What we must do in the silent mental ill health pandemic

kibwana warns of poverty

Prof Kivutha Kibwana

The subject of mental health is of paramount national concern. In 2011, the Kenya National Commission on Human Rights estimated that up to 25% of outpatients and 40% of inpatients attending the country’s health facilities suffered from mental illness.

In 2019, commenting on mental disorders President Uhuru Kenyatta said “Depression has today become a common phenomenon and it affects persons from all walks of life and ages.”

Later in the year, he appointed the Frank Njenga Mental Health Taskforce whose mandate was to address the mental health concerns of Kenyans. The Taskforce recommended that the President declares mental ill health a national public health emergency.

One Sunday when I was MP for Makueni constituency, I played draughts at a place called Senta with a young man described as mad by his community. The “mad man” proceeded to trounce me before I had crowned any piece as “king”. I pronounced that he was not mad; how could he be? Next time I heard of him, he had secured employment in Mombasa.

In 2007 as I campaigned to regain the MP position, I went to Kithumani to canvass for votes. A hurriedly gathered crowd assured me of re-election. However, one young man, who is now deceased, shouted the crowd was lying. The people retorted he was the “market mad man”. But true to his lone words, I lost the election.

When I reflect about these two episodes, I think the young men’s problem was probably depression, but their community misinterpreted their seemingly bizarre demeanor. Clearly, the stereotype “mad” is discriminatory and stigmatizing. That tag trivializes mental illness and its treatment.

The World Health Organization (WHO) defines mental health as a person’s condition with regard to their psychological and emotional well-being through which the individual realizes his or her own abilities, can cope with normal stresses of life and can work productively.

On the other hand, mental illness is a wide range of symptoms that affect mood, behavior, thinking and a person’s perception of the world. Symptoms of mental illness are common and diverse ranging from issues thought to be mundane like worry, sleep disturbance or irritability to complex disorders such as depression, anxiety disorders, suicide, self-harm, schizophrenia, bipolar mood disorders, personality disorders and drug dependency.

Spiritual life

Mental illness has several causes. Biological ones relate to genetics, family predisposition, brain defects or injuries, infections and birth injuries. Psychological causes have to do with stress, history of abuse and adverse childhood experiences. Social causes include poverty, violence, conflicts, isolation, loneliness, bereavement, trauma and unemployment. Loss of touch with one’s spiritual life or moral compass are important causes of mental disturbance. Similarly, disasters often induce mental illness.

Our society perceives mental illness through various prisms which include; witchcraft, demonic possession or medical diagnosis. These perceptions influence patient treatment and care.

A large percentage of mental illnesses present with complains similar to physical diseases. If inaccurately diagnosed especially at lower primary health facility level, the mental health condition can worsen due to delayed referral.

Our communities often ostracize mentally ill patients. Most of us routinely avoid contact with mentally disturbed persons, thinking they pose danger.

The country suffers a huge deficit of inpatient mental health facilities with Mathari mental hospital being the only referral facility. Other inpatient facilities are in Machakos, Gilgil and Port Rietz in Mombasa. Majority of rehabilitation facilities are private sector, faith and NGO based.

Psychiatrist, counsellor and psychologist ratio to the population remains acutely low. For example, there are approximately 120 psychiatrists serving a population of 48M.

The mental health sector is grossly underfunded at both the national and county levels. According to the Kenya Mental Health Action Plan 2021 – 2025, only 0.01% of the national health budget is allocated to mental health. The amount of money ought to be spend on mental health is KES 250 per capita but Kenya is spending 15 cents.

NHIF coverage for mental health diseases although high is not comprehensive. Most insurance companies do not cover rehabilitation treatment for alcohol and drug abuse patients.

Ground for divorce

Kenya’s mental health policy and legal framework is wanting. The current Mental Health Act of 1989 criminalizes mental health patients’ behavior such as attempted suicide and a wide range of substance abuse. So, does the Penal Code. Even Kenya’s marriage law allows a partner’s chronic mental disease to be a ground for divorce.

The above policy and legal regime is inconsistent with the 2010 Kenya Constitution and the Convention on the Rights of Persons with Disabilities which guarantee the right to health.

Existing laws such as the Mental Health Act and the Counsellors and Psychologists Act have not been implemented as required. The Kenya Board of Mental Health and District Mental Health Councils have not been established. Similarly, the Counsellors and Psychologists Board is yet to be installed.

Both the Kenya Mental Health Policy (2015 – 2030) as well as the Kenya Mental Health Action Plan have barely been implemented.

The Mental Health (Amendment) Bill, 2020 sponsored by Senator Sylvia Kasanga promises to breathe fresh air into the mental health legal framework. The Bill’s provisions are mindful of the dignity and human rights of mental illness patients.

At this juncture, let me share briefly Makueni county’s mental health experience. In 2014, 19 people died in Kithuki location after imbibing methanol laced alcohol while about 69 lost their sight. Two years later in 2016, we lost 8 students from Makueni while 35 others survived the Garissa terrorist attack.

In these two instances, we hired counsellors to provide psychosocial support to survivors and the bereaved.

Prompted by the emerging need, in September 2016 we established a mental health unit based in all sub-county hospitals and headed by a psychiatrist, Dr. Joseph Masila Makenga. It is made up of counsellors and psychiatric nurses.

Since inception to March 2020, the unit had reached about 65,905 persons mainly through individual and group counselling sessions.

Prof. David M. Ndetei’s Africa Mental Health Research and Training Foundation supports the unit through relevant research, while Makueni’s First Lady, Nazi Mwambura who is a counsellor acts as unit patron.

In my view the full implementation of Njenga’s Report; passage and implementation of an appropriate Mental Health (Amendment) Act; and the full implementation of the Kenya Mental Health Policy and Action Plan will herald a new era of substantively confronting the country’s silent pandemic.

In conclusion as citizens we must acknowledge mental illness as a reality; commit ourselves to a lifestyle which promotes mental well-being and happiness; and lobby leaders to give due attention to the mental health agenda.

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