Why budgeting for mental health care is crucial

By LUKOYE ATWOLI
Sunday Nation 9 October 2011

Every year, October 10th is marked as the World Mental Health Day all over the world. This year’s theme is “Investing in Mental Health”, an issue that has been on top of the agenda for the mental health community for a long time.

Concerns about under-investment in mental health are backed by global budget figures, with the World Health Organisation (WHO) estimating that most low and middle income countries invest less than 2 per cent of their total budgets in mental health activities, the bulk of which goes to fund mental hospitals and pay workers.

In Kenya, our government continues to pay lip service to the Abuja Declaration that suggested that at least 15 per cent of the budget should be dedicated to health, and our health expenditure as a proportion of total expenditure has been declining steadily over the years. Additionally, health expenditure on mental health remains abysmal at less than 0.5 per cent, most of which goes to pay salaries and allowances of staff at ministry headquarters.

Mental ill health contributes a significant burden of disease globally, more so in low income countries such as Kenya. According to the WHO, depression is currently the leading cause of disability worldwide, and it is further estimated that one in four people will be affected by a mental
disorder at some point in their lives.

These statistics are even worse in Kenya, where no community-level intervention exists to reduce the burden of mental ill health.

No care

Due to under-investment in mental health, it is estimated that over 80 per cent of people with mental disorders in our country do not receive any sort of care, and many go through life believing that it is normal to suffer as they do.

The reason the government continues to ignore mental health in the budget might be attributed to the false perception that mental illnesses do not kill. Quite to the contrary, mental illnesses can and do kill millions of people annually.

For instance, a person commits suicide every 40 seconds somewhere in the world. Most of those that commit or attempt to commit suicide have severe psychological and social distress that can only be addressed by properly organised and funded mental health services.

Additionally, 2.5 million deaths annually are due to harmful use of alcohol, an area of immense concern in mental health. Kenya is among the countries identified as having a large proportion of people with harmful alcohol use, and it is conceivable that many of our “road accidents” are due to alcohol and other substance use.

Mental ill health also increases the risk of acquiring and dying from other serious medical conditions, including HIV/Aids, Diabetes, Cancer, and infectious diseases. Investment in mental health will, therefore, be useful in bridging the service gap in these areas, enabling the provision of care at different levels for people with mental
illness.

Budgeting for increased training of mental health personnel, improved infrastructure, hiring more staff, and providing medications and other resources must be prioritised if we are to make a dent on the burden of mental ill health.

Finally, as part of full implementation of the Constitution, the government must take steps to actualise the citizens’ constitutional right to, among other things, the “highest attainable standard of health”, a right that includes access to good quality mental health care.

Dr Lukoye Atwoli is secretary, Kenya Psychiatric Association and lecturer at Moi University’s school of medicine www.lukoyeatwoli.com