Sunday, October 28, 2012

Continuing neglect of mental health dangerous

By Lukoye Atwoli
Sunday Nation 21 October 2012

Just under two weeks ago, the world marked the World Mental Health Day. In Kenya, it was in a low-key manner unlike in the past when there would be processions and speeches at a public health facility, and usually around the Mathari Hospital in Nairobi.

Perhaps the low-key commemoration was an appropriate metaphor for the amount of attention being paid to this very important aspect of our national life. Despite going through the annual ritual of lamenting under funding for mental health and neglect of the national referral mental hospital, very little seems to change each year.

Indeed, it could be argued that things are getting worse. Predictably, rates of mental illness are increasing as a function of industrialisation and “development”. Further, as people become more and more aware of mental health issues, demand for mental health services continues to rise.

Finally, as the national population continues growing rapidly, the absolute numbers of people with mental illness will follow suit, even if the prevalence rates remain constant. The upshot of this increased demand is that we need more mental health facilities and workers to address this need.

Unfortunately, the health sector as a whole is suffering from systemic neglect born of government policy that considers health to be a side-issue that can be addressed after “more important” sectors have been taken care of. Despite government commitment to spend 15 per cent of the budget on health, current expenditure is still less than half that figure.

Health facilities are still largely understaffed, have old and battered equipment, and suffer from shortages of essential supplies. To make matters worse, less than one per cent of the health budget is spent on mental health, with the bulk of it going to pay salaries. The Kenya Board of Mental Health, established by statute over two decades ago, has yet to be facilitated and its effect has not been felt across the land. Regional mental health boards as provided for in the same Act are unheard of.

Mental health programmes are rare and completely dependent on donor funding. Sponsorship for training in mental health is dwindling, and most postgraduate students in psychiatry have lately been from other countries in the region.

The truth of the matter is that this continued neglect of mental health poses a grave danger to the well-being of our country. The danger is not as abstract as saying that a nation whose mental health is unattended to cannot prosper socially or economically.

It is the real danger that mentally unwell people are running this country and making decisions that affect all of us. Mentally unwell people are teaching our children, preaching in our places of worship, driving our public transport vehicles, and treating our sick relatives in hospitals.

Mentally unwell people are shaping national discourse in the media, and others are leaving their homes in droves to join Al Shabaab and related militias. Mentally unwell people are roaming our streets unattended, posing unspoken dangers to themselves and others. Mental ill-health, running the entire gamut from mild afflictions to the more severe disorders, is very common in this country.

And unless we start funding mental health programmes and paying attention to staffing and infrastructure needs, we might as well give up on all the other national endeavours we are pretending to pursue. 

The writer is the secretary, Kenya Psychiatric Association and a senior lecturer at Moi University’s school of medicine; twitter @LukoyeAtwoli

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