I am currently deep in my dissertation research in Guyana on suicide, and I have a lot of questions, seems obvious: I am writing a dissertation. But these questions, while related to my research, are somewhat tangential, which is why I am reflecting on them here; this might be a footnote in my dissertation.
What I noticed: Guyana has created a surveillance system to monitor people at risk of suicide (I might be making this sound more insidious than it is, but I am also taught to pay attention to language because language is important to how we communicate and how we say what we mean, and to mean what we say, so for this piece let’s run with my cynicism).
First, monitoring someone is not the same as caring for them.
Earlier this year, a young woman died at Georgetown Public Hospital. She had been admitted a few days before and was referred for a psychiatric assessment after making some claims that were considered suicidal. After the assessment, the hospital said she showed no signs she was at risk. Sometimes it is hard to know risk, and depending on the tools we are using, we may not recognize the risks of someone being suicidal, so I will not cast any blame on anyone who did the assessment, because we have to look at the tools and maybe assess those instead of the people.
However, after her death, the hospital said it would review its “suicide watch” policies and improve “patient observation and mental health monitoring.”
Think about that.
A young woman died in a system designed to watch over her, and the response was to watch some more.
I am writing because the way we react matters. When watching failed, the hospital’s first instinct was to watch even more. Notice the words they used: “suicide watch.” These are words we usually hear in prisons, not hospitals.
But we can see this language is used in the country’s main hospital. The watchtower (a short ethics reading on the panopticon for curious readers) has left the prison and entered the hospital.
In an effort to address the high suicide rates in Guyana, the Ministry of Health, in partnership with the World Health Organization and the Pan American Health Organization, has introduced a National Suicide Surveillance System that is spreading across the whole country.
Three years ago, Guyana made an important change to the laws that criminalized suicide attempt survivors. It decriminalized attempted suicide, removing old colonial laws that could send someone to prison for trying to kill themselves. Who can they ask for help when that asking comes with immense risks? This reform was based on a simple promise: suicide is not a crime, and I agree. People in despair and in hopeless situations should not fear punishment when they need help.
But while we have that promise, we also need to look closely at the new system being built.
In the new plan, I can see the thinking behind prison cells is still present, but now it shows up in how data is handled. Health data about suicide attempts is checked against police records. The act that was just decriminalized is still being processed by the same legal system it was meant to escape. Now, instead of being arrested, people are recorded, classified, reported, and their names are checked against police records.
We told people in pain that they were no longer criminals. But we did not tell them they would become data instead.
This is the first problem with relying on surveillance: it quietly punishes people for seeking help, even though it claims to support them, especially in a context where we have not addressed the stigma and shame around suicidality.
But it goes further.
A surveillance system can count people, but it cannot truly know them. The assessment that found “no risk” before someone died shows how big this gap is. Risk can be written down but still not understood. Someone can be watched but still feel alone.
Surveillance also makes people feel alone.
Being watched is not the same as being cared for. When people are observed from above, they can feel even more disconnected. The plan suggests closing the country’s only psychiatric hospital, which could be a good and humane step. But at the same time, it trains teachers, police, and religious leaders as “gatekeepers” to find and refer people who are “at-risk.” The walls of the asylum come down, but a new system of monitoring takes its place. Neighbors, clergy, teachers, and community members become people who refer others rather than just sitting together, listening, and supporting each other.
Confinement has not ended. It has changed form.
That becomes even harder to accept when we consider who is doing the watching, and what the state has chosen to fund. Guyana is now an oil-producing country, newly classified as high income, yet suicide remains one of its most urgent public health crises. For years, the country has spent only a small share of public health funding on mental health, and even that figure must be treated with caution. Mental health funding is not the same thing as suicide prevention. Not every suicide death can be reduced to mental illness, and not every investment in mental health care addresses the social, economic, spiritual, and historical conditions that make life so difficult to live for so many. Still, the contrast is telling. The state has struggled to build a system of care, but it has found the resources to build systems of monitoring: categories, dashboards, databases, reporting structures, and channels of institutional review. The concepts come from Geneva and Washington. The watcher keeps changing uniforms. Its position remains the same: above us, looking down.
So if watching people is not the same as caring for them, then what does real care look like?
This is the question that surveillance cannot answer. It is also the question we need to take seriously. To be fair, Guyana’s national mental health and suicide prevention plan is not just about surveillance. It talks about community care, human rights, and including people with lived experience of suicide. These promises are important. But too often, people with lived experience are only invited after the system is already designed. They are asked to share their stories with a system they did not help create.
That needs to change.
A better response would start by treating suicidality as something to be met with care, not just recorded. We already know what this looks like. In colonized communities, the best protection against suicide, or any kind of violence and suffering, has not come from more monitoring, but from self-determination. This means communities having control over their own bodies, institutions, languages, land, memories, and future. This is an important link that I’m currently seeing missing from Guyana’s national plan and one we should take seriously.
Support community dialogue circles where people can talk openly about grief, shame, debt, despair, and suicidal pain without having their words recorded. Give people who have survived suicide attempts real power to shape what is built, not just a token seat at the table. Strengthen the family, religious, and village networks instead of turning them into surveillance tools. In Guyana, we are developing fast, and development brings multi-layered needs and problems. We cannot just say we’re fixing one thing at a time when the issues in need of attention are interwoven. At times, unemployment, debt, migration, family breakups, loneliness, land insecurity, alcoholism, domestic violence, and the slow harm of being treated as if you do not matter.
Let people, not technology, be the response to suffering. Listen to stories, not just data. Offer company, not surveillance.
The opposite of a prison cell was never a database. It was always company and care. A decolonial response to despair and hopelessness should replace the watchtower with a chair beside the bed. It should choose to be with people without recording them, to show solidarity without reporting, and to care by sitting next to someone, not above them.
I write this as someone who left Guyana. I migrated and now research from afar. I do not have a perfect solution for the Ministry of Health in Guyana or for the people of Guyana. But I am sure of one thing: we will keep losing people if we keep building better ways to watch them instead of working to accompany them in their moments of despair and hopelessness.
Suicide prevention’s goal should never be to observe suffering from a distance. The real task is to sit beside those who are suffering; we have to listen to them. Hear what’s causing their pain and work to find solutions that are workable in their situations and their community; we always have to be slow to import what others are using elsewhere because caring is not universal (I will write another piece on the problems of universality later). At first, things may not work, but we have to keep trying rather than imposing external strategies that do not fit the context or the people.
As I started with the poem by Martin Carter, he helps us see despair as historical and political: not simply a wound inside the person, but a wound produced by a world organized against freedom and seeks to control it, even our dreams.
If you are struggling with suicidality, please find resources available to you wherever you are and reach out to someone.
In Guyana, the Ministry of Health’s Inter-Agency Suicide Prevention Helpline can be reached at +592-223-0001 or +592-223-0009, or by WhatsApp at +592-600-7896 or +592-623-4444.
In the US, Dial 988
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