Mathari’s poor state reflects collapse of mental health sector

Monday July 13 2020

A signpost showing the direction to the Mathari Teaching and Referral Hospital in Nairobi. In 2018, a Senate Committee on Health visited the facility and detailed a host of deficiencies in their report to Parliament. PHOTO | JEFF ANGOTE | NATION MEDIA GROUP


For more than a decade, the Mathari Teaching and Referral Hospital was a ‘favourite destination’ for Health Cabinet Secretary Mutahi Kagwe.

In an exclusive with the Nation, the CS narrated how a childhood friend, who was the best man in his wedding, developed severe mental illness.

“He was a brilliant guy,” Mr Kagwe said on phone. His friend got a scholarship to study engineering in Manchester in the United Kingdom where he even scored a first class. When he came back home, he got a job and rose through the ranks in a multinational company. Then the mental illness happened.

“I watched him get sick and deteriorate. He was hospitalised in the ‘90s and it had become part of my routine to take food and visit regularly,” said Mr Kagwe.

The CS would not reveal the diagnosis or the name of his friend except that he died recently due to complications that were exacerbated by his mental illness.



Nearly 1 percent of the population (about 476,000) suffer from severe mental illness, according to a recent report released by the President’s Mental Health Task Force. This includes psychosis, in which people lose touch with reality and see and hear things that are not real.

In the report published on Tuesday last week, the task force had ghastly statistics — in certain parts of the country, a tenth of children in kindergarten had behavioural and emotional problems; school going children had even higher prevalence of mental illnesses and majority of these were somatic disorders; maternal psychotic disorders were on the rise, some so severe that mothers killed their own children.

Dr Lukoye Atwoli, a member of the task force, gave a heartbreaking description: “A child may experience something so troubling and because they are unable to process it mentally or have not learnt the language of distress to speak about it, it manifests in their bodies like paralysis, convulsions, blindness or deafness that cannot be explained in physical examinations.”

The report also notes the high levels of suicides, of about 5 per 100,000. A majority (60 per cent) were caused by depression or schizophrenia where patients’ thoughts are disordered and often experience hallucinations. Men were three times more likely than women to die of suicide.

Prof Lukoye explained: “Women try to kill themselves more often than men but men are more successful at it because they use very violent means.”

Kenyans with mental health challenges are neglected both by the government and a society that has refused to see it as a medical problem. In November 2018, the Senate Committee on Health visited Mathari Hospital and detailed a host of deficiencies in the report they presented to Parliament in October 2019.

The facility which is designed to hold no more than 700, held double that number. One side was the maximum security prison. Funding was cut yearly; in 2018/2-19, the money meant for drugs was reduced from Sh17 million to Sh2.6 million. Staffing is at 36 per cent — 386 workers against the requisite 1,100.


Interestingly, Mathari cannot use the little money it collects because, unlike other referral hospitals, it is not semi-autonomous. It is a mere department at the Ministry of Health, and whenever the hospital seeks approval to use the money, corrupt officials take them in circles for months.

In 2018, medics at the facility had made peace with giving their patients outdated medicine that psychiatry had abandoned, and this kept patients longer in the hospital with worse side effects: the hospital cannot afford medication for severe forms of psychosis disorders, such as Olanzapine, and for depression, Citalopram.

It’s 2020, and nothing has changed at Mathari. The alternative is private mental facilities, which are expensive. The Kenya National Bureau of Statistics recorded that there were only 421 suicides in 2018. These were figures from verbal autopsy (where people report on their own what they think killed their loved one).

Health experts said these figures are inaccurate — people are often embarrassed to admit that there was a suicide in their family.

Prof Lukoye explained: “Nobody ever asks you ‘why do you have cancer or diabetes?’ But they will always ask ‘why do you have depression?’ And when it is a child in the cases of somatic mental illness, they will say the child is pretending.”