Poor state of mental healthcare

NAIROBI, 30 November 2011 (IRIN) - 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."


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).

"The usefulness of counselling in the healing of mental health problems is not yet well known, especially in the area of torture and other traumatic events," said Carter. "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."

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).

With traumatized people often exhibiting various physical reactions such as body aches, sleeping problems, nightmares and numbness, they mostly go to medical doctors to try to ease their pain, she said, "but the medications prescribed by the physicians help only for a short time... unless the root causes are treated, the physical symptoms continue to persist.

"It is necessary to process the trauma and assist in integrating it within the psyche of the traumatized individual. If the trauma is not integrated within the psyche, the traumatized individual is often found to suffer from Post-traumatic Stress Disorder [PTSD]."

PTSD is characterized by re-experiencing of the traumatic event or persistent avoidance of stimuli associated with the trauma, numbing of general responsiveness and symptoms of increased arousal.

"Unfortunately, people experiencing these symptoms are frequently misdiagnosed with schizophrenia and other psychotic disorders... [and] may end up for many years in mental hospitals where they are 'treated' with heavy doses of medications that do not and never will cure their symptoms."