Sunday, August 16, 2009

Opportunity to define place of mental health in Kenya

Opportunity to define place of mental health in Kenya
Sunday Nation 16 August 2009, Page 31

This week, the Kenya Psychiatrists Association (KPA) holds its first annual scientific conference in Mombasa from 21 to 23, 2009. The theme of the meeting is “Transforming Mental Health Services in Kenya: Challenges and Opportunities”, and various sub-themes run the entire gamut of mental health theory and practice.

Historically, mental health has been narrowly defined in the context of psychiatry, which deals mostly with disorders of the various mental functions and how to treat them.

Within this narrow definition, mental health has been characterised as the poor relation of “more important” medical specialties including internal medicine, paediatrics and surgery. This has led to a false dichotomy between “mental health” and other areas dealing with the human mind such as counselling, psychology and even drug rehabilitation.

Contrary to this narrow definition, mental health deals with all functions of the human mind and their behavioural and social correlates. The World Health Organisation in fact defines mental health as “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.

By holding the first meeting of its kind in this country, KPA is signifying the coming of age of mental health as a super-discipline encompassing all the areas of human existence.

This meeting will be attended by specialists from all fields of mental health, and not just psychiatrists, indicating a convergence of all the positive forces that are struggling with limited resources to deal with problems that would eventually overwhelm the fabric of the state.

An indication of the role mental health has played in our history comes from an unlikely source. The colonial government was once so peeved by the challenges to its power that it declared some freedom fighters “insane” and dealt with them as such. One Elijah Masinde of Dini ya Musambwa was said to be delusional for stating that the white man would not rule Kenya forever, and for his troubles he was “admitted” to the Mathari Hospital!

Some of the people who were incarcerated in concentration camps in the 1950s are still alive today, and a recent study found that over two-thirds of them have suffered a severe mental disorder (post-traumatic stress disorder) as a result of their detention experience.

Due to the official neglect of these individuals, they continue to suffer without any hope of succour, and their offspring enter the same vicious cycle of poverty and despondency.

Violence and mental health have been demonstrated to have an intricate relationship. Exposure to violence, as in the case of the concentration camp survivors, increases the risk of development of mental disorders. Indeed this is the rationale behind offering counselling and other mental health services to survivors of rape and other forms of interpersonal violence.

On the other hand, certain mental illnesses can also increase the probability of an individual becoming violent or even inciting violence. It is a fair bet that at least some of the perpetrators of the violence that rocked this country last year had some sort of mental disorder that made it easier for them to contemplate violence rather than other means of conflict resolution.

Poverty also enjoys a dual relationship with mental illness in that it may act as a stressor, precipitating mental illness in a vulnerable individual, or it may occur and worsen as a result of mental illness.

The productivity of mentally ill people drops drastically unless the illness is treated, and mental illness remains very expensive to treat in this country given that most of the treatment is covered by out-of-pocket expenditure by families.

It can thus be powerfully argued that poverty will be that much more difficult to eradicate as long as the mental health of the population remains unaddressed.

One of the greatest barriers to achieving mental health in this country is the overwhelming stigma attached to people with mental disorders and those that care for them. This stigma not only emanates from the lay population, but also from well-educated professionals, including medical personnel. It stands in the way of people seeking timely mental health services, resulting in unnecessary complications and loss of productivity.

The people and the Government of Kenya owe it to themselves to start thinking about innovative ways of dealing with this stigma among other challenges that face the country today. The KPA meeting later this week will therefore provide an important forum to initiate an action plan leading to the development of a mental health policy that will help propel this nation to the greatness it aspires to.

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

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