Tuesday, January 21, 2014

Insurance ‘exclusions’ a breach of the law

By Lukoye Atwoli
Sunday Nation 19 January 2014

People with mental illnesses tend to be poorer than those in good mental health for several reasons. First, poverty appears to increase the risk of several mental illnesses, especially the more severe, debilitating ones. This is because the social environment plays an important role in determining an individual’s mental health, apart from their physical and psychological condition.

Second, mental illnesses inevitably interfere with an individual’s ability to attend to their daily activities, reducing their potential to earn an income and achieve prosperity. Obviously, then, poverty and mental illness create a vicious cycle that obviates the need to attempt to discover which of them came first.

Eventually, in order to address either condition, one must deal with the other. Thus in treating mental illnesses, measures must be taken to ensure continued productivity of the patient and, similarly, poverty eradication must build in measures to address mental ill-health.

In Kenya, most people pay for their health care out of pocket, and only a tiny minority can afford medical insurance. This is more so for those suffering from mental disorders. Getting a chronic illness, such as a mental disorder, is therefore often a ticket to poverty for most Kenyans. 


Unfortunately, it is now emerging that even having medical insurance is not enough for many people with mental illnesses. Many insurers are getting into the habit of using the flimsiest of excuses to exclude payment for the treatment of mental illness. The commonest excuse is that there is a mental illness exclusion clause in the policy.

Other insurers, who purport to cover mental illnesses as well, often refuse to pay for treatment of specific conditions. The most commonly encountered “exclusions” are alcohol and substance abuse and suicidal behaviour. It is time we put an end to this inhumane behaviour that causes so much suffering for families that are already distressed.

Section 46 of the Mental Health Act, Cap 248 of the Laws of Kenya, provides that “no insurance company shall make any insurance policy providing insurance against sickness, which excludes or restricts the treatment of persons suffering from mental disorder.” Part two of this section makes it an offence to make such an insurance policy.

What this means is that every person in Kenya who has any insurance against any sickness is covered for treatment of mental illness. No insurance policy can reverse this. Therefore all those purported “exclusions” are in breach of the law, and any insurer who engages in such behaviour can be sued and compelled to pay for the treatment of mental illness. 


As to the argument that alcohol and other substance-related disorders can be legitimate exclusions, this is what Section 2 of the Mental Health Act has to say:

“Person suffering from mental disorder” means a person who has been found to be so suffering under this Act and includes a person diagnosed as a psychopathic person with mental illness, and person suffering from mental impairment due to alcohol or substance abuse (emphasis mine).

In other words, alcohol and substance abuse (and related disorders) are rightfully considered as mental disorders for the purposes of Section 46, and no insurer can refuse to cover them for any reason whatsoever.

Unless insurers stop this discriminatory behaviour, they must prepare for the flurry of litigation that will inevitably come as Kenyans increasingly become aware of their rights! 

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Monday, January 13, 2014

Enough of blaming others for our mistakes

By Lukoye Atwoli
Sunday Nation 12 January 2014

Observing social discourse in Kenya, one notices a subtle shift in explaining the distribution of poverty and under-development in certain areas and among individuals. In the past, within relatively homogenous groups of Kenyans, the discussion invariably veered towards “marginalisation” by the dominant tribe(s) in government.

One community, or coalition of communities, would be labelled as oppressors of the majority, and all members of this group would be accused of all sorts of ills that resulted in most others sinking into poverty and want.

Among the so-called “oppressors,” however, the explanation for the opulence in their midst would be put down to hard work and innovative entrepreneurship. They would argue that they worked as individuals to build their wealth, and that those who enjoyed any favours from the State were in the minority and often transcended the tribe barrier.

They would cite examples of people from other tribes who have been engaged in large-scale looting of State resources, and were extremely wealthy, while their own communities remained largely dirt-poor. 


This group was also more likely to explain the high poverty levels in the rest of the country as being a product of laziness, excessive politicking, or lack of the entrepreneurial spirit.

Both these groups exemplify how insulating operating in an echo chamber can be. Repetition of these obviously incomplete narratives turned them into some sort of fact, gradually growing into self-fulfilling prophecies. Many otherwise able-bodied youth would resort to begging or extortion, or other more serious criminality, arguing that due to “marginalisation”, they were unlikely to make it legitimately in this country.

Almost all members of the “marginalised” group would be astounded whenever one expressed a contrary opinion placing the larger share of the blame on the complainers themselves. On the other hand, the wealthy “oppressors” would be shocked to learn that there are genuinely hard-working Kenyans who had been shafted by the system, whose property had been looted, and whose opportunities had been shrunk by operation of the largely ethnic-based system of cronyism.

The long and short of this piece is to demonstrate how things have changed today. A new coalition of “complainers” is emerging, and it has succeeded in resurrecting an old ghost to aid its cause. Today, the colonialist and his neo-colonialist ally are the main cause of our problems, and any indigene who thinks otherwise is dismissed as their lackey simply doing the bidding of his “foreign masters”.

Growing up in the 80s and 90s at the peak of Nyayo’s power, one was made acutely aware of the actual meaning of such terms. Being called a subversive under the influence of foreign powers always meant the withdrawal of the privileges of citizenship, and existence at “president’s pleasure”.

Critically examining the re-emergence of this phenomenon leads one to only one conclusion: We are constantly looking around us for scapegoats that can explain our failures in life, and we are averse to taking responsibility for the negative consequences of our actions.

In 2014, one can only hope that we shall discard this time-wasting habit, examine our own actions and resolve to make better decisions and accept the concomitant results. In order to develop this lovely country of ours, we must leave the West (or the “other” tribe) out of it!

We determine our own destiny!

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com

Suicide a leading cause of death among youth

This post was delayed due to multiple mishaps in the office that would merit full posts in their own right! My apologies, though, for this late posting.

Enjoy your read!

By Lukoye Atwoli
Sunday Nation 05 January 2014

Last week, an acquaintance of mine on social media committed suicide. I had never met him, but he would occasionally comment on my posts and carry on very “normal” online conversations. By all appearances he was a successful professional. He had been married for a couple of years and, at the time of his death, he had a one-and-a-half-year-old son. All this information could be gleaned from his Facebook profile.

I learned of his death one morning when I noticed many messages mentioning his name and following this up with the initials RIP. One of his friends posted: “Why did you have to do this? Was there no other way?” My curiosity was aroused and, on scrolling through his page, I came upon a post in which a close friend of his indicated that he had committed suicide.

That same week, a colleague called me to discuss a mutual patient. Some time in the past he had referred the young man to me for treatment of his mental illness with frequent suicide attempts. We had achieved a measure of success in his management but, after some time, he stopped coming for follow-up.

My colleague was calling to inform me that the young man had also committed suicide. He had seemed well in recent months, and was even enrolled in university pursuing a prestigious course. One day he simply did not leave his room, and when his colleagues went to check on him, they had to break down the door to get in. They found him lying lifeless in bed, having taken a lethal concoction.

I have gone to great lengths to modify the identifying information in these stories in order to protect the privacy of the grieving families, but they do represent an epidemic that is happening all around us. Suicide is emerging as a leading cause of death among young Kenyans in their most productive years, rivalling well-known killers such as road crashes, Aids and other chronic diseases.

Traditionally, suicide was frowned upon in most societies, and some had even developed very elaborate funeral rituals for those that died by suicide. In some communities in western Kenya, for instance, a person who died by suicide would be buried by strangers at night without any honours. There would be no proper mourning or memorial ceremonies and his name would be erased from the community narrative. No child would be named after him. Similar rituals exist in most communities.

The upshot of this is to make suicide appear as a personal choice, a manifestation of weakness or evil on the part of the attempter, and a reason for punishment rather than assistance. The result is that those that unsuccessfully attempt suicide are ridiculed and ostracised, often being urged to find other ways of dealing with their problems.

The unfortunate truth is that suicide is often a manifestation of serious psychological or social problems, and the attempter has reached a determination that these problems are so intractable that the only solution lies in killing themselves. Such a person needs help rather than condemnation.

I believe it is time the government declares suicide a national disaster and unveils measures to address this growing problem. 

Dr Atwoli is a consultant psychiatrist and senior lecturer at Moi University’s School of Medicine. lukoye@gmail.com