By Sophie Nyongesa
The World Mental Health Day is celebrated annually on 10th October, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health. The theme for this year’s World Mental Health Day campaign is increased investment in Mental Health for greater access. The World Health Organization defines mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.
The Government of Kenya recognized the severity of the status of mental health and set up a mental health taskforce in November 2019 led by a team of experts in the field. The task force was mandated to assess Kenya’s mental health systems including the legal, policy and administrative environment to identify areas that may benefit from reform, for optimal delivery. The task force also went around the country and collected views from key stakeholders and organizations working on mental health. Key findings of the Kenya mental health taskforce indicate that Kenya has a high burden of mental illness due to ill health, psychosocial disability and premature mortality with huge gaps in access to care. In Kenya, it is estimated that one in every 10 people suffer from a common mental disorder. The number increases to one in every four (20-25%) people among patients attending routine outpatient services. The World Health Organization’s 2017 report on the world mental health situation ranked Kenya fifth among African countries with the highest number of depression cases. Moreover, the mental health taskforce report shows that there exists high levels of depression and suicidal behavior, high levels of mental distress and substance use in Kenya.
The Kenya Mental Health Policy 2015-2030 is a commitment to pursuing policy measures and strategies for achieving optimal health status and capacity of each individual, with a goal of attaining the highest standard of mental health. The policy outlines that mental health is a key determinant of overall health and socio-economic development. Despite the well outlined guidelines and priority actions in the mental health policy, Kenya still faces a lot of challenges in regards to provision of optimal and affordable mental health care and treatment. One of the biggest challenge is low awareness of mental disorders particularly, the symptoms of this conditions among the persons suffering from the condition and the community at large. This has largely led to instances where mental illness continue to be marred by myths and misconceptions including being a curse, witchcraft and spiritual problem, instead of a disease that can be treated and managed if and when diagnosed and managed professionally. More often the affected people resort to isolation and don’t seek medical help.
The report further showed that Kenya was among the 28% of WHO member states that did not have a separate budget for mental health, and the government expenditure on mental health was 0.01% of the total budget Moreover, the report shows that there are many gaps in mental health infrastructure. Among the 284 level 4 hospitals, mental health services are only provided in paltry 29 of these hospitals, representing only 0.7% of the facilities. Psychiatric units are only available in 26 out of 47 counties in Kenya. Patients seeking mental health care in the remaining 22 counties are most often forced to travel to Mathari National Teaching and referral Hospital, the only national hospital fir mental health. According to the Office of the Auditor General, the referral system in place cannot work for provision on mental healthcare services since most of this staff are unavailable in almost all institutions in level 1 to 4 of referral systems while others are thinly distributed between level 5 and 6 facilities.
Tinada Youth Organization’s 2019 research on the status of mental health policy, rights, financing and service delivery in Kisumu, Kakamega, Bungoma and Vihiga counties revealed a number of pertinent issues regarding the mental health status in these counties. Among the challenges faced by the people with psychosocial and mental disorders in the communities included; financial constraints, discrimination, stigma, fear of violence and inadequate availability of essential drugs for psychosocial and mental disorders. Moreover, the number of health personnel in these counties was very low; with only Kakamega County having one psychiatrist among the four counties while the psychiatric nurses were 7 in Kakamega County, 2 in Vihiga County, 4 in Bungoma County and 5 in Kisumu County. An average of 74.5% of the respondents felt that health care workers stigmatize and discriminate people with psychological and mental disorders. It was also clear that 82.5% of the families with lived experience on mental health are not aware of the mental health packages offered by NHIF scheme and UHC project.
The COVID-19 pandemic has exerted considerable pressure on public mental health globally. The World Health Organization (WHO) reports that by far, the largest public mental health impact has been in the form of stress and anxiety, and predicts a rise in depression, suicide and substance use in the coming days. With the pandemic rapidly rising in sub-Saharan Africa including Kenya, there is need to provide evidence to guide the mental health response in the region. While guidelines for the management of mental health conditions during the COVID-19 pandemic have been prepared, implementation remains a major challenge due to a poorly resourced mental health system. There is no mental health surveillance system in place limiting ability to design evidence-based interventions. The Ministry of Health (MOH) through its Division of Mental Health has nonetheless embarked on efforts to deliver mental health care during the pandemic. Unfortunately, the mental health response is occurring against a backdrop of an under-resourced mental health care system characterized by inaccessible services, an acute shortage of mental health workers and limited funding. This is hindering current efforts aimed at mitigating the mental health impact of COVID-19 in the community.
To mitigate the challenges faced by the mental health sector in Kenya, various strategies have to be put in place. The Tinada Youth Organization research on the status of mental health policy, rights, financing and service delivery in four counties in Kenya made a number of recommendations in improving the mental health status including;
- Fast-track development and approval of a clear roadmap for mental health at the county and national level including the review of the Mental Health Act, finalizing the Mental Health Policy, development and financing of a costed mental health strategic plan.
- Support multi-stakeholder engagement spearheaded by NHIF staff to sensitize the public and families with lived mental health experience on the available mental health packages under NHIF scheme and Universal Health Coverage.
- Enhance the capacity (knowledge, skills and attitude) of caregivers, family members, community mental health champions, community health workers, local CSOs and local leaders on the rights of people with mental disorders and related issues in line with World Health Organization’s quality rights in order to reduce stigma and discrimination.
- Strengthen mental health budget advocacy at the county level in order to increase mental health budget investments to improve community based mental health programs that promote the rights, dignity and social inclusions of all persons with mental health conditions and psychosocial disabilities.
- Improve the current state of mental health infrastructure by improving the bed capacities in psychiatric units as well as training more mental health personnel to be distributed in the various health facilities.
- Strengthen mental health education and training to young people in and out of schools to promote mental health awareness and improve health seeking.
- Build and strengthen the capacity of local and national media stations on mental health reporting to deliver positive messages and advocate for quality health services, protect persons with mental health and psychosocial disabilities against all forms of discrimination and stigma.
- Upgrade the mental health medication beyond first generation medication to lessen the effects.
- Inclusion of distinct mental health reporting indicators in the current reporting tool (MoH 515) and in the DHIS2 portal. Further, CSOs and other stakeholders should continuously advocate for the inclusion of additional distinct indicators in the current MoH reporting tools (513,514 and 515); and support trainings of CHVs and CHEWs in the utilization and administration of the adopted tools.
The county and national governments should declare mental illness a national emergency of epidemic proportions in order to prioritize mental health as a public health and socioeconomic agenda. Moreover, there is need for involvement of various stakeholders from the family and community level to the national level in the quest to ensure mental wellbeing of the people in the country.
As we celebrate the World Mental Health Day, let us look at the body of evidence that exists and fully implement the mental health policy and recommendations of the task force on mental health status. The mental health of every Kenyan is a fundamental human right!