Sunday, June 28, 2009

Mental health needs a vote in ministry’s budget

By LUKOYE ATWOLI
Sunday Nation 28 June 2009, Page 29

The Kenyan budget allocates less than 10 per cent of financial resources to the health sector despite the government’s stated commitment to the Abuja Declaration promising at least 15 per cent of the allocations to the health sector.

Out of this meagre allocation, the ministries of Health jointly allocate less than 0.01 per cent of their expenditure to mental health services countrywide.

Most of the mental health allocation goes to pay Afya House functionaries and provide a few mostly obsolete medications to hospitals in what have often been referred to as the essential drug kits.

The division of mental health at Afya House is woefully understaffed and practically unfunded, and the majority of mental health programmes in this country are funded by non-governmental organisations.

Occurrences in this country since the last days of the colonial administration have left no doubt about the need for a comprehensive mental health policy that adequately addresses the various challenges we face as a nation.

From the Mau Mau concentration camps to the periodic eruptions of collective insanity after elections, evidence abounds on the role of mental ill-health in our national troubles.

The Mental Health Act of 1989 established the Kenya Board of Mental Health as well as District Mental Health Councils to be financed by funds ‘‘voted for the purpose by Parliament’’.

It is unclear whether any of these bodies are operational over 20 years since the Act was passed by Parliament. What is crystal clear is that there is still no vote for mental health in the budget for the ministries of Health!

At the outbreak of the violence that gripped this country last year, there was a mad scramble by various groups to provide ‘‘counselling’’ services in the affected areas. This continued in an environment of poor regulation and many of the so-called ‘‘counsellors’’ did more harm than good to the recipients of their services.

Indeed, the ministry of Special Programmes literally pulled the rug from under the feet of the ministry of Health by creating a department dealing specifically with counselling.

The ministry of Health belatedly published a set of guidelines for offering psycho-social support, but most actors in the field continue to apply disparate standards due to the lack of a clear regulatory framework in this area.

Many of the stated tasks of the government concerning recovery after the violence involve input from mental health practitioners, yet the psycho-social support services in the ministry of Special Programmes have already been terminated for lack of funds.

Every time there is a major disaster in Kenya, organisations and even individuals crawl out of the woodwork to offer counselling services when, in fact, they are on a self-promotion campaign.

This only continues to happen due to lack of a point of reference for such services. As long as the responsible ministry continues to dither and prevaricate on mental health services, this situation is sure to continue and even worsen.

The ministry of Health must move with speed to revamp the division of mental health and expand its composition beyond curative services. The mandate of the division must encompass preventive, promotive and rehabilitative services, quite apart from the provision of curative services in our public hospitals.

Counselling and other services preventing mental illness and promoting mental health are a key frontline domain in mental health, and they must be fully integrated in the mental health division. It remains the responsibility of the division of mental health to produce a strategy for developing and regulating such services in Kenya.

As it is currently, there is no scheme of service for counsellors and psychologists in the civil service. This is a major indictment of the custodians of mental health services at Afya House, and immediate steps must be taken to redress the situation.

Every Kenyan talks about counselling needs whenever tragedy occurs, but when they seek these services in our public hospitals, they end up getting a raw deal. Many of the so-called counsellors have no qualifications to carry out this demanding job.

Additionally, many counsellors do not appreciate their roles on the frontlines of the war against mental illness, and they refuse to send their clients for specialised care. Many try to create a distinction between what they do and ‘‘mental health’’ thus enhancing the stigma many mentally ill patients suffer in the first place.

It is time this confusion in mental health was eliminated through empowerment of the mental health division and expansion of its mandate to encompass all mental health services in Kenya, including counselling!

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine www.lukoyeatwoli.com

4 comments:

  1. Yes, I do concur you with. Inadequate funds can and do compromise on "quantity" of health care. But, then there are gaps within the medical establishment itself that have nothing to do with inadequate funds. For instance, why do a majority of medical professions go bananas whenever issues such as providing appropriate access to health care in cases of gender identity disorders and abortion rear their heads.

    Am not applying a wholesale condemnation on the entire medical workers but lets call a spade a spade not a big spoon; there is palpable bigotry whenever this issues crop up. Why has religion become the sieve to check what should be treated and what not to treat. This is use of public funds to sponsors peoples' prejudiced and oftenly insane religious nonsense. We need to treat all people with respect and even instilling values in the whole medical establishment.

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  2. @Audrey, fair enough... But remember doctors are human too, and their attitudes are shaped by the societies they come from and the people they interact with. By the way, gender identity disorder is recognised in the manual for mental disorders. As for abortion, there is no standard guideline on what doctors should think about abortion. This is determined by the legal and social environment they operate in.

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  3. @Audrey, fair enough... But remember doctors are human too, and their attitudes are shaped by the societies they come from and the people they interact with. By the way, gender identity disorder is recognised in the manual for mental disorders. As for abortion, there is no standard guideline on what doctors should think about abortion. This is determined by the legal and social environment they operate in.

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  4. Hi,
    I am The editor/writer with Counselor.org. I really liked your site and i am interested in building a relationship with your site. We want to spread public awareness. I hope you can help me out. Your site is a very useful resource.

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