Anguish of Mathari inmates rejected by society

The country’s only referral and training mental health facility, Mathari Hospital in Nairobi, is reeling under the burden of abandoned patients, some of whom have been there for 26 years.

Thirteen of the patients who have been in the facility for the longest time have between them spent 186 years, although the hospital’s administration has declared them cured and fit to go home.

Two of the patients have each been at the hospital for 26 years, another two have been there for 17 years each, four have each stayed there for 16 years and another one for 10 years.

Some of the patients have never received visits from family member or inquiries about their condition.

How to cope

Others have stayed for so long that they have made the hospital their home and taken on new roles such as gardening and growing vegetables or educating new patients on how to cope with life. The hospital, which is the only place they are accepted now, is finding the cost of their upkeep too high.

“We are spending a significant amount of resources looking after them, yet we are operating on a huge budgetary deficit,” said Dr Nelly Kitazi, the head of the hospital.

Dr Kitazi is proposing the establishment supplementary centres, known as halfway houses, to act as a bridge between the patients and their families.

The facilities would accommodate ex-patients and try to re-establish a link between them and their families and community.

Some of the patients are suspected of having committed serious crimes ranging from murder to robbery with violence while in a state of mental illness. In one case, the family is yet to reconcile with a man who killed his parents.

“We have not forgotten what he did, and we shall deal with him,” the family spokesperson reportedly told the probation officer when he asked what they thought about him more than 15 years after he was admitted to the facility.

Those who committed crimes are committed by courts to Mathari as Offenders of the Law with Mental Illness for treatment. According to the law, these patients are expected to be held at the hospital for three years as they undergo treatment, after which their status is reviewed.

The hospital does a comprehensive assessment of their mental status through nurses, psychiatrists, occupational therapists and probation officers. Each writes a report about the patient’s mental status and character. The four reports are then presented to the board for approval before the person is released from the facility.

But if one of the reports is inconsistent with the rest, such a patient’s case is not even presented to the board, and the person in question is considered not fit for discharge from the hospital.

This is where the problem lies. While these patients have been certified by the nurses, a psychiatrist, and occupational therapists as fit to be integrated back into their families and society, the fourth report – the probation officer’s – does not favour release.

For a patient to be released, a probation officer or social worker is sent to talk to family members and neighbours about their readiness to receive and live with the person.

A majority of the families have refused to take such people back, with some warning that they would kill them if they came home. Such attitudes make a probation officer write a negative report, for the patient’s safety.

One man, who has been at Mathari for 26 years after killing a family member, cannot go home because his family has rejected him. His wife, who continues to live in their matrimonial home, has had three sons with another man. The sons have been allocated part of the property and are hesitant to have their “stepfather” released, according to probation officers.

The hospital administrators fear that if they release him, he may turn violent on learning what the wife has done. Or he might be killed or injured by his family members who do not want him.

This has forced probation officers to write negative reports on at least three occasions.

Dr Kitazi said some of the patients are likely to commit serious crimes if released. These decisions are informed by past experience. In one case, a woman who had killed her child was released after three years. She went home and killed her second child.

On release from the hospital, some families decline to receive the patient arguing that justice has not been done by holding the offender at Mathari rather than prison to pay for their crimes. Such families even believe some of these people feigned mental illness so as to avoid prison.

Hostility from the family has forced some ex-patients to return to the facility after a couple of weeks at home. Those who return say they consider the hospital a safe and friendly home. Others have been brought back by their kin after a short stint with them.

Due to such attitudes, the hospital has started a campaign for the establishment of halfway houses to accommodate patients who have been declared fit for integration into society.

Dr Kitazi said the hospital planned on approaching leading companies to offer job opportunities to these people while in these halfway houses.

A probation officer would have to monitor their behaviour as they move between the house and the workplace, business or college. The person on whom the officer files a positive report would be allowed to join his or her family.

– An AWC Feature