Behind the walls of the Mathari Hospital, Kenya’s only specialised national referral institution in mental health lies a public health outcry. Overwhelmed by patient numbers, under-resourced and understaffed operations are ‘business as usual’ at Mathari hospital. As stated in the Kenya National Commission on Human Rights (KNHCR) ‘Human Rights Audit of the Mental Health System in Kenya, 2011’, 25% of outpatients and up to 40% of in-patients in health facilities suffer from some form of mental health problem ranging from depression and anxiety disorders to schizophrenia, alcohol and substance abuse disorders 1. According to the World Health Organization, Kenya is one of the top 10 countries in Africa with the highest number of depression cases with 1.9 million Kenyans being clinically depressed at the end of 2016 2. Kenya has also seen a rise in suicide cases with 7000 Kenyans between the ages of 15 and 30 years committing suicide every year 3. Considering that numerous mental health cases go unreported and undiagnosed, such figures just give a snapshot of the mental health problem within the country.
At the moment Kenyan nurses within the public health system are in their 5th month of a strike, three months after the doctors ended their 100-day strike demanding better working conditions and pay. Additionally, corruption scandals have rocked the Ministry of Health in the past years regarding misappropriation of public health care funds further indicating the fragile state of the health system in Kenya. Moreover, Kenya allocates less than 0.5% of its total public health budget towards mental health care 4, which has been a major drawback towards the development of mental health services in the country. Mental health currently ranks as the fifth cause of disability-adjusted life years (DALYs) in the country 5.
Increased waves of insecurity have occurred in the past years in the country. For example, the 2007 post-election violence saw more than 1000 people dead in a span of two months and 500,000 internally displaced as a result of ethnic rivalry within the country due to disputed election results 6. Moreover, in the recent years, the country has been hit by frequent Alshabaab terrorist attacks which have already left hundreds dead and injured 7. These traumatizing events are expected to lead to a rise in mental health problems in Kenyans in the short and long term.
The impact of mental health problems on individuals, communities and the nation are far-reaching and cut across health and socioeconomic development. These can include lack of social support due to stigma, decreased productivity contributing further to decreased income and therefore decreased access to social services such as health. These factors contribute to individuals and families going into poverty. Furthermore, studies done show correlation between poverty and the occurrence of mental health problems; with those in lower-socioeconomic classes having an increased risk of having mental health disorders 1. This means those who are likely to be unable to access quality health care whether in physical or financial terms are the ones most likely to be suffering from a mental health condition.
Mental health stigma is one of the biggest challenges that the country faces; with many Kenyans still categorizing mental disorders as supernaturally caused. Stigma continues to have devastating effects on the lives of the individuals with mental disorders and their caretakers. It leads to increased loss of self-esteem, feelings of worthlessness and poor access to care further exacerbating the illness.
Mental health is and will continue to be an issue unless we start to deal with it now. There is need to address the stigma around it and advocate for a human right based approach to the provision of care with a special focus on integration into primary health care to reach those most in need. The Ministry of Health recently passed a Mental Health Policy (2015-2030), outlining the framework for mental health reforms in the country 8. Though highlighting key issues such as the need for a life course and multi-stakeholder approach in order to tackle the social determinants of mental health; the implementation is lagging. It is my hope that more will be done to ensure universal coverage and access to mental health care for all Kenyans.
Dr Meggie Mwoka serves as a Medical Officer of the Government of Kenya. She has experience in global health and is an advocate for sexual and reproductive health rights. Her passion for youth engagement has led her to volunteer and leadership opportunities at international and national youth–led organizations. She serves as an active member in several organizations where she often provides consultation especially on youth and health issues. She is currently pursuing her Master of Global Health at the Barcelona Institute for Global Health. As an aspiring global health specialist she hopes to close the inequality gap within her country and globally; through collaboration and provision of equal access, opportunities and rights across all social and economic spheres.
- Kenya National Commission on Human Rights (KNHCR). Silenced minds: The systemic neglect of the mental health system in Kenya [Internet]. Nairobi: Kenya National Commission on Human Rights(KNHCR); 2011 November. 73p. Available from: <http://knchr.org/HumanRights/Inquiriesandinvestigations.aspx> [Accessed 12 November 2017]
- World Health Organization. Depression and other common mental disorders. Global health estimates [Internet]. Geneva: World Health Organization; 2017. 24p. Available from: <http://apps.who.int/iris/bitstream/10665/254610/1/WHO-MSD-MER-2017.2-eng.pdf> [Accessed 15 October 2017]
- Kalekye. Depression: A state of the mind. 2017 July 12. In: Kalekye Health [Internet]. Available from: <http://kalekyehealth.com/2017/07/12/depression-a-state-of-the-mind/> [Accessed 14 October 2017]
- Africa Research Institute. Reforming Kenya’s ailing mental health system: Conversation with Victoria de Menil. 2013 Jun 27. In: Africa Research Institute Blog [Internet]. Available from: <https://www.africaresearchinstitute.org/blog/mental-health-in-kenya/> [Accessed 13 October 2017]
- Institute for Health Metrics and Evaluation (IHME). GBD Compare Data Visualization [Internet]. Seattle, WA: IHME, University of Washington; [updated 2016]. Available from: <https://vizhub.healthdata.org/gbd-compare/> [Accessed 13 October 2017]
- Human Rights Watch. Ballots to Bullets [Internet]. New York: Human Rights Watch; 2008. 79p. Available from: <https://www.hrw.org/report/2008/03/16/ballots-bullets/organized-political-violence-and-kenyas-crisis-governance> [Accessed 15 October 2017]
- Bremmer I. These 5 facts explain terrorism in Kenya. The Time [Internet]. 2015 April 10. Available from: <http://time.com/3817586/ian-bremmer-facts-explain-shabab-terror-attack-kenya/> [Accessed 14 October 2017]
- Ministry of Health, Kenya. Kenya Mental Health Policy 2015-2030 [Internet]. Nairobi: Ministry of Health; 2015 August. 32p. Available from: <http://www.health.go.ke/2017/05/advancing-the-mental-health-strategy-for-kenya/> [Accessed 12 October 2017]