Monday, August 29, 2011

Time to finally address stigma in mental health

Sunday Nation 21 August 2011

This coming week, mental health specialists will descend on Nairobi to attend a conference organised by the Kenya Psychiatric Association in conjunction with the African Association of Psychiatrists and Allied Professionals and the World Psychiatric Association.

The conference opens on Thursday, and will be preceded by a three-day training course on leadership and professional skills for early career psychiatrists.

This is, therefore, an ideal time to review the progress made in improving mental health services in our country, specifically focusing on stigma reduction.

For a long time, we have lamented about poor mental health services, worsened by meagre investment in this important area. The official response has been one of tokenism and whitewashing, the most prominent of which was the attempt to rename Mathari Hospital as Upper Muthaiga Hospital.

The former minister for Health had suggested that this change of name would contribute in reducing stigma towards mental illness.

However, as I commented at the time, the effect was more likely to be a transfer of stigma from “Mathari” to “Upper Muthaiga”, without having any impact on the stigma itself. Today, stigma towards the mentally ill is rampant, as recently exposed on the CNN documentary,“Locked up and forgotten”.

This stigma extends even to mental health workers, and emanates not only from the uninformed public, but also from other health workers.

Field of oncology

When the current minister for Medical Services returned home after receiving cancer treatment in the US, he became much more visible in the field of oncology. Suddenly we discovered that there is an epidemic of cancer, and foundations were launched to combat the menace.

Should a mental health catastrophe strike someone in Kenya’s health leadership for us to see an improvement in investment in mental health?

The young psychiatrists who are due to complete their training later this week will be released into an unkind world where their services will be sought in darkness and nobody will want to say to their friends in public, “there goes my doctor”.

Everybody will expect them to work very hard to eliminate mental illness in their area of operation, equipped only with their brains, a pen, and, if they are lucky, a dark abandoned room in a neglected section of a public hospital.

For instance, at the Moi Teaching and Referral Hospital where I work, the mental unit is actually a converted maternity wing of the former district hospital, with very little having changed since its conversion close to 30 years ago.

Mathari Hospital is a former small-pox isolation centre, with most of the structures dating back to the early 20th century.

This situation persists despite global evidence that mental illness is a leading cause of disability, and many countries incur huge costs in managing these illnesses and dealing with the resultant lost productivity.

One wonders who among our health leaders, from the directors in the health ministries all the way to the ministers themselves, would be happy being admitted in a psychiatric unit of a public hospital.

Hopeful, during the opening ceremony for our conference on Thursday evening, the minister will match words with action, and announce what measures the government has taken this financial year to improve mental health services.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s school of medicine

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