Urgently address mental disorders

With many challenges in Kenya, failure by the government to intervene in mental health illnesses is like waiting for a time bomb to explode. This is compounded by ignorance about the extent of the problem, stigma against those affected and mistaken beliefs that the illnesses are not treatable and are voodoo or a spell upon the patients.

Misconceptions from Kenyans about mental illnesses include the belief that certain people are more prone to illness than others. For example, the menace of drug abuse and rampant alcohol addiction has seen the elite hiding and taking their children for psychiatric care abroad, where they spend millions of shillings, rather than expanding and advancing local facilities.

But mental health illness is not a preserve of the poor; among the many affected Kenyans are “big” people.

TREATMENT

Most Kenyans do not understand that mental health disorders don’t affect the cognitive ability although it can drastically alter one’s day-to-day functioning over time, resulting in many of the associated negativities, like suicides and homicides.

Mental health disorder is not a death sentence but a condition that can be managed with early proper diagnosis and treatment.

Another contradicting area where awareness is highly required is on persons with intellectual and developmental disabilities. Unlike with mental health disorders, these conditions manifest before age 22. They have severe limitations on daily functioning skills, conceptual skills, social skills and mobility. It is also very common for a person with a mental health disorder to have developmental and intellectual disability, or duo diagnosis. This category of people requires more care.

According to the World Health Organization (WHO), Kenya has about 55-70 psychiatrists, 35 clinical psychologists and 500 psychiatric nurses. Only half of these work in mental health, which receives just about 0.05 per cent of the national health budget.

DIAGNOSIS

Sadly, about 80 per cent of Kenya’s mental health facilities are in Nairobi; so millions suffer mental health disorders without diagnosis or treatment by a professional practitioner.

Developed countries like the US and Britain have a high level of mental health disorders, often linked to prescription opioids and naturally derived narcotics. In Kenya, South Sudan, Nigeria and South Africa, they are triggered mostly by social factors.

The poor mental health picture is far worse in poorer countries, such as those emerging from civil war and other conflicts, than those that enjoy stability and social justice.

Kenyans have witnessed some key public figures take their own lives in unclear circumstances. It is a shame that we don’t use such tragedies to have a productive debate about the necessary interventions.

In Kenya, when somebody expresses their desire to kill themselves, it’s often taken as a joke. And if their attempt — be it suicide or homicide — is unsuccessful, they end up in prison instead of a mental health institution, where they would be evaluated to divulge or rule out their mental state in relation to the crime before their incarceration.

SUICIDES

Prof Makau Mutua was right when he stated last month that the rampant suicides require an open discussion about the status of mental illness in the country. The relevant health professionals should be involved in mitigating the catastrophe. The adage, a stitch in time saves nine, should be applied so that we don’t continue to lose productive members of our population to treatable mental ailments.

Unlike Kenya, developed countries recognise that sound mental health is critical for a productive citizenry. That is why they consistently inject resources and personnel to address it.

We need the training of personnel, sensitisation of citizens and rehabilitation centres throughout the country where proper diagnoses can be done and proper treatment given.

Lack of accessibility to psychiatry services only perpetuates the problem. In most developed nations, the ratio of patient access is one psychiatrist for 10,000. This is, clearly, not the case in Kenya, where it is 1:500,000 — which is not practical.

A country of 50 million people can comfortably afford at least three certified psychiatrists per county with a mental health counsellor in every high school. Besides, the government should embrace professionals willing to give back to society by making psychiatry practice favourable in the country. Telepsychiatry, which is psychiatry via video access using modern technology, is something it should consider, given that more than 20 million Kenyans use smartphones.

A holistic approach by all stakeholders is required in addressing mental health issues. Sound policies, through service design and awareness, would be the clearest roadmap yet for effective mental health intervention.

Dr Mogondo is a psychiatric medical consultant in Casper, Wyoming, USA. [email protected] @ListerNyaringo. Mr Nyaringo is the president, Kenya Patriotic Movement, a diaspora lobby in USA. [email protected] @motari_tom