Tag: Mental 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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Interviews and Understanding the GPS

By Emma Battell Lowman

Working through the 110 interviews conducted to date (20 prisoners, 30 community members, 30 prisoner family members, 30 prison officers) by or for this research team has been a key aspect of my work with this project. These interviews were intended to draw out details of individual experience and understanding to help develop a well-rounded and carefully evidenced understanding of the Guyana Prison Service (GPS) as it operates today. This work is in support of our efforts to understand the historical roots and present-day operations and challenges of the GPS and more broadly, and specifically, issues around MNS in these systems and spaces.

Some interviews were conducted by members of the project team, but the COVID-19 pandemic interrupted this work. We were lucky to connect with Fiona (Magda) Wills, the Director of SSYDR who took over the interviews in Guyana, with great success. All interview participants gave their consent to be interviewed and audio recorded, for their contributions to be used anonymously by the project team, and generously shared their time, experiences, and impressions of the GPS. Interviewees were thanked with a small cash gift (honorarium).

Interviewing for this project involved connecting with people whose lives are intimately connected – directly and indirectly – with Guyana’s prisons. These can be difficult stories to share, as people revisit sensitive subjects and delicate moments. The experience of deep listening as an interviewer also involves an intensity of experience and emotion. To better understand the experience of interviewing family members of prisoners, people who live near prisons, and prison officers, we asked Fiona to tell us about her experience and she generously agreed to sit down with Clare Anderson and Emma Battell Lowman earlier this year.

We were keen to learn whether prisons were something people were interested in discussing. Fiona explained, “People generally, people are always very willing to talk, I find! […] they want to talk more, and a lot of it isn’t necessarily related to the interviews but they’re just happy to talk.” In some cases, it seems, these interviews offered a space for people to feel heard about their concerns and experiences with the prison system.

What stood out for Fiona across the three groups she interviewed – family members of prisoners, people who live near prisons, and prison officers – was that “they are all stakeholders” and were invested in the prison spaces being well-maintained and tidy as an important aspect of these persons’ mental health. Many interviewees identified the purpose of prisons as being for the rehabilitation of prisoners as part of a shift from a penal to a correctional approach in the GPS. As Fiona identified, “if you really want to rehabilitate, my belief is that you have to make everybody’s space liveable” and that means attending to the physical spaces inside and outside the prison to benefit the diverse communities involved in and impacted by Guyana’s prisons.

It was something more personal that Fiona told us had the biggest impact on her over the course of conducting the interviews. The thing that “jolted” her was the number of mothers she interviewed who had sons – particularly sons in their 20s – in the prison system who were impacted by the incarceration of their child, and often maintained narratives of their innocence. Fiona said this “gripped” her, because she also has a young son, and this connection made these experiences stand out.

Fiona’s team transcribed the audio recordings of the interviews with great care and expertise (good transcription is not easy or fast!), these were then sent securely to the UK-based project team, and that’s where I come in. I’m the most recent addition to the project team and have come on board to help as the project nears completion. The project team is an excellent collaboration between the University of Leicester and Leicester Prison Service in the UK, and the University of Guyana and Guyana Prison Service, which allows us to combine specific skills and expertise from several areas of study with on-the-ground experience and expertise in the GPS. In turn, this means the work we are doing stays closely tied to the needs and priorities of those most impacted by the GPS while also seeking to make contributions and changes to global research on prisons, carcerality, and MNS (mental, neurological, and substance use disorders). By working to analyse and prepare the interview transcripts for use by the research team, I help to support the collaborative work of the project team to produce practical materials for use in the GPS and research articles for public and academic audiences.

My work with the interview transcripts took place thousands of miles from Guyana, but created a sense of proximity and intimacy as I worked carefully through each one to identify themes and information connected with the project’s key questions and concerns. The immediacy of frustration of family members and prisoners at the long delays in moving cases forward in the justice system, the evident strain on family members who have to provide support to prisoners in terms of food, toiletries, and money to ensure a reasonable level of health, and the fear of violence spilling over from the prisons into the streets and homes of people who live nearby all came through powerfully in the words and stories on the page.

The emotional experience of working with these stories is an important aspect of our work – it helps us find empathetic connections with people whose lives and our own are quite different, and it helps us understand from a personal perspective the direct impacts of the prison system as it operates today in Guyana. Taken together, these interviews present a powerful picture of a system whose impacts extend far beyond the prison walls and the strong case for investment and improvement.

Dr Emma Battell Lowman 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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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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Alcohol, Alcoholism and Mental Health in British Guiana, Part 1.

Deborah Toner

As previous posts have highlighted, the use of alcohol, cannabis and other substances form a major part of ongoing discussions about mental health and mental illness in Guyana in the twenty-first century. Concepts relating to the problematic use of substances also shaped historical understandings of mental health issues in British Guiana and the Caribbean. In two linked posts, I aim to explore how alcoholism in particular was understood during two key junctures in the development of mental health infrastructure in the region: the late nineteenth-century period of asylum reform led by Dr Robert Grieve in British Guiana (part I); and the foundational conferences of the Caribbean Federation for Mental Health in the mid-twentieth century (part II).

While the terms alcoholism and alcoholic are still widely used and familiar today, in both lay and therapeutic contexts, clinical diagnoses of problem drinking have long been moving away from these terms. The fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published in 1994, included alcohol abuse and alcohol dependence as two distinct disorders, while the more recent DSM-V of 2013, integrated the diagnostic criteria for both into one “alcohol use disorder”, with gradations in terms of its severity. Public health bodies such as the WHO have increasingly shifted to the language of harmful drinking and alcohol-related harm instead of alcoholism. There are multiple reasons for these developments; an important one to highlight here is that alcoholism as a concept has, since its inception, been a moveable feast.

The Asylum Journal for 1882. Berbice, British Guiana: printed for the Asylum Press.

By exploring the development and application of the alcoholism concept through the history of mental health in British Guiana, these two linked posts constitute a preliminary attempt to write British Guiana into a major aspect of the global historiography of alcohol in the nineteenth and twentieth centuries. The emergence and spread of medicalized understandings of problem drinking and associated concerns about public health have been a major focus of this historiography (Levine 1985; Sournia 1990; Piccato 1997; Tracy 2005; Toner 2015). Until the nineteenth century, habitual drunkenness was largely understood as a moral failing. Across the nineteenth century, new terms like inebriety, dipsomania, addiction and alcoholism diagnosed certain drinking patterns and practices as medical or psychiatric problems. Moral judgements and social prejudices were still embedded within these new concepts, and they varied in their definitions and applications from place to place. In British Guiana, Robert Grieve devoted many pages of the Asylum Journal (1881-86),produced while he was Medical Superintendent of the Public Lunatic Asylum in Berbice, to analysing the connection between alcoholism and insanity. His interpretation combined analysis of the physiological and neurological effects of alcohol with theories about racial difference, degeneration and the impact of social dislocation. By the 1950s and 1960s, Alcoholics Anonymous, formed in the United States in 1935, had established a significant presence in the Caribbean. The “disease” concept of alcoholism, which Alcoholics Anonymous helped to popularise in lay terms around the world, featured in the early conferences of the Caribbean Federation for Mental Health, alongside broader interpretations of problem drinking that considered the psychological and social legacies of colonialism and ongoing processes of rapid socio-economic change.

Part I: Intemperance, Alcoholism and Insanity in the late Nineteenth Century

Rather than using alcoholism to denote particular patterns of alcohol use, late nineteenth century medical practitioners in Europe, North America and elsewhere typically used the terms alcoholism or chronic alcoholism to describe the range of physiological, neurological and psychological conditions that alcohol consumption could cause. Physicians in British Guiana followed a similar pattern. They made few and only vague attempts to describe an “alcoholic” pattern of drinking behaviour and more consistently employed the terms “drunkards”, with “intemperate” or “vicious” habits in the use of alcohol to convey prolonged or excessive patterns of consumption. In quantifying excess, Robert Grieve ventured some specific observations. In discussing the importance of good diet for general physical and mental health, he stated that the quantity of alcohol consumption “within which safety lies is very limited, not more than a wineglassful of ordinary spirits or its equivalent in the twenty-four hours” (Asylum Journal, 1881). Case histories presented in the journal sometimes described heavy drinking patterns that led to specific symptoms as alcoholism. A 41 year old migrant from Barbados, diagnosed with syphilitic insanity, reported that “he had been drinking freely for some time and he rather proudly declared that he could take a bottle of strong rum without staggering”. Grieve subsequently noted that he had been suffering hallucinations upon his admission to the asylum, “no doubt dependent upon the alcoholism under which he then laboured” (Asylum Journal, 1882). Dr Godfrey, in Georgetown Hospital, was initially stymied in treating a patient suffering from shooting pains and paralysis of the arm, which the doctor suspected had been caused by excessive drinking. The patient, a 39 year old sugar distiller, claimed to drink only “a glass or two of alcohol during the day”, but his wife subsequently informed Godfrey of a “clear and exact history of alcoholism which had been going on for some time”. On giving up drinking altogether, the patient slowly recovered over a period of several months (Transactions of the British Guiana Branch of the British Medical Association, 1891).

Plans for Berbice Lunatic Asylum, The National Archives, CO 116, British Guiana Blue Books.

Medical and psychiatric experts more consistently attributed to intemperance in the use of alcohol, various physiological and neurological imbalances that caused different forms of mental illness. Writing in the Journal of Mental Sciences, James S. Donald described intemperance as “one of the most fertile causes” of “lunacy” in British Guiana, singling out the consumption of high-strength rum, known as “high wine”, for producing “cerebral lesions” over time (1876). Grieve wrote quite extensively in the Asylum Journal about the prevalence of Bright’s disease (an out-of-use term for various kidney diseases) amongst patients of the Berbice asylum, where it was a leading cause of death over several years. He attributed the comparatively high rate of Bright’s disease within the asylum to the long term effects of malaria, poor diet, and intemperance in the use of alcohol, and also argued that drinking alcohol compounded the negative effects of malaria and malnutrition on the kidneys. Further, he postulated a causal link between Bright’s disease and neurological changes that led to insanity and hence, admission to the asylum. For example, in a case history of a 50 year old female patient, “said to be of intemperate” habits, Grieve traced a causal link between her kidney disease and her “cerebral excitement”, which manifested on admission in symptoms such as incoherence, delusions, violent and erotic outbursts, severe head pains and memory loss, and ultimately led to her death via a brain haemorrhage. He concluded the case history: “we have therefore a case of insanity arising directly from Bright’s disease and remotely from intemperance” (Asylum Journal, 1881).

Finally, in exploring the causes of mental illness, Grieve pondered connections between intemperance and theories of racial difference, degeneration and social dislocation. Grieve sometimes attributed an inherited predisposition greater causal weight to mental illness than environmental or lifestyle factors, but all three could be linked through the theory of degeneration. “Proclivity to any disease is influenced by all the previous conditions of life not only of the patient but of his ancestors”, he argued, and that insanity as a disease could often be understood as the last step in the “evolution of degeneration of which too often overindulgence in drink forms the starting point” (Asylum Journal, 1881). Assessing the numbers of patients admitted to the asylum in Berbice up to 1880, Grieve explained that there was a considerably higher proportion of migrants than creoles – a distinction based on being born outside or within British Guiana – likely as a result of having less of a family support network to provide care during periods of mental distress. Within the category of migrants, Grieve further attributed a disproportionate number of African patients in the asylum population to racial difference, in two senses. First, the disorientation of being displaced from a “savage” lifestyle in Africa to the comparatively high “civilisation” of a British colony. And second, as a “race which possesses less of civilisation than any other seen in the Colony”, he argued Africans were unlikely to suffer mental illness because of “mental strain”, a common explanation of insanity in Europe at the time. Instead, the high rate of Africans being admitted to the asylum in British Guiana was taken as evidence that “vice”, especially in the use of alcohol, was a “more active agent in the manufacture of the insane” than “mental strain” (Journal of Mental Sciences, 1880). While so-called ‘moral causes’ of insanity – including anxiety, domestic strife, the strains of modern life – predominated in English cases of insanity, Grieve suggested that in British Guiana such problems weighed little on the minds of people of either African or East Indian descent. Amongst these groups in the colony, alcohol and cannabis (or gange) were respectively considered the leading causes of insanity (Asylum Journal, 1882). The close connection Grieve drew between African asylum patients and alcohol use was also linked to their higher fatality rate as patients compared to other ethnic groups, as a consequence of co-morbidities between cerebral abnormalities, chronic heart disease and Bright’s disease (Asylum Journal, 1883).

By the time the Caribbean Federation of Mental Health was formed in the 1950s, medical and psychiatric professionals around the world increasingly viewed alcoholism as a mental illness or physiological disease in its own right, and the term had become a familiar part of everyday language in discussing problem drinking. Come back to the blog for Part II of this post to find out how such ideas were debated at the Caribbean Conferences for Mental Health in the 1950s and 1960s.

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 Suicide Prevention in Guyana

World Mental Health Day was first observed on 10 October 1992. At that time, globally, not only was mental illness commonly associated with social stigma, but it was often unhelpfully and sometimes dangerously elided with cognitive and developmental disabilities. In 1992, the authors of the ICD (the International Classification of Diseases, then just into its tenth edition) and the DSM (the Diagnostic and Statistical Manual of Mental Disorders, favoured in the United States, then awaiting its fourth edition) were beginning to understand that mental illness spans a range of multiaxial conditions that require nuanced clinical diagnoses. Both classification systems recognized that mental illness has an organic cause but is frequently exacerbated by environmental pressures.

World Mental Health Day, as it was conceived just over a quarter of a century ago, has been focused on raising consciousness about mental health and in ensuring mental illness is treated equally to physical disease. It has also provided a platform to urge governments to adopt policies that integrate individuals who have been or are being treated for mental health conditions into community life, rather than long-term hospitalization in often inadequate state or county facilities. At a time when Western nations, such as the United States, are witnessing more than 25% of its citizens being treated for diagnosable mental health conditions, and when a further 25% are likely to suffer from depression during the course of their lives, it is hard to know where to begin to deal with experiences that stem from multiple factors, some biological and others environmental.

The ICD was adopted in the Caribbean region as the official diagnostic manual by the Pan American Health Organization prior to the independence of many of its nation states. But, partly due to the colonial histories of the region, including a tense relationship with Western medicine, the topic of mental health has only emerged as a priority across the region in the last decade. During the 2010s, CARICOM governments and advocacy groups came to realize that heightened awareness is just part of the solution to what the World Health Organization (WHO) calls a “global health burden” that requires sustained funding, a robust healthcare infrastructure, and treatment courses that integrate drug interventions with person-centred therapy. In Guyana, where there are only 10 trained psychiatrists (3 of them newly graduated in autumn 2019) and limited hospital provision for mental health care (centred on Georgetown Public Hospital), and where mental, neurological and substance abuse disorders are prevalent among the nation’s prisoner population, this is a difficult task.

A starting point for the Guyanese government has been to increase funding for the Ministry of Public Health to ensure that its Mental Health Unit (formed in May 2016) has the physical infrastructure to identify, document, and consciousness-raise about mental health. Led by Dr Util Richmond-Thomas, the Mental Health Unit has used capital development funding (the mental health budget was $105 million Guyanese dollars in each of 2017 and 2018, compared to $17 million GYD in 2016, followed by $43 million GYD in 2019) to better integrate with social care services, to ensure that it is representative of Guyana’s rural regions, and to prioritise specific causes, such as the 2019 focus of World Mental Health Day on “Mental Health Promotion and Suicide Prevention”. This theme dovetailed with World Suicide Prevention Day, which had its own dedicated date a month earlier, on 10 September, organized by the International Association for Suicide Prevention in collaboration with WHO. While Dr Richmond-Thomas recognizes that only a coordinated effort will reduce the health burden of suicides in Guyana, numerous conversations during my two visits to Georgetown in April and September 2019 give me a sense of hope that the national health narrative is on the turn.

Self-harm and suicide rates in Guyana were one of the worst globally in 2017 and they have become a high priority for its Ministry of Public Health, set against the recognition that 79% of suicides occur in low- to middle-income countries (according to recent WHO statistics). Part of the solution is for citizens to feel that they can, without stigma or shame, ask for help in crisis situations, though social and gender coding means (as is the case in parts of the UK and US) that mental health challenges for men and boys often goes undetected until it reaches crisis point.

Another element of the solution is to try to reduce, if not eliminate, social isolation that many advocacy groups identify as the major cause of depression globally but is often a trigger for suicidal ideations. While no national healthcare or social services system is expansive enough to prevent all suicides, the fact that a high prevalence of cases occur in the rural regions of Guyana where access to health facilities is limited (particularly amongst farming communities, where a common means of suicide is the ingestion of agrochemicals), and that mental, neurological and substance abuse disorders are common in Guyana’s jails, are illustrations of the importance of such developments.

On World Suicide Prevention Day 2019, following a 500-person march through the streets of Georgetown, Util Richmond-Thomas delivered a powerful speech titled “Working Together to Prevent Suicides” at the National Cultural Centre, focusing on the complex interplay of factors that contribute to mental health challenges and the need for public-private partnerships to help promote anti-suicide messages. The statistics about the reduction in documented suicides in Guyana in 2018 are positive, reducing from 184 suicide-related deaths nationally in 2017 to 141 documented deaths from suicide in 2018 (according to Ministry of Public Health statistics) out of a population of 747,000. The success of reducing this prevalence was also evident in the awareness of the young Guyanese marchers on 10 September on their two-mile march through the streets of Georgetown. It was an uplifting experience for me, but I was left to wonder whether the message and resources are getting through to the 25% of Guyanese living in rural regions away from the Atlantic coastline.

Given that mental health challenges are part of the fabric of everyday life, only medical interventions via inpatient treatment or a course of prescribed drugs are easy to document and trace. Unless suicide has a clear cause it is also difficult to know if a more accessible health centre or more visible public health information in scattered communities or better job prospects would make a difference overall. The truth is that all these measures would help. As other countries have found, no single-step solution to tackling debilitating mental health conditions is likely to work in the long term, while drug interventions might only temporarily mask complex underlying issues.

There is a temptation to turn to faith for the answer to the despair that can sometimes leads to suicide. This faith can take lots of forms. It can be the faith of organized religion, which is particularly important for Guyana, a country in which 63% of its citizens (according to the 2012 Census) are Christian, 25% Hindu and 7% Muslim. It can be faith in a scripture or a faith in a community of believers, but it is important that it also a faith attuned to the complex socio-economic pressures that might sometimes strain against what these three great religions deem as right living. Or, on a secular level, it can be the faith that life goes on despite hardships, linked to the belief that all individuals can be agents of change, especially when they share and work collaboratively.

Reflecting on the 2019 Suicide Prevention Day March in Georgetown, I was particularly struck by a young University of Guyana student, Dwright Ward, studying in the Department of Communications, who proudly held the banner “You have the power to say this is not how my story will end!” I have looked at this photograph a number of times since that day – a bright young Guyanese student with a powerful message – and I have thought about both its cultural specificity and its transnational resonances because it puts into action the 2018 theme of “Young People and Mental Health in a Changing World”.

On that day of 10 September 2019, so many young Guyanese were willing to put hope and awareness over their studies and their work. This image offers hope for an open narrative that can help safeguard mental health, though it can never guarantee it. And the image offers a powerful symbol for a young nation that recognizes only a sustained, collaborative and multi-pronged approach will shift the dial on suicide prevention long term.

Guyana Inter-Agency Suicide Prevention Helpline: +592-600-7896, guyagency@yahoo.com

Martin Halliwell is Professor of American Studies and Head of the School of Arts, University of Leicester, UK. All photographs taken by the author.

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An historical perspective on Guyana’s jails

Clare Anderson

In the nineteenth and twentieth centuries, the colonial administration of British Guiana managed over a dozen jails, three of which still stand today. These are: Camp Street (Georgetown), New Amsterdam, and Mazaruni. The history of prison building and incarceration in British Guiana was the focus of a recently completed project, funded by the British Academy and conducted by researchers from the University of Guyana and the University of Leicester. The project asked questions about the role of prisons in the colonial justice system, and about historical patterns and experiences of imprisonment. It sought to find out whether history can offer lessons from the past that might be useful for understanding jails today.

HMPS Mazaruni, 19th century

The project team comprised myself and Dr Kellie Moss (Leicester) and Dr Mellissa Ifill and Estherine Adams (Guyana). Together, we undertook extensive research on colonial-era records held in our respective national archives, where we discovered a rich history of continuity and change. We found that colonial prison administrators kept coming back to the question ‘what is prison for?’ From that stemmed near-continual discussion of the same topics. These included the desirability of the separate treatment of different kinds of offenders (and adults and juveniles); the role of religion in rehabilitation; the deficiencies of prison infrastructure; prison security and escape; the morale of prison officers; and the education and training of inmates.

We presented some of our research to a group of serving prison officers, in autumn 2018, and had the opportunity to visit Mazaruni and New Amsterdam. Three things became immediately apparent. First, a great deal of colonial-era infrastructure survives today. Second, at least some of the daily rhythms of incarceration (including modern prison regulations) date from the British period. Third, there remain many parallels between the past and the present, regarding the active debate of exactly those issues that were discussed in the past.

Estherine Adams and Kellie Moss, project workshop, Georgetown, November 2018

New Amsterdam and Georgetown Prisons are the oldest operating prisons in Guyana. They were built by the Dutch, and extended by the British after they took control of the colony in 1814. Later, in 1843, the British constructed Her Majesty’s Penal Settlement (HMPS) Mazaruni, near Berbice. They also built numerous other district prisons, along with several ‘lock-ups’ in the more remote regions. The government of Guyana built the other two modern institutions, Timehri and Lusignan, following Independence in 1966.

The project found that the history of Guyana’s jails is intertwined with the history of colonialism, notably enslavement, immigration, and population management. During the era of slavery, the owners of enslaved persons punished their human property for what they perceived as labour infractions or ill-discipline, often using extremely brutal measures. After emancipation, the colonial state took on this role, and this was the background to the development of prisons in the 1830s and 1840s. The British imprisoned emancipated slaves and others, including Asian indentured labourers, for a range of offences. These included crimes against property, but also what they called ‘idleness’, and breaches of harsh labour laws, including unauthorised absence from home or work.

Indentured Indian sugar workers, early 20th century

The project also discovered that the architectural design of and daily regimes instituted in Guyana’s prisons were strongly influenced by changing European and American thinking about their ideal form and function. The British adapted and built jails according to ‘modern’ prison design. Ideally, prisoners would occupy individual cells, and they would be punished and rehabilitated through a programme of education, work, training and Christian instruction. One notable feature of nineteenth-century punishment was the use of prisoners in colonial building projects. Inmates built and repaired streets and pavements, and constructed parts of the Sea Wall – in the latter case including through the draft of prisoners from Mazaruni to Georgetown. However, despite Britain’s claim to penal ‘modernity’, prisons could be violent places in which prisoners were chained, flogged or placed on harsh rations. Georgetown prison even had a treadmill, which constituted an extreme form of physical punishment.

Mazaruni Prison, 2017. Photograph: Obrey James.

From the very earliest days, where there were efforts to reform and rehabilitate prisoners, they were often frustrated by a lack of resource and difficulties in recruiting guards and other personnel. In large part, these failures reflected the fact that the British never came to a firm conclusion on the rationale for incarceration. Rather, jails always served a variety of purposes, and these were often incompatible with each other. For example, though the British wanted to use jails for different types of offenders, the pressure of numbers meant that prisoners were often transferred to inappropriate locations, and this put a strain on prisoner training, education and work. Also, guards often left employment, or retired early, due to stress and overwork. There even erupted various scandals where it emerged that guards had violently beaten and mistreated prisoners. This led to the establishment of a Board of Prisons in 1862, and the appointment of an Inspector General of Prisons from 1879. These measures increased government regulation over prisons, and enabled some positive interventions such as the introduction of tickets-of-leave (or what we would now call probation), which helped to rehabilitate and resettle inmates.

Several other themes emerged during our research project, notably regarding the mental health of inmates and guards. For example, we found archives that suggested that historically there was excessive consumption of alcohol (by inmates and guards), and that inmates routinely smoked marijuana. We also discovered that some prisoners hallucinated or had delusions, became suicidal, or were transferred to the ‘lunatic asylum’ in New Amsterdam. This led the research team to develop a more focused project, with the goal of exploring issues around the prevalence of mental, neurological, and substance abuse (MNS) disorders in Guyana’s jails. A collaboration between the universities of Leicester and Guyana, in partnership with the Guyana Prison Service and HMP Leicester, this project is both historical and contemporary. Funded by the Economic and Social Research Council, it will run until the autumn of 2021.

Social scientists know that attention to the relationship between lives and environments, and the production of an evidence base, are vital for successful research impact in a field now known as ‘global mental health’. As well as understanding individual health, we need to be sensitive to history, society and culture. Recently, researchers have argued that western concepts and models of MNS disorders require refinement, so that they do not produce misconceived diagnosis or become neo-colonial in their application of knowledge on a problem defined in the West. Our earlier historical research, against the background of this concern, forms the background to our new project.

The project team, University of Guyana, April 2019 – from left, Di Levine, Queenela Cameron, Deborah Toner, Clare Anderson, Dylan Kerrigan, Martin Halliwell, Estherine Adams, Shammane Joseph Jackson, Kellie Moss, Kristy Warren. Photograph: Mellissa Ifill.

The historians on the team, now including also Shammane Joseph Jackson and Dr Deborah Toner, are returning to the archives. Our team of anthropologists, criminologists, political scientists, and sociologists – Dr Tammy Ayres, Queenela Cameron, Professor Martin Halliwell, Dr Dylan Kerrigan, Di Levine and Dr Kristy Warren – are currently examining modern records and undertaking interviews, and will be running focus group workshops, with prisoners, prison officers, and prisoners’ families. Some of the things we want to find out about are how different communities – and men, women and youths – define/ defined and experience/ experienced MNS disorders; what constitutes/ constituted MNS disorders management and welfare provision; and how Empire and Independence impacted on prevalence, representations and experiences.

We want to see if it is possible to connect present-day challenges associated with MNS disorders to the history and legacies of the British Empire in Guyana. Our hypothesis is that the existence of MNS disorders in jails today can be traced back to the British colonial period. Thus, they cannot be disconnected from the country’s history as a sugar colony that employed and controlled indigenous people (Amerindians), enslaved Africans, and indentured labourers. We hypothesize that Empire created particular forms of trauma, shaped demography and religious practice, and instituted patterns of population control including through the building of jails. We seek to render this history actively part of the process of change today, by connecting new historical work to new research in and around prisons in Guyana today.

Clare Anderson is Principal Investigator of the ESRC GCRF project Mental Health, Neurological and Substance Abuse Disorders in Guyana’s Jails, 1825 to the present day.