The Covid-19 era has come with a surge in mental illness, depression and anxiety, yet only 25 per cent of Kenyans can access mental health care.
Kenya is among the 28 per cent of WHO member states that do not have a separate budget for mental health, and government expenditure on mental health is 0.01 per cent of total expenditure.
Consequently, people with mental health disorders have to pay out-of-pocket for treatment. Private medical insurance covers are discriminatory, and most insurance companies do not cover for mental health care.
Chiromo Hospital psychiatrist Dr Anne Mwongela says the pandemic has been a major setback in mental health, with depression and anxiety being the main aftermaths of Covid-19.
Mwongela defines depression as a mental health disorder, mostly characterised by persistently depressed mood or loss of interest in activities that can actually cause significant impairment in daily life.
Depression itself is severe in that it interferes with the brain function and can lead to altered activities, hence causing biological, psychological and social changes in a patient.
Biologically, depression is brought about by an imbalance in brain chemicals. Extreme emotional burden or life-changing events can trigger depression.
Mwongela says the pandemic has been attributed to the emergence of depressive episodes, especially among highly vulnerable populations.
“The Covid-19 era has come with a lot of mental illness, depression and anxiety being on the top of that list,” she says.
"It is a disease that has no cure and it is affecting the brain in a big way, which can lead to depression. Socially, we have seen financial setbacks that have come with the pandemic, resulting in people losing their jobs."
LOSS OF JOBS
For instance, in a study conducted in urban informal settlements last year, 82 per cent of caregivers lost their jobs due to the pandemic.
Loss of jobs, which has hindered the ability to cater for basic utilities, such as rent, food and even caring for children needs, has had a significant effect on mental health.
The study covered Bangladesh in Mombasa county as well as Mathare and Dagoretti’s informal settlements (such as Kawangware) in the Nairobi Metropolitan Area.
It found that a significantly higher proportion of mental health issues were reported by caregivers who reported two perceptions about Covid-19 mitigation measures.
One is that they affected their jobs and other income activities. The other is that they affected their interactions with family and other people outside their households.
The mental health issues included depressive symptoms, Covid-19 related anxiety and general anxiety.
The survey describes mental health issues among caregivers of young children and pregnant women in the three urban informal settlements in Kenya during the first pandemic year.
A total of 1,262 participants were approached for the survey. Data was drawn from 845 participants.
Kenya recorded its first Covid-19 case on March 12, 2020, since the beginning of the outbreak in China in December 2019.
The Ministry of Health subsequently introduced guidelines that required full cooperations from Kenyans to mitigate the effects of the pandemic.
Kenyans were advised to maintain a distance of at least one metre between themselves and anyone who is coughing and sneezing, no public gatherings, stay at home in case one suspected they are sick, observe a dawn-to-dusk curfew and maintain personal hygiene.
Some of these mitigation measures, according to the study, strained families from the stated settlements, who have a high dependence on casual jobs.
Key findings from the study indicate that during the first year of the Covid-19 pandemic, caregivers of young children living in Kenya’s urban informal settlements who participated in the survey experienced a high burden of mental health problems [depressive symptoms (34 per cent), generalised anxiety (14 per cent), and Covid-19 related anxiety (20 per cent)].
The report found that caregivers in Bangladesh had higher depressive symptoms and Covid-19 related anxiety scores compared to caregivers in Dagoretti’s informal settlements.
This, the study says, could possibly be explained by contextual differences.
That is, some settings could be experiencing more hardship than others partly due to varying socio-economic levels (for example, Dagoretti has relatively better standards of living compared to other informal settlements), varying infrastructure levels and resource access.
The study highlights that caregivers living in urban informal settlements experienced a high burden of mental health issues during the first year of the Covid-19 pandemic and that care for caregivers is critical to mitigate negative effects on children.
“If left unchecked, children growing up in such exposed environments have a higher risk of developing various cognitive, behavioural and emotional difficulties later in life,” the study indicates.
HEALTHCARE WORKERS
A separate study covered the mental health disorders among Healthcare Workers (HCWs) during the Covid-19 pandemic in Kenya.
Severe symptoms of depression, anxiety, insomnia, distress and burnout were more commonly reported among frontline HCWs than colleagues who were not frontline HCWs.
For example, severe depression was reported among 11.6 per cent of frontline HCWs compared with 3.8 per cent among workers not directly caring for patients with Covid-19.
The study was conducted between August and November 2020. The mentioned hospitals where the research paper was drawn from are Coast General Teaching and Referral Hospital, Mombasa (CGTRH)) and two private hospitals (Aga Khan University Hospital, Nairobi (AKUHN) and Avenue Hospital, Nairobi).
Of the 725 invited HCWs across the three hospitals, 433 responded to the survey. The median age of the participants was 32.8 years.
MINISTRY'S RECOMMENDATIONS
The Ministry of Health also released a report on the issue, titled, ‘Mental health and well-being towards happiness and national prosperity'.
It found that 75 per cent of Kenyans are not able to access mental health care despite the heavy burden of mental ill health on the country.
The only national referral mental hospital, Mathari Hospital, was built in 1910. Most of the infrastructure is 110 years old and dilapidated, and it lacks basic infrastructure to deliver modern evidence-informed psychiatric care.
The report was compiled by a task-force on mental health in the country. It recommended that the Ministry of Health rebuild Mathari National Hospital.
It found that frontline health care workers suffered from high levels of stress, and many developed clinically significant depression and anxiety.
The task-force recommended the setting up of a Mental Health Commission that can oversee the improvement of the level of national preparedness and readiness to provide mental health and psychosocial support during emergencies and humanitarian situations.
It further called for an increase in equitable funding for mental health services by urgently reducing reliance on out of pocket-payments for mental health services.
This, they said, should be done by increasing public funding (budgetary allocation) for mental health from general government revenues to closely match the international average mental health financing of $2.5 (Sh250) per capita per year.
Other recommendations are that the government ensures that the existing health insurance programmes, especially the National Health Insurance Fund (NHIF), provide comprehensive coverage for mental health, including tax exemption for people living with mental illness, just like persons with disabilities.
The task-force further recommended that insurance companies include mental health in their packages.
MISUSE OF ANTRI-DEPRESSANTS
One of the tell-tale signs of depression, says Dr Mwongela, is the persistent feeling of sadness. This can be very intense.
There is also a lack of interest in activities once enjoyed.
“Low energy, fatigue, disturbed sleep, poor concentration and being indecisive,” she said.
"Low self-esteem, inappropriate guilt, being agitated over small things are also some of the signs. In some extreme cases, there are suicidal thoughts."
She explains that by the time someone is thinking about death, there is already much damage to their brain. Suicide is the severest form of depression.
“This is someone who needs help. Suicidality is an emergency and such people are in dire need of being linked up with a psychiatrist,” the doctor says.
Even as cases of mental illness are on the rise, she said, there are people who tend to misuse antidepressants. Most misuse it for sleep, which should be discouraged because of the side-effects it presents.
These include nausea, vomiting, dry mouth and constipation. Severe forms lower blood pressure, trigger convulsions and seizures, memory impairment, blurred vision and urinary retention.
The doctor recommends that people should talk more on mental health. They should be educated and campaigns conducted to champion matters of mental health. This, she says, should reflect in organisational setups.
“Self-care is critical when it comes to mental health. Work out. Engage in activities that are healthy to your mind, body and spirit. Keep a small, meaningful circle. A group of friends you can trust,” she says.
The doctor further states that spiritual health is also key to getting through depression. It is part of self-care.
“An affiliation to a supreme being is helpful in treating depression because someone is obtaining their hope in a higher power,” she says.
"But as they do this, they should not neglect the biological and doctor's help. There needs to be a balance."
