New strategy needed to beat mental health

Last week I spent some time with mental health experts from across the globe discussing latest findings from research and planning next steps for mental health globally.

New findings in diagnosis and treatment of mental illnesses were presented and discussed, and evaluations of previous interventions were done by the experts assembled in Lisbon, Portugal.

What we all agreed on is that those of us in Africa need to do more work to delineate the burden of specific mental disorders on the continent, and to begin working of interventions that will work for African people.

The truth is that mental disorders are going to become the biggest challenge of our generation, given that lots of works is being done to control infectious diseases and chronic physical conditions.

A particular area of concern in Africa and other regions considered to be ‘poor’ is the tendency to throw our hands in the air and declare that we shall never have sufficient human resources to address the huge and rising burden of mental illness in our countries.

EXPERTISE

As a result of this, and with the support of international agencies, many of our countries have lighted upon a policy that entails training people for short periods of time and then deploying them to provide extremely specialised health services to our populations.

This has been called various names depending on the promoting agency, from task-shifting to task-sharing to all variations on this theme.

Mental health has been particularly affected by this phenomenon, with everyone coming up with ‘mental health interventions’ that can be implemented by all sorts of lay persons.

Lots of papers have been published demonstrating how easy it is to train grandmothers to provide highly specialised psychological treatments to random persons who believe they have all sorts of mental disorders.

However, very little evidence exists to show that this approach is actually useful in dealing with the problems it purports to help.

Part of the reason why we are facing this problem is that whenever we are thinking of interventions for mental illness, we begin with considerations of the money required for them.

FINANCIAL ANGLE

Of course this is a phenomenon that runs across all sectors in this country.

All our projects are presented based on the amounts of money that are required for them.

We therefore have ‘multibillion-shilling’ stadia, hospitals, roads, dams and agricultural projects, and the actual planned activities are only secondary.

While the tendency to think in terms of financial implications seems to be a largely Kenyan thing, there is a global paralysis in governments whenever mental health is mentioned because everyone focuses on the money involved.

Calculating the amounts of money needed to conduct any intervention causes an unconscious mental block, and draws attention away from the intervention to the resources required for it, which produces an automatic response that “we do not have that kind of money”.

EVIDENCE

Our resultant ‘solutions’ are therefore based on a scarcity mentality, or what we have come to know as “poor medicine for poor people”.

It is my opinion that we must move away from this kind of thinking, and begin to plan using established evidence on interventions that work to improve our people’s mental health, and health in general.

Creating new categories of workers to deal with old complex problems is completely wasteful at national and at individual level.

Lukoye Atwoli is Associate Professor of Psychiatry and former Dean, Moi University School of Medicine ([email protected])