This is how expensive it is to access mental healthcare in Kenya

A section of mentally ill patients under rehabilitation at Mathari Mental Hospital in Nairobi. (PHOTO DAVID NJAAGA/STANDARD)
NAIROBI, KENYA: Exactly two days after the world Mental Health Day on 10th October, a manager at PricewaterhouseCoopers (PwC) Nairobi jumped to his death from the 17th floor of Delta house building in Nairobi’s Westlands. Stephen Mumbo was an Assistant Manager of Executory and Forensic Investigations at the international audit firm.

A few days after Mumbo’s tragic death, Nandi County Assembly was thrown into mourning after Stellah Jepkoech, 25, a finance officer of the county assembly committed suicide. Her body was discovered in a hotel in Eldoret town after she was reported missing for two days.

What is even more shocking is that Jepkoech is the third employee at the Nandi County Assembly to commit suicide in the last one year. In May 2017, Kevin Kemboi, a procurement officer hanged himself and a few months in October, Shadrack Biwott a technician at the county referral hospital, committed suicide by taking poison.

LUCKY TO BE ALIVE

Valentine Nyakiere, 29, has attempted suicide several times. The most recent was in July 2018. Before she attempted suicide, she left a cryptic suicide note dated July 23 on her blog - kaschanaa.blogspot.com.

“I am headed to a place where my rapists will no longer invade my nights, humans will no longer torture my emotions, and there shall be no religion to judge me anymore. My shortcomings shall not be recited to me. Oh how sweet it shall be. I want the exit to be enjoyable, for me, I want to enjoy the pain of life one more time, I want to feel that for once I have brought freedom to myself and the pain will not torture me, it will free me,”
part of the blog reads.

Fortunately, her recent suicide attempt was not successful. She was saved by a friend who rushed her to hospital where she spent eight weeks seeing specialists.

In an interview with Standard Digital, Valentine says the cost of accessing mental illness treatment in public hospitals is prohibitive and doesn't allow many with the condition to come out to seek remedy. Even so, she says, "the cost could be higher depending on the hospital one goes to."

COST

Dr Njuguna Eric, a Psychiatrist based in Nairobi put the cost of treating mental illness at between Sh50, 000 to Sh100, 000 before factoring in on the doctors consultation fee of Sh10, 000.

Mathari, Kenya’s known public mental health facility requires a down payment of Sh10, 000 before admission, but one can get express admission if he/she has the NHIF card.

According to suicide survivor Valentine Nyakiere, the cost of accessing treatment in private hospitals is much higher owing to the fact that a patient has to part with between Sh3000 to Sh5000 per day every time a psychiatrist attends to a patient.

“There are instances where I had daily visits by a psychiatrist and at least a weekly visit by a psychologist who would also charge another Sh4000 per visit; remember some doctors recommend a patient to stay for between 2-3 months before recovery,” she adds.

 ‘’The cost is crazy after the whole process, it needs to be figured out to encourage many people get the proper treatment,” she says.

“Mental health in Kenya is grossly underfunded, forcing most of those suffering from it to seek private treatment which is very costly. In cases where they cannot afford to seek treatment, they continue to suffer from the effects of mental illness.”

Amani Counselling Center, Mathari National Teaching and Referral, Kenyatta National Hospital, Aga Khan, MP Shah, Nairobi West are some of psychiatric hospitals and mental clinics in Kenya.

October 10 is a day set aside for global mental health education, awareness and advocacy against social stigma. The day was first observed on 10 October 1992.

The focus of the 2018 World Mental Health Day campaign was on Young People and Mental Health in a Changing World. According to the World Health Organisation (WHO), half of all mental illness begins by the age of 14, but most cases go undetected and untreated.

When the Ministry of Health launched the Kenya Mental Health Policy 2015-2030, it stated that one in every four Kenyans will suffer from a mental disorder in their lifetime.

Sadly, in Kenya, as at 2016, there were only 88 psychiatrists - most of them located in Nairobi. In rural Kenya, the ratio of psychiatrists to citizens is 1:5,000,000 compared to 1:10,000, the globally accepted ratio. This is according to Iregi Mwenja, the founder of Psychiatric Disability Organisation, a community-based organisation based in Nakuru.

According to Dr Njuguna Eric, a Psychiatrist based in Nairobi, cases of mental illness in Kenya are on the decline compared to ten years ago. He attributes the weakening trend to awareness which has seen many shun traditional beliefs previously associated with the illness and seeking medical services from specialists.

"Most cases of mental related illnesses are still more prevalent in urban areas compared to rural sides of the country, this justifies the higher concentration of psychiatrists in bigger cities such as Nairobi compared to other areas," he says.

"We are currently 100 professionals in the country with 90 percent based in Nairobi. The higher concentration in Nairobi is due to the fact that many people caught up with the illness come out to seek treatment, they have realized that the condition is like any other illness which requires proper medical attention," he said.

Rubie Miseda, a Nairobi based Psychologist lists genetics, environmental factors as some of the causes of mental illnesses and notes that many affected are slowly but steadily moving away from traditional and religious beliefs to seek normal treatment, a factor which is helping manage the disease in the country.

However, she notes that challenges such as the cost of treatment and scarcity of specialised health facilities needs to be addressed to help the country fight such cases.

"Although the exact cause of most mental illnesses is not known, it is becoming clear through research that many of these conditions are caused by a combination of biological, psychological, and environmental factors," she says.

"People are moving away from linking the disease to traditional beliefs and realizing that it is a brain condition. There is a need to build more specialised public hospitals for mental health to enable patients from low income areas also come out and seek services at affordable rates," she says.

"Mathari National Teaching & Referral Hospital, which is commonly known public facility is not enough to take care of low income patients; there is a need for more public facilities to counter the private ones frequented by the middle income earners," she notes.

She challenges the government through the ministry of health to allocate more funds in building public mental hospitals like Mathari National Teaching & Referral Hospital.

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