Admission requests for mental health patients in Nyeri health facilities climax during festive seasons.
This is to give family members or caregivers ‘freedom’ to celebrate in peace, away from the patients referred to as a ‘nuisance’ and the stigma associated with their care.
A recent report by Health Rights Advocacy Forum titled 'Community Report Card on the Status of Mental Health Services in Nyeri County' records this trend.
The report was based on experience of patients, their families, care givers, civil society organisations and Nyeri county and national governments.
The Ministry of Health and other mental health actors including public and private service providers and religious institutions were also involved.
Researchers sampled five out of the 125 health facilities, which are Nyeri County Referral Hospital, Karatina Level 4 hospital, Kiamabara, Karaba and Bellevue health centers.
The five were sampled due to their high mental health workload.
The county referral facility is the only one offering in-patient mental health services. Karatina is the only facility with a consultant psychiatrist and an out-patient clinic, while Kiamabara, Karaba and Bellevue health centres have trained mental healthcare workers.
On mental health infrastructure, only Karatina Level 4 and the county referral hospitals have designated psychiatric consultation rooms.
Primary healthcare facilities share general consultation rooms, some which fail to meet the recommended psychiatric standards as they are small, lack exit doors or lighting and proper air circulation.
“Moreover, the waiting bay at Kiamabara is shared by all service seekers including individuals with psychosocial, intellectual or cognitive disabilities.”
This leads to disruption and conflict incidences between the psychiatric patients and other patients.
The county referral hospital’s in-patient facility has only 20 beds leading to a long admission wait list.
To avoid congestion, the county discontinued admissions on weekends and nights denying patients' need for fast service delivery.
The consultant psychiatrist is also not available during these times and patients find other medical officers on duty.
Statistics of mental health patients are not effectively captured and only the number of new and old patients seeking services is recorded but not the kind of disorders or the patients’ essential data.
“Facility data therefore as reported on Kenya Demographic and Health Survey, had limited indicators of new clients and old (repeat) clients to inform data analysis for planning.
"Available Community Health Volunteers reporting tools are not mental health specific to input Kenya Health Information System reporting,” the report read.
An analysis by the county department of health showed a major fall in people seeking psychiatric, rehabilitative and referral for mental health services in 2020 compared to 2019.
The year 2020 recorded a drop to 9,534 (psychiatric visits), 1,042 (rehabilitative) and 624 (referrals) compared to 2019’s 11,051, 3,722 and 3,521 respectively.
The reduction was blamed on Covid-19 pandemic which led to stigmatisation of health facilities which were viewed as points of infection.
The government had initially advised people to keep off the facilities unless for critical services.
The county disease surveillance unit recorded high cases of suicide with 56 of the 61 cases of persons aged 25 to 35 reported in 2018 being male farmers or casual labourers.
“Of the 61 reported cases, 44.3 per cent were from Mathira East subcounty. Nonetheless, no study has been conducted to understand the driving forces behind the suicides,” it noted.
Most of those who took their own lives did so through taking poison or drowning.
Though the county’s number of mental illness patients is unknown, it is estimated that 25 per cent of out-patients and 40 per cent of in-patients have mental illness of some form.
However, the report noted that mental health staff slightly improved from eight in 2019 to 14 in 2021.
In 2019, Nyeri had one psychiatrist, one clinical officer, six nurses and zero psychologists. But in 2021, the number rose to two psychiatrists, three clinical officers, six nurses and three psychologists.
Though a legal framework and policies on mental health services existed, the same was not well disseminated leading to stigmatisation, discrimination and human rights violation of people with mental problems, by members of the public and health workers.
The patients were also denied legal services such as the right to marriage, property ownership, voting rights and freedom of association.
“Moreover, derogatory labelling of persons with mental disabilities as mad people with no socioeconomic value was eminent within the community.”
Though the number of people with mental illnesses continues to increase, the county government still has challenges financing mental health.
This has been blamed on lack of a cost plan, low prioritisation at the County Integrated Development Plan or Annual Development Plan levels including lack of clear Key Performance Indicators, targets or stand alone budget line for mental health.
Lack of clear budgetary allocation has led to poor prioritisation of mental health services.
This has resulted in inconsistencies in supply of mental health products and commodities, poor mental health infrastructure and inadequate human resource.
Kenya’s mental health budget is estimated to be roughly 0.5 per cent allocated for both levels of government.
(Edited by Bilha Makokha)
