The dire state of mental health in Kenya

On October 13 last year, the death of a high-flying corporate manager shocked the city.

The incident occurred just a day after the commemoration of World Mental Health Day.

In a similar incident, Richard Wangai, 40, died by suicide after jumping off a balcony on the fourth floor at Adlife Plaza in Kilimani, Nairobi, on January 6.

It was alleged that Wangai had jumped to death after losing his Sh15 million to gambling in a casino within the building.

The casino, however, dismissed the reports by a section of the media connecting them to Wangai’s death as ill motive and only meant to tarnish their name.

Millions of Kenyans are suffering in silence, unable to get the help they need. Cases of domestic violence are also on the rise.

The worst of it is that even educated and enlightened members of society have fallen victim.

Popular belief holds that people suffering from mental health issues must look unkempt, live on the streets or eat out of dustbins. However, the recent spike in suicides, including by children as young as nine, shows there are many Kenyans who are not even aware they suffer from mental illness until something triggers concern.

STATE INTERVENTION

This scenario triggered the nation, including President Uhuru Kenyatta, who saw the need to push a wholesome discussion on the reality of the state of mental health in Kenya beyond depression. He directed the Health ministry to establish a task force on the status of mental health in the country.

The nine-member team, co-chaired by Dr Frank Njenga and an official from the Health ministry, was inaugurated on December 11 by outgoing Health CS Sicily Kariuki.

She said, “We are greatly concerned by the rising trends of suicide mortality, acts of violence and the burden of mental health conditions.”

The team was thus tasked with coming up with new policies to address growing concerns about mental health among Kenyans.

Its chair Njenga said, “The task force has received and will compile the views of Kenyans on all matters mental health. The likelihood is the task force will be making recommendations embedding the views of Kenyans in all matters to do with healthcare delivery.”

The task force was expected to assess the mental health systems, including the legal, policy and administrative environment, to identify areas that may benefit from reform for optimal delivery.

“We were given 80 days so we don’t have too many days left. The intention is that we will have finished writing and we will present the report to the government underlining the urgency of the matter by February 28,” Njenga said.

In addition, the team was urged to broadly consider the changing social dynamics and how they threaten mental well-being. Such dynamics include substance abuse, gambling, sexual and gender-based violence, cyberbullying, child abuse and neglect.

PUBLIC PARTICIPATION

The team went across the country to collect the views of Kenyans in regards to mental health.

The forums were conducted in Meru, Makueni, Eldoret, Nakuru, Mombasa, Kakamega, Kisumu, Nyeri and Garissa. Nairobi was the last county to host the taskforce on January 27.

The team also met a group of special populations, such as the youth and religious leaders, and organised forums with employers to try and establish the burden of mental health in workplaces.

Lukoye Atwoli, a task force member, pointed out the matters arising.

“Among the recurrent themes is that from an early age, we start teaching about mental health literacy the same way we talk about hygiene and sanitation,” he said.

"The people are saying they need to be taught about mental health from an early age in terms of how to promote mental health, how to prevent mental illness and how to get care when you start feeling unwell."

To some Kenyans who appeared before the task force during the public forums, growing cases of mental illness are as a result of hard economic times.

In submissions to the mental health task force, Kenyans associated the rise in mental health cases to the effects of the economic meltdown caused by endemic runaway corruption.

It emerged that most people are stressed by personal debts, low income, unemployment, retrenchment, diseases and disasters like floods, landslides and drought.

Prof Atwoli said other factors commonly mentioned by Kenyans are drug and substance abuse and the depression associated with chronic illnesses, such as hypertension.

“Most people talked about drugs, depending on the various places we went to. For instance, at the Coast, heroin was the most mentioned, while in rural parts of Kenya, things like alcohol, bhang and miraa were the most common contributors,” Atwoli said.

Evan Oloo from the International Society of Substance Use told the task force, “Substance use disorders should be brought to the mental health table and classified as mental issues rather than a security or moral issue.” 

Some felt that politicians should produce a mental health report before being allowed to vie for any public office.

Catherine Gachutha, a counselling psychologist, noted that there is a lot of toxicity in the environment because of what politicians say in complete disregard of how it affects Kenyans.

Gachutha is the director at the Kenya Institute of Business and Counseling Studies and the Community Anti-Drugs Coalition of Kenya.

Insurers, on the other hand, said the mental health landscape in the country is plagued with insufficient data to show the economic impact of mental illnesses.

“Mental health is an area the population has chosen to ignore to the extent that we don’t have statistics. In insurance, we deal with statistics. We need to have the numbers to know what we are dealing with,” Benjamin Masai from the Insurance Regulatory Authority told the task force.

In addition, insurers want suicide decriminalised to offer a suitable cover for Kenyans affected with mental illness.

“Suicide is criminalised in law. That should be changed because we can’t cover what is illegal,” Masai said.

Garissa residents attributed the escalating mental illness cases in the county to retrogressive cultural practices, such as female genital mutilation.

In oral submissions before the task force at Tana Gardens, it emerged that girls and women who had undergone the rite had difficulties in giving birth, and some were traumatised, causing depression and mental conditions.

“The mental health situation in this area has been complicated by the ignorance of most affected individuals that they have a problem that requires medical attention,” Health executive Dr Ahmed Omar told the task force.

“The problem is compounded by a lack of awareness among communities and the continued stigma that is associated with mental disorders.”

Meru residents attributed increased cases of mental health in the county to uncontrolled consumption of drugs, miraa, alcohol and the breakdown of the social fabric in the county.

Meru Health executive Misheck Mutuma said 7,000 patients with mental illness were treated in the county, arguing that the cases outstripped the capacity since the level 4 hospital has a psychiatric unit with only 17 beds.

“We need to establish a rehabilitation centre and to launch public education on the dangers of substance abuse that has led to the upsurge of suicide cases,” Mutuma told the taskforce.

He said the crime rate is also on the rise due to mental illnesses, adding that the ministry needs to establish psychological counselling help desks in the county to ensure mental health cases are detected early.

From the presentations, it also emerged that the withholding tax imposed on betting companies by the government had actually fuelled addiction since Kenyans are now placing more on bets with the hope that should the win be taxed, they will still have a bigger share.

HEALTHCARE AND DEPRESSION

Millions of Kenyans who struggle to meet basic needs are exposed to mental disorder triggers stemming from their environment.

For the poor masses, quality primary health care is a mirage. Government statistics indicate that at least one in every four Kenyans suffers from a mental illness at one point in their lives. This is about 11.5 million people.

Unfortunately, Kenya has only 88 psychiatrists, 427 psychiatrist nurses who are trained to handle mental illness, about 10 medical social workers and a few mental psychologists and counsellors who are competent to handle mental issues.

Mathari, the main mental hospital in the country, suffers from understaffing, old buildings, leaking roofs, insufficient medicine supplies, poor lighting, poor drainage and sanitation services and old equipment.

Depression is the most common mental illness, affecting more than 300 million people worldwide, according to the World Health Organisation.

A recent report released by WHO on the world mental health situation places Kenya as the sixth most depressed country in Africa.

Depression is also the leading cause of disability. If not attended to, it can lead to suicidal thoughts.

WHO estimates that about 800,000 people commit suicide every year, and it is the second-leading cause of death among youth age 15-29 globally.

“Although we have gone to a sample of counties, the information we have collected will be representative of information from the whole country,” task force member Halima Mwanesi said.

It also emerged that the psychological wellness index among Kenyan workers in the civil service stands at 39 per cent, which is relatively low.

The report is expected to be presented to the President by February 28, and will later be debated by the Cabinet.

Njenga hinted that the task force is likely to declare mental health illness a national disaster.

“We have hit a crisis point as far as mental health issues in this country. Daily reports come in the media that tell us of all sorts of issues associated with mental health. Mental health in our country is deteriorating,” he said.

However, the government is known for forming costly task forces and committees to look into various issues affecting the country, but the findings and recommendations are never implemented.

They develop recommendations that never see the light of day, yet members walk home with fat perks after spending days in committee rooms and posh hotels, writing the reports.

With the task force expected to hand over the report to the President in a few days’ time, Kenyans are waiting to see whether the recommendations will be implemented or the report will be left to gather dust, as has been the case with several others.

Edited by T Jalio