MENTAL ILLNESS IS A SILENT EPIDEMIC IN KENYA

Kenya’s Suicide Rate Statistics are at an all-time high, recording a staggering 483 cases being reported in the last three months according to the Directorate of Criminal Investigations. A spike in reports of life threatening assaults have also been recorded at an alarming 409 incidences. Experts have attributed these patterns to various mental illnesses which are prevalent amongst members of the society and have not been dealt with. Amongst them is the Mental Health Care Unit at the Ministry of Health, which is of the opinion that the current laws in force relating to mental illnesses are a huge hindrance to the improvement and treatment of such cases.
What legislation is in place?
Legislation regarding mental health in Kenya was kicked off with The English Mental Health Act 1959, which provided a baseline for medical treatment for patients in this sector. It was later repealed by the Mental Health Act of 1989. It sought to achieve the integration of mental health services with general health services. Specifically, it allowed for any hospital to provide for mental healthcare services on a voluntary basis to people suffering from mental illness. It also created a regulatory board to oversee its implementation.
This Act is still in force to date and has been criticized largely by Doctors, Experts and members of the society for its archaic nature, its failure to adapt provisions of Kenya’s 2010 Constitution in particular, the fact that health care is now a devolved function and its incompatibility with present international standards.
To mention a few shortcomings, it fails to address patient’s rights to information, consent to treatment, confidentiality and conditions in mental health facilities. It also fails to embrace the World Health Organization’s model of mental health treatment which recommends an optimum mix of mental health services such as counselling, psychotherapy, aftercare and rehabilitation services besides pharmacological interventions. Further, it does little to promote community mental health services at the primary care level and makes no distinction between mental illness and mental disability. Bodies to oversee the implementation of the provisions of this Act have also not been put in place, a lack of sufficient resource allocation being sited as the main reason.
Kenya is also signatory to international rights conventions that provide for state protection of the rights of people with mental illness, their property and their treatment. An example is the Convention on the Rights of Persons with Disabilities. It obliges member states to provide people with disabilities with access to any support that they may require in exercising their legal capacity, as well as safeguards to ensure that such support is not abused.
The Constitution of Kenya 2010 provides for fundamental rights and freedoms to all persons, including those with mental illness. Article 43 of the Constitution provides that every person has the right to the highest attainable standard of health.
What does “the highest attainable standard of health” really look like for a person suffering from mental illness in Kenya currently?
Recent estimates from the WHO show that Kenya has about 1.9 million cases of mental illness. These include depression. It has been ranked fifth among African countries with the highest number of these cases. A large proportion of depression cases in Kenya may still be under-detected and therefore undertreated.
On the other hand, what might be missing and therefore underreported is the proportion of individuals in the community who are depressed but not seeking any form of help because of various reasons. On top of the list is stigma.
Stigmatization of mental illness in Kenya is a common problem, so much that the original name of the most commonly known mental health hospital in the country, Mathari Mental Hospital, had to be changed to drop the word ‘mental’ because many people were shunning it. The move has not greatly changed the attitude of Kenyans against mental illness nevertheless. Many still shy off from seeking help because of the fear of being judged by the community. Some members of rural communities also associate mental illness with witchcraft and curses.
It is also apparent that a majority of Kenyans may not be aware that they are depressed. The terms “nikona stress” and “wacha ku-overthink” have been normalized as sayings amongst members of the society. Most citizens would not seek any further assistance on the same and just go on with their daily affairs, unfortunately, continuing to exhibit symptoms of depression, bipolar and other mental illnesses towards other people. From consistent quarrels in the office to an unjustified display of road rage on your way home, you might have come across someone struggling with mental illness, and unfortunately you were the recipient of the effects of non-treatment of such.
Substance use and Addictive disorders are also being masked by members of the society as being a part of “Kenya’s Culture.” A number of youths look for any excuse to drink and indulge in other forms of substance abuse as a form of “escape” while being in complete denial that it could be associated with depression or other mental health conditions.
The shortage of mental health experts to effectively diagnose and treat depression in Kenya does not do anything to help our current crisis. It was estimated that about 30% of people seeking outpatient services in local health facilities had a treatable mental illness but most end up being misdiagnosed. As of 2010, Kenya had only 70 psychiatrists (24 in private practice) and 250 practicing psychiatric nurses for a population well above 38 million people. Current statistics in 2021 show that only 30 more Psychiatrists have been licensed since then, raising the number to a an approximate of 100.
Kenya’s well known Mathari Hospital, the only psychiatric Hospital in Kenya, was once referred to as “Kenya’s Terrible Secret” after CNN released a shocking expose of the conditions patients in the facility were being kept in called “LOCKED UP AND FORGOTTEN”. The hygiene standards of the hospital were beyond poor, most of the patients had been drugged into oblivion, reports of rape amongst patients were not being investigated by staff and most of the time being outwardly denied. However, what sent most of its viewers over the edge was a dead body being revealed in one of the rooms, where it had laid for a while, forcing other patients to sleep right beside the corpse. The government blamed this on the lack of resources available to improve the conditions of the Hospital. It invests just 0.01% of the health expenditure on mental health.
10 years since the debut and not much has changed. Consequently, mental health services remain practically inaccessible to most Kenyans particularly those who need it most – the poor and marginalized groups.
Suicide and mental disorders
The clear link between suicide and mental disorders, particularly depression is undeniable.
Other mental conditions associated with suicide are : Bipolar disorder, Schizophrenia whereby patients hear voices telling them to end their lives, Impulsive suicide which is drug-abuse related and includes alcoholism and use of illegal substances, Youth suicide among young people which is a cry for help and a way for them asking to be heard, amongst other reasons such as work or family related stress.
Chapter 63, section 226 of the Penal Code 2012 stipulates that any person who attempts to kill himself or herself is guilty of a misdemeanor and could be looking at up to two years of imprisonment. This law, like all Kenyan laws at the time, was adopted from the British common law. The irony, however, is that in 1961 England and Wales decriminalized suicide, so that those who failed in the attempt to kill themselves would no longer be prosecuted.
CAPRE Kenya, says anyone who attempts to end their lives needs to be provided with treatment or psychological therapy. “That law needs to be reviewed. Such a person should be taken to an institution for mental health — not jail.”

The Mental Health Care Unit at the Ministry of Health, says “The law as it stands now is a hindrance to people living with suicidal thoughts, because the knowledge that it is a criminal offense makes them go into hiding rather than seeking help.”
Users and Survivors of Psychiatry-Kenya, says the law increases the level of stigma, discrimination and isolation for survivors of suicide attempts and their families. By making it a criminal offense, the law makes it clear to the public that someone who attempts suicide is a criminal.
It is clear that what takes preeminence is the punishment rather than the care and support for the person. Adding salt to injury, the available services are kilometers away and are mostly in deplorable conditions not adequately resourced to meet the increasing demand for mental health care.
What has been done to improve the mental health laws in place?
Senator Sylvia Kasanga introduced the Mental Health (Amendment) Bill in 2018. The Bill proposed to provide necessary resources for the medical treatment of patients in this sector. The bill also aims to strengthen the rights of persons with mental illness, protecting their rights as part of a community, but also their rights to receive mental health services at their full potential, which includes considerations about the right to participate in the design of the treatment, and the right to access medical insurance. Further amendments are also proposed in the bill, to protect the rights and increase the quality of treatment, for instance through judicial power measures.

The Presidential Taskforce on Mental Health

Furthermore, a mental health taskforce was formed by the order of the President. The team says it has begun the process to make sure the current law on the criminalization of attempted suicide is rescinded so that people who attempt suicide can seek treatment without fear of being jailed. It has also recommended restricting access to firearms, educating the media on responsible reporting of suicide and implementing programmes among young people to build life skills that enable them to cope with life stresses.

The Health Ministry also launched the Kenya Mental Health Action Plan (2021-2025) to promote mental wellbeing among citizens. The action plan provides a framework for the national, county governments and other key stakeholders to implement policies that promote the mental and psychological well-being of citizens through devolution.

Key highlights of the mental health action plan are :
Parliament to enact legislation for establishment of an independent mental health board or equivalent governance institution such as a mental health commission/authority,
Establishment of County Mental Health councils and Mental Health Coordination Units,
Review of the Mental Health Act 1989 to establish County Mental Health Councils,
Establishment and operationalization of counselling and wellness units in all Government Ministries, State Departments and Agencies to address mental health and wellness.
Mental health literacy through inclusion and training of mental health modules in schools and college curricula,
Mental health promotive and preventive interventions through community, school and workplace programs,
Implementation of the suicide prevention program,
Integration of mental healthcare services at primary care and community level through cascading training of Community Health Volunteers (CHV) and primary care providers,
Establishment of functional referral County Mental Health Units in all counties
Strengthening of existing mental health units to offer substance use disorders treatment and rehabilitation services,
Coverage of comprehensive mental health services under the UHC health benefit package,
Establishment of a Mental health fund to address mental health disparities and establish community mental health programs,
Revise training curriculum in medical colleges to include human rights and disability as it relates to mental health,
Prioritize and increase scholarships for mental health professionals training at the County and National Government,
Infrastructure development of community based mental health services with psychosocial support units,
Restructure and improve Mathari hospital to a National specialized referral hospital and institute of mental health with affiliated six regional training and specialized services referral centres,
Conduct a National Mental Health survey to establish the burden and resource gaps, and
KEMSA to stock all psychotropic medicines in the Kenya Essential Medicine list (KEML)

Lastly, regarding the facilities in place, the taskforce claimed the Government has already allocated 200 acres of land around Ngong area to have Mathari National Teaching and Referral hospital relocated from where it has been since 1911.

Conclusion:
It is quite evident that Kenya needs to give priority to improving mental health policies in order to break the devastating chain of suicides and neglect towards people suffering from these conditions. Thomas Jefferson once said, “Let the eye of vigilance never be closed.” Kenya has been blind towards the mental health sector for far too long, it is only fair to demand a change.