Why the Government should address mental disorders urgently
By Joseph Lister Nyaringo and Tom Motari Mogondo | August 16th 2019
With many challenges in the country such as intractable poverty, corruption, substance abuse, infectious diseases, and marital conflicts, failing to apply interventions on mental health illnesses by the government is like waiting for a time bomb to explode.
It must be remembered that challenges related to poor mental health are compounded by these factors: Ignorance about the extent of mental health problems, stigma against those living with mental illness and mistaken beliefs that mental illnesses cannot be treated and that, it’s some type of voodoo or a spell upon the affected.
There are many misconceptions from Kenyans about mental illnesses with the belief that certain people in society are more prone to illness than others. For example, the menace of drug abuse and rampant alcohol addiction has seen the elite hiding and taking their children abroad for psychiatric care where they spent millions of shilling rather than invest locally to expand and advance the care to meet the local needs.
Mental health illnesses are not a preserve for the poor. It affects all and sundry in the society. That's why Kenya's leadership should not overlook the menace since a good number of famous people are directly or indirectly affected.
Many Kenyans suffer from a wide range of mental illnesses, including schizophrenia, bipolar disorder, depression, dementia, Borderline Personality Disorder (BPD), dissociative disorders, Obsessive-Compulsive Disorder (OCD), schizoaffective disorder, suicidal feelings, Post-Traumatic Stress Disorder (PTSD) to mention but a few.
The need for mental health awareness
Majority of Kenyans do not understand that mental health disorders don't affect the cognitive ability of the affected persons although it can drastically alter one's day-to-day functioning over time; hence resulting to many of the negativities associated with mental health illnesses like suicides and homicides. Mental health disorder, therefore, is not a death sentence but a condition which can be well-managed if a proper diagnosis is made and the right treatment sought.
Another contradicting area where awareness is highly required is on persons with intellectual and developmental disabilities. Unlike those with mental health disorders, the condition of individuals with developmental and intellectual disabilities manifests before one reaches 22 years of age. The individuals in this category have severe limitations on daily functioning skills, conceptual skills, Social skills, and mobility.
Examples of common developmental disabilities include Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorders, Cerebral Palsy, Down syndrome, and vision impairment. It's also very common for a person with mental health disorder to have developmental and intellectual disability, better known as duo diagnosis. This category of people requires more care as opposed to those with mental health disorders.
According to the World Health Organization (WHO), Kenya has about 55-70 psychiatrists and 35 clinical psychologists, fewer than its 500 psychiatric nurses of which, only half work in mental health. This is so yet the country spends only about 0.05% of its health budget on mental health. Discouragingly, about 80% of mental health facilities in the country are located in Nairobi. Millions of Kenyans suffer mental health disorders without any diagnosis or treatment because they cannot access any professional mental health practitioner.
Some developed countries like the US and Britain have a high level of mental health disorders, which are often linked to prescription opioids and naturally derived narcotics.
In Kenya, South Sudan, Nigeria, and South Africa, mental health disorders are triggered mostly by social factors like unemployment, poverty, and marital conflicts. The poor mental health picture is far worse in poorer countries, especially those that have recently experienced civil wars and conflicts than those who enjoy stability and social justice.
The current stigma
Kenyans have witnessed some key public figures take their own lives under unclear circumstances. It is deemed a shame that such a person did commit suicide instead of using the tragedy to help the nation have a productive debate about the right interventions on mental health disorders. The most recent example is the mystery surrounding Prof. Gitau Mugenda's death, where it was purported to have been as a result of suicide.
The man might have been very depressed silently if not having bipolar disorder, which is associated with the most successful suicide outcomes.
There is also the shocking story of a young mentally troubled man Naftali Kinuthia, from Thika who traveled hundreds of kilometers from Central Kenya to Eldoret where he ended up committing homicide by killing his lover Ivy Wangechi, which seems to be clear evidence of a psychotic obsession.
There are numerous critical examples related to mental health disorders. Just recently, a clearly psychotic young man; a University student, Brian Kibet Bera, scaled the walls of State House armed with a knife. Brian appeared to have been suffering from schizoaffective bipolar type disorder based on his thinking and writings on Facebook.
In Kenya, when people talk about having the desire to kill themselves, its often taken as a joke and if you try unsuccessfully be it suicide or homicide, you will end up in jail instead of a mental health institution. Many mental health patients are in prison instead of mental health institutions where they will be evaluated to divulge or rule out their mental state in relation to the crime they committed before their incarceration.
What can be done?
Professor Makau Mutua, was right when he stated last month that the rampant suicide in the country requires an open discussion about the status of mental illnesses in the country. Relevant health professionals should be involved for purposes of mitigating the catastrophe. The old adage, which states that a stitch in time saves nine, should be applied so that we don't continue to lose productive members of our population due to treatable mental ailments.
There is no denying, in developed countries, there are mental health issues. However, unlike Kenya, these countries do recognize that sound mental health is critical for a productive citizenry. That is why consistently inject resources and personnel to address it.
What we need in Kenya is the training of personnel, sensitizing citizens about the stigma of mental illnesses and setting up rehabilitation centers throughout the country where proper diagnoses can be made followed by proper treatment of patients.
Lack of accessibility to psychiatry services is only perpetuating the problem. In most developed nations, the ratio of patient access is one psychiatrist to every 10,000 people. This is clearly not the case in Kenya, where we have approximately one psychiatrist for over 500,000 people, which is not practical.
A country of about 50 million people can comfortably afford at least three certified psychiatrists in every county with one mental health counselor in every high school. This will be the beginning of addressing mental health disorders in Kenya.
The government should embrace professionals willing to give back to society by enacting policies that are favorable for psychiatry practice. Telepsychiatry, which is psychiatry via video access using modern technology is something the government of Kenya should consider given the fact that over 20 million Kenyans are currently powered with smartphones.
Developed nations have enhanced telepsychiatry access, which has proved cheaper, accessible, and faster. One of the authors of this opinion is currently providing telepsychiatry services via video link from the comfort of his office in Wyoming, United States.
A holistic approach from all stakeholders is required in addressing mental health issues. The government, legislators, the citizenry, the church, and other professionals have to play a role. The national government should work closely with the County governments to provide funding and expertise to mitigate mental health disorders.
Sound mental health policies through service design and awareness will be the clearest road map for effective mental health intervention. Other actors who have direct contact with mental health victims are teachers, professors, and medical practitioners who can play a pivotal role if they're empowered with knowledge and the basics of mental illnesses.
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