Several events informed the choice of mental health as the focus of this week’s column. Firstly, I came across the 2022 report by NACADA, Kenya’s national substance abuse institution, on the status of drug and alcohol abuse.
The contents of the report were disturbing. There was a worrying increase in substance abuse especially among the younger population much of which pointed to depression arising from youth hopelessness and helplessness.
The second event were the grisly happenings in Shakahola with more bodies joining hundreds of dead Kenyans already exhumed. Among other causes, Shakahola, points to a level of desperation that leads to mental health challenges.
Finally, I had a long conversation with a good friend who is a long-term campaigner on mental health issues who introduced me to the shocking reality of this issue that is now a global and local emergency.
First some numbers. A 2014 report by the World Health Organisation, indicates that one in four Kenyans, 25 per cent of our population, has some level of mental health challenge. This includes the whole range of mental health complications from mild depression to severe psychosis.
Note that this report was issued at a time when the economy was healthier and before the Covid pandemic which turned mental illness into a global emergency. I suspect the numbers now are higher.
The second set of critical numbers is mental health professionals. While Kenya has a general deficit of medical professionals, the situation is most acute in mental health. Kenya has only 116 psychiatrists and 500 registered psychiatrist nurses in a population of 50 million people, 25 per cent of whom may need professional help!
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To its credit, Parliament passed fairly progressive legislation on mental health in 2022, through four years of tireless efforts by former nominated Senator Sylvia Kasanga. The Act makes provision for protection of persons with mental health challenges and makes extensive provisions that would reduce the stigma. One of its most useful innovations is a focus towards community interventions in managing the illness, largely in view of the dearth of professionals in the sector.
The Act has useful provisions on devolving mental health so that counties make local plans and allocate funding towards this issue. Unfortunately, it appears there is a campaign to recentralise mental health, which would be retrogressive.
One hopes that progressive minds will prevail. Sadly, despite these lofty provisions in law, the lethargy of our approach is evidenced by the fact that a year after the board was established, it has been moribund. Other than the Act, Parliament also made significant budgetary allocations towards mental health including plans for a new Mathare hospital, though this has not been actioned. Consequently, it would appear that our challenges in tackling mental health issues are not in the law or policy but on implementation. To avoid this scourge running out of control, implementation must take priority. Some urgent interventions include an acceptance that this is a national problem.
This calls for concerted efforts by media, the education sector, religious communities, professional and other non-state actors to remove the issue from the shadows and treat it as any malady that affects society. The days of mental health stigma must end. Secondly, government must invest in community health interventions in the sector as a matter of urgency.
In his interview last week, President Ruto talked of the investments being made jointly with counties to engage more community health promoters. This cohort must include trained mental health promoters.
There must be enhanced efforts to deal with the problems that are progressively leading to more serious cases of mental health including the helplessness and hopelessness that send people to drugs and cults that exploit them.
More civic awareness is needed so that society owns this issue and perceives it positively. Finally, government must convert the laudatory legal and policy pronouncements on mental health to reality.
Kenyans, we have a problem, and it is devastating our population. It is not unmanageable. Yet. But handled poorly, it will shortly reach pandemic proportions.
The writer is an advocate of the High court of Kenya