I'd have attack in matatu and nobody would help me

I was diagnosed with diabetes when I was six years old, leading to many hospital visits, thereby, inspiring me to pursue a medical course. In primary school, other children teased me during the self-inject insulin routine, but I shrugged it off.

In high school, the disease took a toll on me and I missed classes while seeking treatment.

One day along Tom Mboya Street in Nairobi, I got a hypoglycemic attack and almost fainted. My speech became incoherent and I tried by sign language to communicate to those nearby.

They thought I was drunk or had smoked bhang and pushed me away from the notice board which I was leaning on. I moved falteringly to an adjacent restaurant and a waiter brought me a soda.

The other incidence occurred in a bus to Utawala, when my blood sugar dropped without warning, making me unable to alight at my home stage. The bus stopped at its final destination and the conductor noticed me. Since I could not talk, he angrily pushed me out of the bus. My help came from a pharmacy shop attendant who sensed I might be sick and gave me a sweetener.

ALCOHOLIC FATHER

These incidents show how ignorant the public is about health.

Due to this, I decided to be a clinical officer specialising in psychiatry. Mathari Hospital accorded me the much-needed practical experience.
A psychiatric clinical officer is trained in psychiatric assessment, diagnostic and treatment.

One of the reasons I chose a career in mental health was because my father was an alcoholic. He would swear and make a resolve to change his ways, but was unable to. I wondered why he would go back on his word.

My work has made me realise how unaware the public is on the mental wellbeing of their close family members. One time I handled a case of a 13-year-old boy brought in by his mother. The mother was very devastated and needed help on how to handle a drop out exhibiting odd behaviour.

The mother was convinced that all these ‘problems’ were due to witchcraft. However, the boy shared his experience on how his parents were always fighting, creating a chaotic environment for him. This led him to smoke bhang.

MISDIAGNOSIS COMMON

Kenyans have little understanding of mental health. According to the World Health Organization, mental health is a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.

Most people will attach mental illness to curses, witchcraft, cultural practices like non-payment of dowry or polygamy. There is lack sensitisation on mental health when people visit hospitals.

When a patient visits a hospital and explains their case, if it is unclear to the health worker, they get treated like those who are physically unwell. Precious time is lost treating and attending to misdiagnosis while the real issues of mental health are not tackled.

To start with, specialists should create sessions for mental health awareness. For example, when people have malaria symptoms they know it and seek help at once. If the public is aware of the tell-tale signs of mental illness, it will encourage health-seeking behaviour.

The awareness will reduce stigma associated with the condition. When people are aware of what it means to have bipolar disorder, depression, schizophrenia, alcoholism among others, they will not stigmatise those with the conditions.

Several factors inhibit the mental health approaches for the population. Firstly, some hospitals do not have a resident psychologist, yet we have them trained in our institutions. For instance, there are so many government-trained psychiatric clinical officers, psychiatric nurses and psychologists who have requisite skills, but are not engaged. This has created wide gaps in mental health approaches in our country.

Secondly, a large section of patients are using first generation antipsychotics (drugs for treating mental illnesses) discovered many decades ago. These drugs are cheap and readily available in common drug stores. However, their side effects are intolerable and patients withdraw from them before remission.

COVID-19 PANDEMIC
Thirdly, those unable to tolerate side effects are recommended the second generation antipsychotics. They have minimal side effects with good prognosis and the outcome is favourable. However, they are priced higher than first generation antipsychotics.

It would be better if all patients visiting a health facility and exhibiting mental illness symptoms are attended to by a specialist with psychiatric knowledge. The synergy between medical doctor/clinical officer, psychiatric clinical officer/psychiatrist and psychologist can go a long way in filling the gap in mental health interventions.

Doctors will normally check for illnesses like malaria, amoeba or cholera and if they do not find these diseases, prescribe painkillers and reassure the patient. However, a mental health specialist will take keen interest in the multiple unexplained symptoms and pick up signs of anxiety as pointers to an impending depression.

The impact of the current wave of the Covid-19 pandemic will create so many silent mentally-ill patients who will risk being treated as physically unwell patients. Their situation will continue to worsen such that by the time clear pointers to mental illness become noticeable, recovery will have been compromised.

One reason mental health is not given high priority like other ailments is due to lack of critical data or documentary evidence of all true mental illness cases in the country. Accurate causes of death, including suicides, are not always captured or documented especially those having propensity to mental illness.

One setback in mental health approach is that patients feel untreated when therapy is prescribed instead of injections, tablets, X-rays or brain scans.

Some forums have come up that address the challenges brought about by Covid-19 by supporting patients currently on medication and who may need refilling of drugs. Owing to the prevailing situation, they are unable to go to hospital due to curfews and transport hitches in some counties.

There are online platform for tele-counselling where psychotherapeutic approaches are dispensed via online platforms.