Amidst the gloom and dread of a national crisis, it is difficult to notice a chilling trend in mental health: Children are experiencing great anguish, but society and the health system do not know how to respond.
Apart from the reported cases of successful and attempts of suicide amongst teenagers, the school fires show an increase in violence amongst children.
The pandemic robbed young people of milestone events and the semblance of normal life, and now they have this tight school calendar. Some children have lost their parents and loved ones to the pandemic.
It is especially concerning because three in every five Kenyans (about 32 million) are below 24 years. The explanation about Covid-19 being a cause of this feels right. However, feelings are not facts. And the facts are that mental illness has been a crisis hiding in plain sight, long before March 2020 when Kenya reported its first Covid-19 case.
In 2021, the President was so concerned about the cases of reported deaths by suicide that he asked then Health Cabinet Secretary Sicily Kariuki to form the National Taskforce on Mental Health to recommend ways to deal with the matter.
The taskforce, comprised of psychiatrists, began a national listening session countrywide. It also reviewed literature like research and clinicians’ notes. From the report, what the physicians had always feared popped up. Nearly one per cent of the population (about 476,000) suffer from severe mental illness, manifesting with severe symptoms such as psychosis where people lose touch with reality and see and hear things that are not real. The number is higher for those suffering from mental illness, not the severe forms of it.
The most sobering in the report is that in certain parts of the country, a tenth of children in kindergarten had behavioural and emotional problems. Schoolgoing children have a higher prevalence of mental illnesses and the majority of these were somatic disorders. These are physical symptoms in one’s body that cannot be entirely explained through a physical examination.
Somatic disorders occur when a child experiences something so troubling and because they are unable to process it mentally or have not learnt the language of distress to speak about it, it manifests in their bodies like paralysis, convulsions, blindness or deafness.
As a parent, it would break my heart that my child would be fighting for his life but not know how to explain that and I would not know how to respond to help him even though I am a doctor myself. Yet, this is the reality for many children. They are suffering, but their parents or guardians and even the health system are neither prepared nor aware of what to do.
This is the time to ask ourselves: How have we re-oriented our services in the health system and communities to address the crisis facing the youth?
We can start with an open dialogue with children where they can safely express how they are feeling and we listen without judgement and criticism. When society acknowledges mental health problems at their onset in children, they will be preventing them from becoming severe to the point that you lose the child altogether.
Institutions should add this compassion-driven approach to the health and education systems. The systems can take a client-centred service delivery approach where we look at the needs and preferences of the children and build a system to meet those needs.
Do young people know whom they can call when they are losing their mind? Can they come to an emergency room and say, “I feel like taking my life” and get help without questions such as, “What would a child like you be so worried about to want to take your own life?”
Working in sexual and reproductive health, I know first-hand that it is not as easy as making the services available in hospitals and then young people will flock there. Whatever the obstacles to access to care, the education system is key in responding to young people’s concerns because teachers spend more time with children.
In her 2017 study in Child and Adolescent Psychiatry and Mental Health, Judy Kamau from the Department of Psychiatry, University of Nairobi, studied more than 166 parents in a referral hospital in Nairobi.
She found that substance abuse disorders were the most prevalent presentation (30.1 per cent) followed by depressive disorders (13.9 per cent). She learnt that it took as long as 15 years (183 months) for children to get care after the first symptoms of mental illness.
Whichever the case, the study found that teachers and medical practitioners guided the young ones and their parents to seek care in the first place.
Now that we have established it is not just enough to make hospitals ready—because young people often seek care when they are in so much pain—how about taking the care to where they spend the better part of their day anyway?
We should structure our educational institutions from the foundational and primary level to the tertiary to include capacity to offer basic health services, including the necessary space, tools and staff.
Medical doctor, public health specialist and Kenya country director for John Hopkins affiliate, Jhpiego
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