This past week, mental health was once again in the news, but not in an entirely positive way. The Leader of Majority in the National Assembly declared that a former Cabinet Secretary accusing him of impropriety at the National Youth Service “has a psychiatric condition”.
It is of course easy to see how the presence of mental illness can be used to make it appear that an accuser is mistaken or making things up.
History is replete with examples of such misuse of psychiatry. In Kenya, the colonial government condemned its African opponents to have mental illnesses, and many of them were confined at Mathari Hospital to have their “bizarre delusions” treated. The content of these “delusions”, of course, was that Kenya would one day attain self-rule and the yoke of colonialism would be broken. Elijah Masinde of the “Dini ya Musambwa” was admitted at Mathari Hospital for precisely having such “bizarre delusions”, and many Mau Mau fighters also suffered a similar fate.
The practice of labelling people as mentally ill and, therefore, unreliable and in need of treatment fits very well in the environment of intense stigma against the mentally ill and their carers.
Unless one is well endowed financially, the diagnosis of a mental illness is often the declaration of a socio-economic dead end. Many patients are locked up in their homes and ignored, left for dead for all intents and purposes.
This happens not because their relatives do not care, but because they either do not know what to do, or they do not have the resources required to provide good quality care for them.
Stigma researchers have identified three key interrelated components of stigma. Firstly, stigma is mainly driven by ignorance. When little is known about a condition, people tend to make up stories about people with this condition, ascribing bizarre causes to their suffering. Due to ignorance, many Kenyans believe that mentally ill people are demon-possessed, subject to a curse, or paying for their own sins or those of their forebears.
DEVELOPED NEGATIVE ATTITUDES
This leads to the second component of stigma, which is prejudice. Due to the misinformation arising out of ignorance, many people have developed extremely negative attitudes towards the mentally ill. We make quick negative judgments about people with mental illness.
We are unlikely to believe the testimony of persons previously treated for mental illness. We consider them to be untrustworthy and extremely volatile, even when their mental illness is mild and unlikely to be associated with violence.
The third component, born of the first and the second, is discrimination. This entails behaviour that segregates, shuns, marginalises or blatantly ignores the needs of mentally ill persons. For instance, in a street encounter, we are likelier to avoid a person appearing to be mentally ill than one with an obvious physical condition.
Thus we will run away from unkempt persons talking to themselves in the street, but will approach without fear the dozens of Kenyans with burns, tumours or fractures who often parade themselves in our streets asking for assistance.
The evidence of this discriminatory behaviour was demonstrated in a report on one of the national TV stations on the state of the National Mental Health Referral facility, Mathari Hospital. According to the report, the facility is in a deplorable state, with inadequate and poorly maintained spaces, old and unserviceable equipment, no medications for the severely mentally ill Kenyans admitted there, and woefully inadequate human resource.
Recent changes in the management of the facility have not done much to improve things, with the replacement of the psychiatrist who was managing it with a person with little experience or training in mental health.
It is tragic in my view that we treat the mental health of our people so casually, yet no country can develop when a significant proportion of its population suffers from undiagnosed and poorly managed mental illnesses.
It is a Sisyphean task to attempt to achieve lofty development goals while hobbling ourselves with an avoidable burden of mental ill health. There is no development without health, and no health without mental health.
Atwoli is associate professor of psychiatry and dean, School of Medicine, Moi University; [email protected]