Poor state of mental healthcare

A shortage of mental health specialists and facilities, ignorance and stigma, are among the challenges facing the provision of quality psycho-social care in Kenya, say specialists.

"There is a huge treatment gap in Kenya, where there are currently 81 psychiatrists for a population of 41.6 million," Monique Mucheru-Wang'ombe, a consultant psychiatrist at the Ministry of Medical Services, told IRIN.

With most psychiatrists in private practice, only about 25 are in the public sector and then largely in the urban areas while the population was primarily rural, said Mucheru-Wang'ombe.

According to the UN World Health Organization (WHO), in most countries, particularly low- and middle-income countries, mental health services are severely short of resources - both human and financial - with more being spent on the specialized treatment and care of people with mental illness and to a lesser extent on integrated mental health systems.

Instead of providing care in large psychiatric hospitals, WHO urges countries to integrate mental health into primary healthcare in general hospitals and develop community-based mental health services.

"Institutionalization is not the way to go," echoes Mucheru-Wang'ombe, adding that community-based mental health services helped to make the provision of care more accessible and reduced stigma.

She added that the integration of other health services such as dental or maternal and child services within the same institutions would also help to reduce stigma, as would awareness-raising on the importance of treatment and long-term management.

Cases of families hiding away mentally-ill patients are common due to the negative perceptions associated with such illnesses. "Mental illnesses are thought to be a consequence of demon possession, evil spirits or curses. It therefore takes long for patients to seek help from the formal health sector," she said.

A general misconception in the coastal region where drug abuse is rife, for example, is that most of those suffering from mental illnesses have themselves to blame, exposing them to social ridicule.

Some families therefore opt to hide their sick relatives to avoid embarrassment.

The media has also been blamed for helping to perpetuate the stigma. "...It is a shame that coverage is almost always sensationalistic and further dehumanizes people who are already relegated to the fringes of society," writes Judith E. Klein, the director of the Mental Health Initiative in a blog.

"The stigmatization of people with mental disabilities runs very deep, and it is very difficult for them to shed it," says Klein. "Sensationalist media coverage does everybody a disservice because it reinforces the message that disabled people are hopeless, pathetic burdens to society and that if only they received more charitable assistance, perhaps society could take a breath and forget about them - again - at least until the next scandalous story breaks."

Untreated

According to Frank Njenga, a consultant psychiatrist, there is little psycho-social help available to those in acute need, such as survivors of frequent rapid onset disasters in the country, for example, the recent Sinai slum fire.

Widespread poverty is also a factor, said Njenga.

Mama Naima* told IRIN that a lack of money to take her 22-year-old son for specialized treatment had forced her to rely on traditional herbal concoctions.

The provision of mental health services is a relatively new area in Kenya, says Adrienne Carter, a psychotherapist/trainer with the Independent Medico-Legal Unit (IMLU).

According to Carter, an experience is considered traumatic if the person never experienced it before, it is overwhelming and it changes one's life completely, it involves death or serious threat to one's life. Witnessed events may include observing the serious injury or unnatural death of another person due to violent assault, accident, war or disaster or unexpectedly witnessing a dead body or body parts.

The disorder developed as a result of traumatic events may be especially severe when the stressor is human (such as in torture, rape).

 "There are numerous communities within Kenya that suffered greatly during the post-election violence. Some... managed to get psychological assistance, but most of them continue to suffer, untreated," she said.

“Fortunately, after traumatic events like the Kenyan violence most people do not develop mental health problems. Most don't need psychological or mental health treatment,” said Nancy Baron of the Global Psycho-Social Initiatives (GSPI).

“After experiencing a traumatic event everyone has symptoms of distress ie: nightmares, hyper vigilance and anxiety - these are quite normal after such experiences. As time passes, the symptoms disappear for most only sometimes reoccurring due to the common misery of daily life after an emergency.”

Often about 20 percent may continue to struggle with feelings of distress that affect their ability to function in their daily life and will benefit from more engaging community and family support and problem solving, she said. “About 10 percent may need support from someone with more training that can offer a way to assist them to more constructively process the experience.”

An estimated 2-3 percent of any population worldwide has a serious mental illness - after an emergency or traumatic event this rate only goes up 1percent. They go up a bit more for populations who have been tortured, raped...usually about 8 percent.”

“Though the percentage of people with a serious mental disorder is small, this is a significant number and the people with mental illness most definitely need treatment,” she said. “In countries with limited mental health care available it is particularly important to not flood the system with people who don't need this treatment and provide mechanisms to search for those who do.”

According to the Inter-Agency Standing Committee (IASC) guidelines on mental health and psychosocial support in emergency settings, it is important to recognize that people are affected by emergencies in different ways with some being more resilient than others who may need specialized support. Where appropriate, local cultural practices should be used to support local people, say the guidelines.

aw/mw