Lack of experts leaves mentally ill children in a bind

It takes around 16 months for a child or adolescent who has a mental disorder with evident symptoms to access specialist care, a recent study shows. One child waited for 183 months — 15 years — to access care at the child and adolescent mental health clinic at the Kenyatta National Hospital. By this time, the condition had become worse and the child had to live with the burden of disease, disability, and mortality (suicide).

The World Health Organisation shows that depression is the number one cause of ill health and disability.

The study titled Who seeks child and adolescent mental health care in Kenya? A descriptive clinic profile at a tertiary referral facility, published last month, shows that mental disorders diagnosed in children were due to substance abuse, particularly cannabis/bhang use. Three in 10 children in the study had depression that stemmed from bhang use while others reported using tobacco, alcohol, as well as cocaine.

“The high presentation of substance use disorders to the child and adolescent mental health clinic in the Kenyan setting could be due to the intensified public and media campaigns against drug and alcohol abuse in the country by the National Authority for the Campaign Against Alcohol and Drug Abuse,” says the study.

The other diagnosis was major depression which is characterised by low mood for more than two weeks and lack of interest in nearly all activities, lack of sleep and energy, feeling worthless and hopeless and a feeling of guilt or even suicidal thoughts, the survey on 166 children and adolescents aged two to 18 years attending the child and adolescent mental health clinic at the Kenyatta National Hospital shows.

SILENT ILLNESS

Other mental illnesses such as anxiety disorders, mood disorders, personality disorders, addiction disorders and impulse control disorders also stem from tobacco or alcohol use, psychological distress and impairment in social functioning, among others causes. Others are genetic, linked to imbalances in chemicals in the brain.

Twenty-three children and adolescents in the study reported experiencing suicidal thoughts, and seven had attempted suicide at least once.

However, different cultural contexts and beliefs influenced the parents’ perceptions on whether or not a problem behaviour is an indication of mental health problems.

This could explain in part why very few of the children in the survey, about 19, were referred to the clinic by their primary caregiver. A majority, about 57 children, were referred to KNH by medical practictioners, while another 44 were referred by their teacher. One participant came into the clinic after getting information about the clinic from the media.

The silence around mental health is mainly due to the stigma, discrimination, and isolation that comes with the illness. The research led by Dr Judy Kamau, a child and adolescent psychiatrist, alongside four other scholars, lays bare the challenges of access to mental health treatment in the country at a time when specialists including child psychiatrists and child psychologists are few and far in between, with most of them in Nairobi.

There are about 88 to 92 psychiatrists out of whom, less than five specialise in mental health for children.

Kenya has a population of 44 million, a largely youthful population comprised of 48 per cent children and adolescents. As a result, the study shows most of the treatment is provided by paediatricians, general psychiatrists and general psychologists and nurses, rather than specialists in paediatric psychiatry. The findings of this study will go a long way to support the establishment of programmes that improve timely child and adolescent mental health service delivery.

RED FLAGS

This is vital because these services will be in high demand in the country as there are children infected with Human Immunodeficiency Virus (HIV), those who are sexually abused as well as young criminal offenders. The study adds: “The involvement of various stakeholders such as those from the education sector and the community is key in the development of these programmes.”

The study looked at factors influencing help-seeking in terms of choice of type of care, psychiatric morbidity, sources of referral along the way and time taken to seek help after onset of symptoms.

Signs to look out for: 

•             Feeling worthless, helpless or hopeless.

•             Sleeping more or less than usual.

•             Eating more or less than usual.

•             Becoming angry, disagreeable or argumentative.

•             Skipping classes or school.

•             Having difficulty concentrating or making decisions.

•             Loss of interest in activities.

•             Avoiding people.

•             Overwhelming feelings of sadness or grief.

•             Feeling unreasonably guilty.

•             Loss of energy; feeling very tired.

•             Thoughts of death or suicide.

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Depression is a common mental disorder that affects people of all ages, from all walks of life, in all countries. The risk of becoming depressed is increased by poverty, unemployment, life events such as the death of a loved one or a relationship break-up, physical illness and problems caused by alcohol and drug use. Untreated depression can prevent people from working and participating in family and community life. Talking with people you trust can be a first step towards recovery from depression.

QICK FACTS

• Depression is the leading cause of disability worldwide, affecting up to 350 million people, according to the World Health Organisation.

• Two in 10 of the world’s young people experience a mental health disorder each year.

• Workplace depression— which affects productivity—is collectively costing the nations of Brazil, Canada, China, Japan, Korea, Mexico, South Africa and the US more than $246 billion a year.

• Every dollar invested in scaling up treatment for depression and anxiety leads to a return of $4 in better health and ability to work according to a study in The Lancet Psychiatry.