In the months since COVID-19 began and measures including lockdown effected, there have been increased cases of domestic violence reported. Jobs have been lost and livelihoods wiped away. This is a pointer to increased stress and depression.
Prior to that, on Jan 5, 2020, a church service in Mombasa turned bloody after the pastor stabbed his wife to death and committed suicide in full view of congregants. He reportedly left a 17-page suicide note left now in the hands of the police. A number of artists such as Paul Wakimani Ogutu have confessed to going through depression and others including journalists have committed suicide.
Yet with all these rising cases, currently, 75% of Kenyans are NOT able to access mental health care. As of December 2014 mental health care was only available in 29 of the 284 level 4 hospitals. Basic psychiatric units are only available in 25 of the 47 counties in Kenya and the public is not fully aware where they are located as there is no existing database for reference. Patients seeking mental health care in the remaining 22 counties must travel most often to Mathari Hospital in Nairobi.
A few weeks ago, The Presidential Taskforce on Mental Health in Kenya, submitted their report in which they drew attention to the rising yet ignored state of mental health in the country. According to the taskforce, Kenya is going to need a lot more mental health practitioners and spend a lot more money rebuilding its neglected infrastructure, otherwise all emphasize placed on the economy will be naught.
The Njenga- Taskforce observed that the common mental illnesses in Kenya are depression and suicide, substance use disorder, bipolar disorder and schizophrenia. The illnesses affect everyone without discrimination including otherwise healthy looking beings as well as special populations such as children and youth, women, refugees, prisoners, disciplined forces, sexual minorities, the boy child, people living with chronic physical illnesses, persons with disability, and survivors of gender-based violence.
The Presidential Taskforce seeks to “declare mental illness a national emergency of epidemic proportions” and adopt a multi-sectoral approach in much the same way as the country did towards HIV/AIDS two decades back. Has Kenya actually reached this level in its mental illness concerns?
Unfortunately, yes, even with the very limited data available. On the one hand, the World Population Review places Kenya at 114 among 175 countries with the highest suicide rates globally. On the other hand, the World Health Organisation (WHO), 1408 Kenyans commit suicide every year.
Simply put, this translates to four deaths daily, a number that is higher than what the Kenya National Bureau of Statistics reported for 2018: 421 deaths. In 2017, the WHO ranked Kenya as the sixth African country with the highest levels of depression with at least 1.9 million diagnosed Kenyans suffering from depression. The WHO acknowledges that this is a conservative figure because Kenya lacks vital data on the causes of death.
This lack of data, alongside the legal stand that suicide is a crime in Kenya supported by the penal code, cultural stigma and cultural beliefs contribute to lack of adequate knowledge on the subject. Finally, Frank Njenga, the co-chair is an easily recognizable name in the field. His word alone is enough to give credence to the pronouncement.
A large number of mental health problems remain undiagnosed and consequently unmanaged across Africa. Mental illness has thus been termed the continent’s “silent epidemic”. A sure way of preventing suicides is by early identification, treatment and care of people with mental and substance use disorders, or individuals in chronic pain and acute emotional distress.
Initially built as a “lunatic asylum” in 1910, the Mathari National Referral Mental Hospital remains the only mental hospital I the country. With its 110 years old dilapidated, infrastructure, it cannot be expected to deliver modern evidence-informed psychiatric care. This facility when it was built in the pre-colonial times was ‘hidden’ and isolated from the rest of the hospital services further leading to their neglect, a practice that continues to date. It houses the only forensic psychiatry inpatient unit located in the entire country that admits all the mentally ill offenders and certainly provides no environment for rehabilitation of the illness as well as the criminal behaviour component of those admitted.
Indeed, given the increasing incidences of mental ill health, there is need to adopt and implement a number of the proposed measures urgently. First there is need to urgently conduct a national mental health survey as a first step to have more comprehensive research on mental health which will be enabled by reduced stigma so people can openly talk about causes of illness and death, that mental illness is not equal to being a lunatic. Parliament moving fast to decriminalize suicide attempts will help to reduce stigma and discrimination and encourage help-seeking among people that are feeling suicidal.
Secondly, there is need to urgently reduce reliance on out of pocket payments for mental health services by increasing public funding for mental health from general government revenues to closer match to the international median of $2.5 per capita per year. This will then help to shift funding towards community based and preventive mental health enhancing services away from the current trend where most of the funding goes only to mental health hospitals.
Third, existing health insurance programs especially NHIF should provide a comprehensive coverage for mental health including community based mental health services at the primary healthcare level.
Finally, re-building Mathari Mental Hospital, and making the mental health units’ part of the general service provisions will go a long way in transforming mental health landscape in Kenya.
The full report of The Presidential Taskforce on Mental Health is available at https://mental.health.go.ke/download/mental-health-and-wellbeing-towards-happiness-national-prosperity-a-report-by-the-taskforce-on-mental-health-in-kenya/