandatory use of facemasks for inmates and staff, testing of new admissions, and the provision of buses for staff – to mitigate the risk of infection while travelling to and from work. Staff are briefed in daily meetings, with frontline officers required to oversee daily operations, ensuring that safety measures are adhered to or alternative arrangements put in place.

The safety measures seem to have worked well within the institutional, systemic, resource and infrastructural constraints of the prison system. There has been a reduction in the inmate population, the result of close collaboration between the judiciary and the prison system, and the more routine use of bail and community service sentencing. However, there is no question too that the pandemic has exacerbated chronic staff shortages, including through fear and concerns about safety. The remoteness of some sites, such as Mazaruni prison, has further added to these concerns as vaccination rates among staff remain significantly lower than elsewhere in the service. Staff absenteeism led to increased incidences of agitation among inmates, and complaints and demands to see the welfare and medical officers. Prisoner concerns included lost opportunities to work and earn; remission of sentences; loss of family visits; inability of some families to take advantage of virtual visits; and poor internet capacity which interrupted virtual visits with attorneys and families and caused trials to be rescheduled.

Prisons present ideal conditions for viral transmission, and the prevention of social contact in them has been a priority in numerous global locations. Overall, the cautious and pragmatic approach of the Guyana Prison Service during the early months of the pandemic impacted on prisoners’ access to justice and rehabilitation, and increased tensions inside the jails. Moreover, though there have been attempts to limit it, the ingress and egress of staff and supplies means that it is not possible altogether to eliminate the entry of the virus into prisons.

Later on, digital technologies enabled the resumption of trials and visitations. However, these digital strategies, while useful and reportedly spurring the courts on to increased productivity, have removed the human centred approach in circumstances where prisoners and their families are not entirely familiar – or even familiar at all – with new technological innovations. It is important therefore, that care is taken not to perpetuate inadvertent discrimination in such contexts. And, as Guyana rolls out its vaccination programme the cost of this is in terms of enhancing inequalities for some sectors of the population remains to be seen. Important questions for the future also remain. Will the measures instigated over the past year remain effective? And what will be the long-term impact of the pandemic on the health and mental well-being of staff and inmates?

This research was a collaboration between the University of Leicester and University of Guyana, in partnership with the Guyana Prison Service. It was funded by the University of Leicester’s QR Global Challenges Research Fund (Research England) and led by Professor Clare Anderson.

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Enhancing Mental Health Communications in Guyana

Martin Halliwell

Two of the trickiest aspects of mental health care to get right are psychiatric diagnosis and public health communications. The challenge for health providers around the world is to maintain consistent standards of classification for mental health and illness without imposing a rigid framework that overlooks social determinants and cultural specificities. Similarly, while public health education is part of the machinery of government – advising citizens about healthy behaviour or instructing them what to do in emergencies – this top-down model sometimes overlooks the importance of horizontal modes of communication within and between communities.

In this blog, I reflect on these two different types of health communications – the first directed towards health care providers, the second towards the public – to think through implications and challenges for developing a dynamic model of public health in Guyana, especially at the intersection of mental health and incarceration for a multicultural society.

Mental Health Diagnostics

Guyana, like the Caribbean as a whole, uses the International Statistical Classification of Diseases and Related Health Problems (ICD) for its diagnostics. This is a globally held standard for both physical and mental health, except for in the United States and parts of Canada, where the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM) has more specifically informed psychiatric classification since the early 1950s. First established in Paris in 1900, the ICD has gone through 11 editions in the 120 years since and is closely wedded to health standards upheld by the World Health Organization (WHO). This compares to the DSM, established by the American Psychiatric Association in 1952 to provide consistency to the hitherto psychiatric categories deployed in the medical department of the US Armed Forces. DSM has expanded dramatically through five editions, moving away from psychoanalytic language in the third edition of 1980 to develop an organic framework for describing psychiatric disorders and, since 1994, a multi-axial system for understanding the various causes and components of mental illness.

The most obvious commonality between ICD and DSM is the word ‘disorder’ for describing a group of conditions that includes mood disorders, neurotic disorders, schizophrenia, personality disorders, neurodevelopmental disorders, and mental and behavioural disorders due to using psychoactive substances. As well as variance in scope, there also some key differences between the two systems. In a July 2014 article, Peter Tyrer points to the global reach of ICD and its attention to primary care in low and middle-income countries, in contrast to DSM’s focus on high-income countries and its specificity as a psychiatric manual. The ICD also stands apart from DSM’s links to health insurance, which determines whether a patient in the US with a diagnosed condition is eligible for co-pays, Medicare or Medicaid. Given its global reach and flexibility as a system, researchers like Cary Kogan and Peter Tyrer hope that ICD will eventually replace DSM in Canada and the US. Published in June 2018, for adoption by member states from January 2022, ICD-11 has moved away from a categorical to a dimensional approach to mental, behavioural and neurological disorders, offering a more nuanced account of a patient’s changes over time and seeking to integrate traditional medicine.

The main problem about both diagnostic models is that psychiatrists deem ‘disorder’ to be a neutral term referring to a disequilibrium or impairment within the human organism, yet from an analytical sociological lens it is a heavily coded word shaped by social determinants and cultural experiences. In clinical terms, diagnosing a disorder can sometimes lead to relief for a patient. Just as often, though, it can lead to the medicalization of a person who might be experiencing a temporary fluctuation in mood and behaviour; or who needs interpersonal support rather than medical treatment; or whose environment is not conducive to the best of health.  Crucially, sometimes the diagnosis of a major disorder can be stigmatizing and can resonate more forcibly within certain demographic groups. For example, there were numerous studies in the post-World War II period that linked ‘disorder’ to the perceived behaviour of Black males, with discourses commonly slipping fluidly between health, home and society. It is easy to see how the term becomes mired in ideology if a disorder in or of the self mirrors a breakdown in family or social order. This insight has led critics like Daryl Michael Scott in Contempt and Pity (1997) and Jonathan Metzl in The Protest Psychosis (2010) to critique what they see as the invidious racial coding of this kind of psychiatric language.

This does not mean that we should dismiss ICD and DSM as being part of the micropolitics of the state, especially as ICD seeks to cross borders and promote health access globally. Through their numerous revisions, the two manuals have attempted to balance questions of scale and duration and take into account multiple factors before reaching a diagnosis. However, even if we embrace the progressive spirit of ICD, the consequences of a clinical diagnosis for treatment and operational practice are subject to significant variations in national health infrastructures across global regions. This is especially the case if we think about the availability and cost of certain therapeutic drugs, if and how comorbidities are treated, and to what kind of interpersonal care a patient has access – whether it is in a state or private facility or within an outpatient setting. Used crudely, an ICD or DSM diagnosis can be life transforming in the wrong way. A diagnosis of a major disorder, particularly among some demographics, can lead to custodial care or a course of drugs that might not be in the patient’s best interest, leaving social determinants largely untouched.  

Public Health Communications

In contrast to diagnostics, public health communications seem to be, on the surface, less controversial. Surely, the balancing of official communications at state level and a sensitivity to the needs of a particular community offers a balanced way forward for health officials. This balancing of vertical and horizontal approaches is one that Chelsea Clinton and Devi Shridar uphold in their 2017 book Governing Global Health, aligned with WHO’s view that health is a right and not a privilege. The Pan American Health Organization, established in 1902, embodies the views of the WHO within the Americas, and in 2018 it mapped out a sustainable health model through to 2030, which places as much emphasis on human resources and crisis response as it does on access to medicine and the resilience of health systems. On this view, the most effective kinds of public health communication are less about the balancing of vertical and horizontal axes, and more about promoting a holisitic understanding of physical and mental health as part of an ecosystem of well-being.

This PAHO model shares with a ‘One Health’ approach a recognition of the interconnected nature of human health and animal and planetary health. Yet, this does not necessarily provide public health workers with easily distributable public health information. This is especially true when budgets are tight, or where there are barriers of language and literacy, or where some communities are hard to reach. This last factor is true of Guyana, which centres its state health apparatus on Georgetown and the seaboard, leaving a number of rural regions and localities (in the interior and close to the borders with Venezuela, Brazil and Surinam) underserved in terms of access to well-staffed health services, instead relying on sparse health units operating on a part-time basis.

On visiting all of Guyana’s prisons in April 2019, in collaboration with the Guyana Prison Service and Guyana’s Ministry of Public Health, members of our research team were struck with how patchy and out-dated health information was, and in some prisons was lacking altogether. Where we did see posters or leaflets in the prison system, or in allied medical facilities, they focused almost entirely on physical health and disease, such as malaria, anaemia or HIV/AIDS.

Only occasionally did we see very basic information on mental health. At the National Psychiatric Hospital near New Amsterdam Prison we saw three versions of the 2017 PAHO World Mental Health Day poster ‘Depression: Let’s Talk’, representing different ethnicities and genders (as illustrated here), despite the conditions of the hospital ward being almost unbearable and not conducive to talk therapy. We also saw a ‘Break the Silence’ poster on domestic sexual violence in the prison hospital at Mazaruni (a men’s prison), with an emphasis on abused women speaking up against hidden crimes that are often covered over, and with the tagline at the bottom of the poster: ‘A real man can control himself’.

Recommendations for a Dynamic Public Health Model

Whether or not health information in communities and prisons are improved and updated, it may still overlook the WHO’s view that health is a dynamic process that needs underpinning by care-oriented facilities, not simply a textbook issue to diagnose and treat. The implications of the WHO and PAHO model are that public health communications should not just be offered to a community as a service, but be embedded in that community in a co-owned space in which prevention is prioritized over treatment. We saw an example of this co-ownership in Georgetown, with the participation of many students in a World Suicide Prevention Day march on 10 October 2019 (see my December 2019 blog), alongside the Ministry of Education’s efforts to integrate classes on health and family life into school curricula from age 5 upwards. Nevertheless, there are three key aspects of an integrated public health model that might be usefully adopted.

The most obvious aspect is for an updated and more nuanced set of posters, leaflets and online resources about the signs and symptoms of mental distress that might help to deepen social views of mental health and would support the work of health officials in terms of education and outreach. It presents an opportunity, for example, to ensure health education among male prisoners does not simply skew towards anger management, as is the case in Guyanese prisons. This opportunity might link to a broader programme of prisoner rehabilitation classes, including sociological, historical and literary topics, in order to help inmates better understand their behaviour and to learn about harm prevention from a wider frame of reference.

Secondly, we could point to the need to ensure that public health literature brackets off discourses of ‘right behaviour’ understood in moralistic, religious or legalistic terms – which is particularly tricky when it comes to countries that criminalize recreational drug use across a broad spectrum. Such a move needs to be carefully considered and managed, in order to focus less on punitive discourses and more clearly on self-care, care of others, and how to access health services. The independent Drug Policy Alliance in the US, established in 2000, offers a model of this, given that one of its key values focuses on ‘empowering youth, parents and educators with honest, reality-based drug education’ that moves beyond ‘fear-based messages and zero-tolerance policies’.

A third important area would be to ensure that prisoners, as well as patients treated for lengthy periods in inpatient facilities, have broader access to two-way communications beyond the institution. Within the US prison system, one example is the Restorative Radio Project, run by Sylvia Ryerson, a researcher at Yale University. This project enables families of prisoners in Appalachia to share ‘audio postcards’ and music with imprisoned family members via toll-free public radio – and there is potential for inmates to reciprocate with their own audio postcards. Such an opportunity can help alleviate loneliness, isolation and a loss of self-esteem among prisoners, as well as what Johanna Crane and Kelsey Pascoe call the ‘chronic health condition’ of incarceration itself.

This radio-facilitated model can be linked to larger step changes, such as Yale University’s efforts to expand prisoner education via for-credit courses with the aim of imagining ‘a future beyond mass incarceration’ and ensuring that prisoners and empowered and educated rather than being treated or managed. The fact that this is an elite Ivy League institution with a $1.5 million Mellon grant to develop an educational initiative that dovetails with criminal justice reform takes us back to structural questions about capacity, economics and racism which are never easy to resolve. However, the initiative also speaks to other national models, such as in Norway in which all prisoners have a right to education and a commitment to rehabilitation through positive experiences.

Concluding Thoughts

There is much promise at state level in Guyana of meeting the challenge of tackling the burden of mental illness, as the development expert Ramesh Gampat recommended at the end of his two-volume 2015 book Guyana: From Slavery to the Present. In addition to the aim of the Ministry of Public Health to reduce suicide rates and destigmatize mental illness with the aid of WHO’s mhGAP Intervention Guide for use in non-clinical settings, we saw evidence of art therapy practised at Mazaruni Prison, alongside (patchy) library material and outdoor recreational facilities in most of Guyana’s prisons. This reveals a growing awareness that health and well-being are multifaceted.

The challenge remains for us, though, across the intersecting global communities of the early twenty-first century, to imagine a future where public health information is a shared resource rather than an arm of government that flourishes or withers on the strength of budgetary priorities.

Martin Halliwell is Professor of American Studies in the School of Arts and a research expert at the University of Leicester. His new book American Health Crisis: One Hundred Years of Panic, Planning, and Politicsis published by the University of California Press. He would like to thank Clare Anderson, Queenela Cameron, Dylan Kerrigan and Kellie Moss for their valuable help in developing this blog.

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Police Lockups and Mental Health in Colonial British Guiana

Shammane Joseph Jackson 

“Left Plantation 41 for Fort Wellington. As I baited my horse at the police station here, I heard a loud commotion outside of the station house. Upon enquiring a reason for such a commotion, I saw a group of about eight women and one young man only 18 years old. This young man named Georgie seemed in great mental distress. He claimed to be the Governor of the colony and many times his ramblings were incoherent. The women were pleading with Stipendiary Magistrate De Groot for help and when they saw me turned their pleadings also to me. One woman, whom it was later revealed to be his mother, stated that her son had always behaved in this manner for years, however of late this behavior is daily. After much back and forth and me intervening by speaking to the young man, Stipendiary Magistrate De Groot placed him in the small lockup at Fort Wellington for a few days at which time I am sure he would return to his normal self.”

C.H. Strutt, Stipendiary Magistrate, 1843.

This extract taken from the Stipendiary Magistrate C.H. Strutts’ annual report provides some insight into the connection between mental health issues and police lockups in post emancipation British Guiana.  For much of the period, local officials used these facilities as a substitute for asylums to deal with individuals suffering from mental health issues.  Even before the first official asylum in the colony began operations in New Amsterdam 1867, police lockups served as unofficial holding spaces for persons considered insane.

Post-emancipation British Guiana saw to the introduction of police stations strategically located at the edge of African Guyanese villages. These villages emerged on the colony’s Coastal Plane along the plantation belt from Essequibo to Berbice. For example, on the West Coast of Berbice, in the villages such as Hopetown there is Fort Wellington police station, at Blairmont there is the Blairmont police station at the front, at the intersection of Weldaad and Belladrum villages there is the Weldaad Police Station. This distinct pattern continued in Essequibo where there were the Stewartville, Den Amstel, Parika, Anna Regina and Aurora police station and for Queenstown there is Capoey. Throughout the colony’s capital and along the East Coast of Demerara, police stations were located at Kitty, Plaisance, Beterverwagting, Vigilance, police station is found at the edge of Buxton/Friendship, whilst there was Cove and John (at the boundary of Victoria, Nabacalis and Golden Grove), just to name a few (History Gazette, No. 71, 1971).  Because the administrators of British Guiana were struggling to deal with many of the social problems such as mental health in these villages and the rest of the country, these stations served as quasi-asylums for villagers who displayed signs of “insanity (Gramaglia, 2013).”

Having lost control over the freed people who bought plantations and became villagers, colonial officials stereotyped them as “problematic,” “raucous to law and order” and “belligerent.” Some villagers, who were maroons that came out of hiding after slavery ended, were labeled as “aggressive.” Their mental soundness was always in question whenever there were confrontations with the rural constables and colonial officials. Many were quickly labeled insane, which meant that they were a danger to others. Oftentimes it meant that they were detained for weeks in police lockups, without seeing the magistrate.

The villagers also regarded the police stations as an intrusion since the planters always used these institutions to persecute and control them. There are several instances of villagers being locked up for extended periods with due recourse of the law or on suspicion of their mental incapacity.  For instance, in 1855 two men from Buxton village were locked up at the Vigilance police station for three months, because the rural constables labeled them insane. The police stations were therefore a daily reminder of villager’s inequality and inability to challenge the powers that be (Gramaglia, 2013). It is because of these experiences that the police stations became alien to these communities.

The New York Public Library. “British Guiana police.” The New York Public Library Digital Collections. 1910.

Villagers also viewed rural constables in charge of these police stations with suspicion and fear (Danns, 1982). According to Allan Bent, the police in colonial society did not “exist to serve the expectations and needs of society;” (Bent, 1974) they were there to protect the colonizers. The result was further disdain for rural constables throughout British Guiana. The dislike also developed from the fact that the persons in charge of the police stations were white and although by the 1860s some rural constables were black; they were not creole blacks. Most of the rural constables were islanders, especially Barbadians. These circumstances only cemented the belief that such an institution was alien to the creoles (Danns, 1982).

Further, creoles from the villages developed their own biases for the rural constables. The rumors that followed the rural constables were many times fabricated and exaggerated due to these biases. The accusations increased even more when local newspapers constantly highlighted the wrongs of the “foreign constables (Daily Chronicle, 1865).” Creoles always questioned the rural constables’ “morals and values.” Villagers stereotyped the Barbadian rural constables which sometimes destroyed rural constables’ careers (De Barros, 2003).  There was a case involving rural constable R. Wren attached to Weldaad police station. A villager accused him of “improprieties.” The accusation sounded so authentic that the rural constable was suspended pending a hearing. It was during a confrontation between the accused and accuser that it revealed that it was all lies (Daily Chronicle, 1871). Instances like these cemented those stereotypes and ensured the mass “locking-up” of villagers as their mental health constantly came into question.

Most police stations were unsuitable to detain anyone as events following the Angel Gabriel 1856 Riot, which began in Georgetown quickly advanced to the Berbice, demonstrated.  During the riot Portuguese shops in Belladrum, Blairmont and in many other villages were destroyed. However, in Hopetown many villagers prevented one particular shop, owned by L. Gonsalves, from being burglarized and raged. When the rural constables from Fort Wellington police station and reinforcements from the other stations arrived on the scene, they arrested everyone they found outside the shop, including those who were protecting the business.  Those arrested, including three “lunatics” as the report noted were locked up at Fort Wellington police station. Twenty-three persons (both males and females) got placed in the lockup together. It was built to accommodate only three persons at a time. Two women and two men were eventually convicted, and several villagers were fined (Guiana Graphic Newspaper, 1856). Further, the lockup was poorly ventilated, and the police station did not have the cells to accommodate such numbers. The two elderly men fell who fell sick got released. Examples like these widened the rift between the villagers and the rural constables for a protracted time.

            Given the turbulent history that existed between the police stations, colonial officers, and the villages, Stipendiary Magistrate C.H. Strutt’s response to Georgie is no surprise. His attitude towards the young man’s state is indicative of the responses of villagers and many others in post-emancipation British Guiana. Whenever a villager portrayed mental health symptoms and other behaviors which were deemed troublesome, they were placed in the police lockups for periods ranging from a few hours to several days, until he or she “returned to their normal self.”

Rural constables during this era got no formal knowledge or training about mental health issues. The stigma affixed to persons suffering from such issues also gave the rural constables the “permission” to “brutalized” them. According to C.H. Strutt, upon his return his return to Fort Wellington police station days later, he enquired from Stipendiary Magistrate De Groot as to the welfare of Georgie.  Magistrate DeGroot reported that Georgie got a “sound thrashing” from the rural constable and “he quickly found his sanity and returned to the neighbouring village where he shares a house with his mother.”

Even the churches reached out to the rural constables to assist them in dealing with “lunatic” members of their congregation. In an 1853 report from St Michaels Church in, the catechist stated that it was a constant battle between himself and men from the neighboring village who were bent on disrupting Sunday morning church because of their “intoxication and lunatic behaviors.” He further noted that on two occasions he sent members of the congregation to Fort Wellington police station to get the rural constable who “promptly arrested the drunkard.” Later he found out that the congregant was not drunk but periodically would behave “irrationally even when unprovoked (HCPP, 1853).” In another report dated 1858, the catechist stated that church members identified three young men smoking “something” which was “highly repugnant to the nose” (the assumption here it might have been marijuana) behind the church building. They tipped off the catechist, when one man reacted to whatever he smoked by breaking the church windows. He was arrested, charged with vandalism, and locked up at Fort Wellington police station.

Persons who lived in proximity to these police stations and who suffered from any signs of mental illness were taken to the station houses. The responses of the rural constables and colonial officials were incarceration of the affected. This response for obvious reasons did not work and only worsened the mental state of the sick. British Guianas’ earliest asylum system to deal with the psychologically ill came into effect in June 1842. The system was part of Governor Henry Light’s social welfare project to ensure some form of common advancement in the colony. For many years, the conditions at the asylum were so unwholesome that the officials moved the structure. They eventually founded the “lunatic asylum in 1867 at Fort Canje near New Amsterdam, adjacent to the Berbice General Hospital (Gramaglia, 2003).”

Shammane Joseph Jackson is a research associate on the ESRC GCRF project Mental Health, Neurological and Substance Abuse Disorders in Guyana’s Jails, 1825 to the present day. She is also a lecturer in the Department of History and Caribbean Studies at the University of Guyana.

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East Indian Immigration and Incarceration in Post-Emancipation British Guiana.

Estherine Adams

It drives one out of his mind,
British Guiana drives us out of our minds.

In Rowa there is the court house,
In Sodi is the police station,
In Camesma is the prison.
It drives one crazy,
It is British Guiana.
The court house in Wakenaam,
The police station in Parika,
The prison in Georgetown, Drive you crazy.

(Ved Prakash Vatuk. “Protest Songs of East Indians in British Guiana.”)

This post presents some initial thoughts on the connections between East Indian immigration and incarceration in Colonial British Guiana between 1838 and 1917 as so poignantly expressed through the lyrics of the East Indian Protest Song. Allusions to the period of East Indian immigration in British Guiana does not generally evoke images of prisons but disproportionate number of immigrants spent their period of indenture in this institution. 

Each year, on average, magistrates served warrants on twenty percent of the indentured population in British Guiana, had a conviction rate above fifteen percent and an imprisonment rate of about seven percent (Bolland, 1981). This, according to one historian, “represented tens of thousands of prosecutions instituted by managers and overseers against labourers” and resulted in their stark overrepresentation in the colony’s penal system (Mohapatra, 1981). In 1874 for example of the 4,936 persons in the Georgetown prison, 3,148 were indentured labourers. This trend epitomizes the planters oft-quoted remark that the place of the indentured immigrant was either “at work, in hospital, or in gaol [prison],” and captures the connection between the prison system and the immigration schemes that emerged in Colonial British Guiana (Guyana Chronicle, 2014).

Estate Hospital in British Guiana, The Illustrated London News, 23 March 1889.

The arrival of East Indians in British Guiana coincided with Emancipation and the Village Movement, two significant developments that initiated labour scarcity. The gradual withdrawal of freed Africans from plantation labour led to the introduction of East Indian immigration and the expansion of the prison population due to exploitation and the stringent enforcement of the contract and the labour laws. These labour laws were heavily skewed against the immigrant, even though they stipulated the obligation of both the employer and the labourer. The plantocracy easily manipulated the laws and the courts system in general, to control the immigrants who could be prosecuted for refusal to commence work, or work left unfinished, absenteeism without authority, disorderly of threatening behaviour, neglect or even drunkenness (Dabydeen, 1987). As Guyanese historian Tota Mangar notes, “court trials were subjected to abuse and were, in many instances, reduced to a farce as official interpreters aligned with the plantocracy while the labourers had little opportunity of defending themselves” (Guyana Chronicle, 2014).

In 1838, East Indians comprised less than one percent of the total population. By 1851 this increased to six percent, jumped to 25.8 percent in 1871, and rose again to 42.2 percent in 1901 (NAG, 1901). The prison population followed the same trajectory: as immigration schemes expanded, the prison population expanded. Similarly, as the scheme declined in the early twentieth century the colony’s prison population noticeably declined. Although earlier prison reports differentiate between prisoner by race (white, coloured and black) and crimes committed rather than nationality, a look at the categories of crimes for which persons were incarcerated and the duration of sentences strongly suggests high rates of East Indian incarceration.  

The number of annual convictions for offences against “the Masters and Servants Act including acts relating to indentured Indians” also alludes to a large incarcerated Indian population.  The annual reports indicate that local authorities mainly convicted immigrants for this crime punishable by fines or imprisonment for periods of two weeks to two months. The average immigrant could not pay the fines thus, prison was often the only alternative. For instance, in 1840, of the 1403 persons incarcerated 951 served sentences of three months or fewer for breach of contract.  By 1860, of the 4313 total prison population, 3005 served prison sentences of three months or fewer, while in 1880, of 8393 prisoners, 7459 served similar sentences.  As the general prison population began declining in the waning year of immigration, the high rate of incarceration for persons serving sentences for three months or fewer remained constant. In 1900, for instance, 3045 of the 4610 persons incarcerated served sentences of three months or fewer. It was only after the abolition of immigration in 1917 that a perceptible decline can be observed, for example, in 1918, of 3367 1321 were incarcerated for this duration (TNA, British Guiana Blue Books, 1860, 1880, 1890, 1920).

Beginning in the 1880s Annual Prison Returns categorized convicted persons according to their nationality.  The authority’s need to classify the prison population by nationality is of itself an indicator, not only of an increasing East Indian population in the jails, but also their disproportionate incarceration.  For example, the total population of the colony for 1884 was 252,186.  The East Indian segment of the population was 32,637 of which 15,251 were under indenture. The Annual Prison Returns for that year reveals the following: of the 4,659 persons incarcerated, there were 11 Madeirans, 36 Americans, 43 Chinese, 57 Africans, 84 Europeans, 97 other West Indians, 658 Barbadians, 1630 British Guianese, 2043 East Indians (NAG, 1884).  While in this year East Indians represented 12.9 percent of the Colony’s total population, they represented 43.9 percent of persons in jail.

Associated with the rise in incarceration rates for immigrant labour was an exponential growth in prison locations in the colony. These prisons, interspersed along the sugar belt, ideally located for immigrants to serve short sentences.  Planters continuously petitioned the local legislature for additional prison locations, complaining that in some area “five or six days might be spent in journeying to and from the prison where hard labour was to [be] perform[ed] so that short sentences of seven days or less were rendered ludicrous [and] an expensive waste of time” (NAG, 1860).  In 1838, British Guiana boasted three prison locations in the three administrative counties–Demerara, Essequibo and Berbice–to serve the colony’s 65,556 inhabitants. The two prisons at Georgetown and New Amsterdam, pre-dated British occupation (1803), while the Wakenaam Goal was established in 1837.  At indenture’s abolition in 1917, the colony, with a population of 298,188 had eleven prison locations (NAG, 1860). 

During the seventy-nine years of indentureship, the colony established Capoey Gaol (1838), Her Majesty’s Penal Settlement Mazaruni (HMPS) (1842), Fellowship Gaol (1868), Mahaica (1868), Suddie (1874), Best (1879), Number 63 Gaol (1888), and Morawhanna (1898) (Adams, 2010).  After the abolition of the indentureship system most of these prisons became uninhabited and closed for lack of inmates, thus by 1920 only Georgetown, New Amsterdam, HMPS Mazaruni and Morawhanna prisons remained open (NAG, 1921). This strongly suggests that immigration was the driving impetus for prison expansion. The country currently has five prison sites for its 750,000 inhabitants.

These statistics elicit a number of questions including: what were prison experiences like for these immigrants?  What accommodations, if any, were made for them in the system?  How, in other words, was the penal system, and the administrative structures that supported it, transformed by the presence of this new group of people whom those in power wished to control?  Other historians have established a connection between immigration and increasing mental health issues among East Indian immigrants. (Moss, 2020) To what extent did incarceration influence this phenomenon or did mental health issues influence incarceration?  I anticipate that as our team continue its research into Mental Health, Neurological Disorders and Substance Abuse in Guyana’s jails, we will uncover answers to these questions.   

Estherine Adams is a research associate on the ESRC GCRF project Mental Health, Neurological and Substance Abuse Disorders in Guyana’s Jails, 1825 to the present day.

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Epidemics and pandemics in British Guiana’s jails, in the 19th and 20th centuries

Clare Anderson and Kellie Moss

As has become evident as the Covid-19 pandemic extends its grip all over the world today, jails are environments in which infectious diseases can be easily spread. This is especially the case in overcrowded conditions, most especially where prisoners share accommodation and washing and toilet facilities. Historically, outbreaks and epidemics of diarrhoea, dysentery, respiratory illnesses, and whooping cough were the most prevalent diseases in the colony of British Guiana, including in prisons. To these can be added the mosquito-borne illnesses malaria and yellow fever. Limited levels of healthcare and poor sanitation within the prison system meant that after the British began its jail building programme from the 1820s, containing the spread of disease was an ongoing problem. In Her Majesty’s Penal Settlement (HMPS) Mazaruni in 1871, for example, over a third of the prisoners in hospital were suffering from diseases incurred by overcrowding, bad ventilation, and a ‘total lack of any sanitary measures’. The following year, fears were expressed that in the event of an epidemic, Georgetown jail was so overcrowded that the consequences would be disastrous. In fact, this scare underpinned a call for a reduction in the number of prisoners overall, though this did not follow until the first part of the 20th century.

Plan of New Amsterdam Jail, 1841, showing the hospital (“C”)

Despite this recognition, a general lack of concern regarding the welfare of prisoners ensured that epidemics continued to plague the prison system in the decades that followed. Furthermore, once an infectious disease entered the system, the authorities were unable to keep it contained. For example, following an initial case of influenza at HMPS Mazaruni in 1895, recurring outbreaks of the disease were reported in Georgetown, New Amsterdam and Suddie prisons until 1899. The medical officers however, routinely denied any connection between ‘prevalent diseases’ and living conditions. The outbreaks were, instead, attributed to the debilitated condition of the inmates prior to their admittance to prison. This, the medical officers noted, left many prone to catch the disease after only the ‘slightest exposure to chill’. It would be almost 20 years before colonial prison authorities were willing to take responsibility for the conditions that facilitated the spread of infectious diseases.

HM Penal Settlement on the Rio Massaruni, c. 1870-1931. Source: The National Archives UK CO1069/355
‘This view is taken from the side gallery of the Superintendent’s house. The Prison faces East, towards the river. These Halls … are now the oldest portion, and are built of stone … The Union Jack is hoisted on Sundays and special festivals. The Convicts are fallen in on parade, for muster and search before proceeding to labour after their dinner, and represent about 300 men. The end of the roof of the Commissioners’ House is seen to the right among the trees.’

In September 1919, the Acting Surgeon-General of British Guiana J.H. Conyers submitted his usual annual report to Governor Sir Wilfred Collet. In it, he noted the prevalence of the ‘influenza epidemic’, or what we now commonly refer to as the ‘Spanish flu’. What had started out as a mild strain in August 1918, had by November become a severe epidemic that had penetrated the furthest reaches of the colony, including especially dwellings on the plantations. The hospitals of Georgetown and New Amsterdam were, Conyers reported, ‘sorely tested’. In words that resonate today as the Covid-19 virus challenges health systems all over the world, he concluded that the medical service had only managed the situation through deferring all non-urgent operations and other hospital work. Efforts were also made by the health authorities to isolate patients, and their visitors, to eliminate the possibility of the spread of the infection by acute carriers. We now know that the Spanish flu killed between 25 and 30 million people worldwide. The most devastating pandemic in modern history, it affected the whole of the Caribbean, including the colony of British Guiana. It was estimated at the time that out of a total mortality of 8,887 in the months of December, January and February, influenza was responsible for 6,378 deaths. Historian David Killingray puts the figure even higher, at perhaps as many as 20,000.

The influenza pandemic also impacted on the colony’s prisons. From the first recorded patient in Georgetown jail, in December 1918, a virulent strain of the disease spread rapidly throughout the prison population. The transfer of inmates between prison sites meant that cases of the disease emerged soon after in Mazaruni, New Amsterdam, and Suddie. In comparison to previous years the total number of deaths recorded tripled. In 1917, 17 inmates had died in hospital. In 1918, the figure was 30, or 6.5% of the daily average (i.e. the number of prisoners in jail on any given day, not the total number admitted during the year). Although we do not have details of the cause of all these deaths, the Acting Surgeon-General noted the pandemic was to blame for ‘a considerable part’. It was also noted, at the time, how prompt preventive measures by prison authorities, such as the isolation of those displaying symptoms, and improved sanitary measures helped to prevent an even greater spread within the system. This was a difficult task given that fever and dysentery was rife amongst members of the prison staff. Most significantly, however we have no sources that indicate how prisoners and prison officers – or the population at large – understood and experienced the pandemic. Whatever the case, we do know that the overall mortality from the influenza pandemic in the colony was high, as 17.7% of those who contracted the disease died. This figure rose to 21.1% in the colony’s prisons. This means that although a relatively small number of inmates died, they died in larger numbers than the free population. Furthermore, the colonial authorities used prisoners to dig graves in the colony’s capital of Georgetown.

New Amsterdam Hospital, c. 1950. Source: Government Information Agency, Guyana

In the wake of the outbreak, a concerted effort was made by the prison system to enhance levels of hygiene. From this point a small group of prisoners were designated the task of improving sanitary measures within each prison. Efforts to isolate sick inmates and disinfect their cells were also strictly adhered to, although these attempts were not always successful in impeding the spread. Medical officers were often required to convert association wards into temporary hospital bays due to the number of cases, and the lack of suitable medical facilities. At a senior level further attention was also paid to reducing contaminated water supplies, and the breeding of flies, common sources of dysentery and diarrhoea. Yet, despite these efforts intermittent outbreaks of disease continued to plague the colony, although never again on the scale experienced in 1919. For example, there was a localised epidemic at the end of 1933. This caused higher rates of morbidity and mortality overall across the whole colony, but for reasons which are not entirely clear did not impact on prisons.

Clare Anderson is Principal Investigator, and Kellie Moss is Research Associate on the ESRC GCRF project MNS disorders in Guyana’s jails, 1825 to the present day.

Sources:

Papers relating to the improvement of prison discipline in the colonies (London: Harrison and Sons, 1875).

The British Library, Surgeons-General Reports, 1894-95, 1895-96, 1897-98, 1898-99, 1917, 1918, 1919, 1933, 1935 & 1938.

The British Library, Inspector of Prisons Reports, 1894-95, 1895-96, 1897-98, 1898-99, 1917, 1918, 1919, 1933, 1935 & 1938.

The National Archives UK, British Guiana original correspondence, 1872; Colonial Office Photographic Collection, c. 1870-1931.

Richard Coker, ‘Expert Report: Covid-19 and prisons in England and Wales’, 31 March 2020

David Killingray, ‘The Influenza Pandemic of 1918-1919 in the British Caribbean’, Social History of Medicine, Volume 7, Issue 1, April 1994, pp. 59–87.