Tuesday, February 25, 2014

Mental health philanthropy is good, but …

By Lukoye Atwoli
Sunday Nation 23 February 2014

Two weeks ago in this column, we discussed the need for a high profile advocate for mental health in this country. I was at the point of despair, having given over and over again the reasons why it is important and even profitable to invest in mental health. Despite these noises, the Ministry of Health had gone ahead and illegally disbanded the division of mental health, at a time when such a division should have expanded to address the mental health challenges of Kenyans.

A few days after the article was published, I spoke with the Cabinet Secretary for Health, who assured me that the government was aware of the challenges facing the sector, and was doing something about it. As it turns out, First Lady Margaret Kenyatta did visit Mathari Hospital accompanied by benefactors from the Safaricom Foundation who donated Sh50 million to help rehabilitate the facility.

The donated funds will go towards renovation of some wards and purchase the necessary equipment and necessities to improve patient care. One must necessarily thank Safaricom Foundation and the First Lady for taking the initiative to highlight the plight of the mentally ill and their carers. One also hopes that Mrs Kenyatta has, through this kind gesture, accepted to be the voice of the mentally ill and look out for their best interests.

Unfortunately, however, the Mathari situation is emblematic of our treatment of the mentally ill in our country, in our homes, and in our social circles. We do not plan for their needs, and instead “out source” them to charitable individuals and organisations. Most activities aimed at improving the mental health of Kenyans are funded by donors and private individuals.

I hope that with the involvement of the First Lady and the well-heeled donor fraternity, the government’s conscience will be sufficiently pricked, encouraging those responsible to take mental health more seriously. If I had my way, I would ensure that a few steps with huge gains are implemented immediately to obviate the need for Safaricom Foundation to make a similar visit this time next year. 


The Ministry of Health would move to fully implement the Mental Health Act’s provisions on funding of mental health services and creation of a board to advise the government in this area. The Division of Mental Health would be revitalised and facilitated to enable it to handle emerging mental health problems, including suicide, homicide, road crashes and substance use, such as alcohol related problems.

A vote for mental health services would be created in the Health Ministry budget in order to adequately fund mental health services, including mental health research, health promotion, prevention of mental illnesses and treatment services for the mentally ill. All government programmes and policies would be examined for their mental health impact, and those that pose a risk to the mental health of the population would be refined to reduce or eliminate this risk.

Doing these things does not constitute a favour to Kenyans. It is a right guaranteed to all those residing in this fair republic by the supreme law of the land, under the right to health. It is a responsibility bestowed upon our elected governments, and cannot be ceded to well-meaning philanthropists. 

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

Thursday, February 20, 2014

‘Secular’ hypocrisy on show in Kisumu

By Lukoye Atwoli
Sunday Nation 16 February 2014

Last week I was forcefully reminded by a friend of mine that Kenya is a secular state that is proud of its freedoms enshrined in our hallowed constitution. This happened in the context of the riots and demonstrations that beset the lakeside city of Kisumu over what the demonstrators argued was an attempt to erect a satanic monument in the centre of the city.

According to news reports, a group of businessmen who happened to subscribe to the Sikh faith had commissioned a monument to commemorate a hundred years of the community’s presence in Kisumu. The county government allegedly approved the project and the businessmen commissioned a local sculptor with instructions about the message they intended to convey.

It is in fact said that the construction of the monument continued openly, and nobody took any notice of it until a band of religious zealots linked its presence to some environmental phenomena going on in Kisumu at the time. They quickly determined that the monument was satanic and had to be demolished before fire and brimstone rained on the city.

They organised protests and demonstrations, culminating in a very public “lynching” of the figure. The Sikh businessmen eventually removed the image “in order to avoid further trouble”. The ensuing debates took on a shrill tone, with some commentators equating the Sikh religion with devil-worship, and others tarring all Kenyans of Asian origin with the same “devil-worshipping” brush. 


This is the genesis of the assertion that Kenya is a decidedly secular state, and no religious symbols must be allowed to occupy public spaces.

Those that hold this position are a variegated collection, so it would be unfair to accuse all of them of the same sin, so to speak. There are those who have always held this position, and are against any display of religious symbols or rituals in public spaces. They are against prayers during public functions, religious services or symbols on public property or display of the same by public officers.

A second section of this group, though, only discovered their indignation at the desecration of Kenya’s secular nature when the “satanic” symbol was hoisted in the “Christian” city of Kisumu. This is the hypocritical bunch that organise religious ceremonies in public schools, open public functions with prayers, teach religious studies in schools (often no more than proselytising ventures), and have no apologies peppering official speeches with praises for their deity. They remain oblivious of the feelings of others, and their secular sensitivities are only aroused when a competing faith gains prominence with some assistance from officialdom.

We must make up our minds in this country on whether we are a truly secular state, in which case religious symbols and rituals should be banned from all public spaces, or a multi-religious society in which all religions are given equal space in the eyes of the state. The second option is difficult to maintain given the multiplicity of religious claims, many often contradicting others, that would inundate the state under those circumstances. The default, then, is for us to bolster our secular credentials and ban all religious expression in public spaces and functions.

In conclusion, one must note that the sponsors of the Kisumu sculpture have vehemently denied any religious connection to the work, making its take-down all the more ridiculous. 

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

Mental health needs high-profile advocate

By Lukoye Atwoli
Sunday Nation 09 February 2014

There has been a flurry of prominent and influential personalities selecting and supporting causes they hold dear to themselves and to Kenyans at large. They have taken up roles in advocacy and support of these causes, organising activities and raising funds for them. For instance, the President and his Deputy have taken agriculture very seriously and have invested heavily in programmes aimed at bolstering food security in our country.

The Deputy President’s wife has taken women’s empowerment to the next level, with her most prominent activity being in support of women’s groups across the country. And just last week, the First Lady launched preparations for a half-marathon in support of programmes to improve maternal and child care. She has also been involved in raising funds and awareness for HIV/Aids initiatives, and supporting orphaned or abandoned children.

In short, the top leadership in our country is involved in charitable initiatives aimed at empowering Kenyans of all walks of life. All these causes are equally worthy, and have far-reaching impacts on this country’s socio-economic situation.

But one thing is missing.

In my opinion, the most vulnerable members of our society, male or female, rich or poor, young or old, are those suffering from mental disorders. Wherever they are to be found, they are ridiculed, discriminated against, ignored, hidden or abused most savagely. So, for instance, people with HIV/Aids and mental illness have worse outcomes than those without mental illness.

It is in realising this that about 10 months ago I attempted to recruit such a high-profile personality through an open letter published on this page. I wrote the letter to the then newly-elected President Uhuru Kenyatta while he was still celebrating his victory in last year’s General Election.

In that letter, I challenged President Kenyatta to make his presidency count for health and, more specifically, for mental health. I pointed out the challenges facing the health sector as well as the consequences of neglecting the mental health of our people. I indicated to him that a decision to invest in health and mental health would make it much easier to address other sectors of our economy.

Unfortunately, most of the things I said then clearly still need to be repeated, which is why I am constrained to make this appeal again. I am looking for a high-profile Kenyan to take up an advocacy role for mental health in Kenya. If it pleases the President or any other similarly well-connected person, I would like to invite them to take up the cause of improving the lot of Kenyans suffering from mental disorders.

Any little thing done in support of this cause will go a long way in improving the lot of all Kenyans, not just those that are mentally ill. Such an advocate could team up with mental health advocates and give talks, participate in walks and marathons, help raise funds and try to influence the decision-makers at the heart of this government in favour of better mental health for all Kenyans.

Currently mental health workers, advocates and patients have few friends, and are considered queer, weird, or even misplaced whenever they appear anywhere in public. A high-profile advocate will help to change this situation, and improve the quality of life for these vulnerable individuals. 

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

Mentally ill deserve equal job opportunities

By Lukoye Atwoli
Sunday Nation 02 February 2014

Last week there were numerous newspaper reports about a mentally ill doctor being nominated and interviewed for a top post in a county government. While most reports were factual and reported events as they actually happened, some were outright sensational and insulting both to the candidate and mentally ill people in general.

One newspaper headlined the story using the term “mad doctor”, while another referred to a previous case in which the doctor was alleged to have killed someone during an episode of illness. Almost all the stories had an incredulous tone, expressing surprise that a mentally ill individual could be nominated for such a post in a county government.

But what are the facts?

Mental illness can only be diagnosed by a qualified professional after taking a detailed history of the patient, and a physical and mental state examination. In many cases, investigations have to be carried out to establish the exact cause of the symptoms and, in some instances, physical causes are identified and treated, eliminating the mental illness totally.

Many people with mental illnesses are unaware of this fact, and continue to suffer from serious symptoms without knowing that they can be assisted to live a happier, healthier life. These “silent sufferers” are to be found at all echelons of society, from the poorest community to the most affluent groups. It follows, therefore, that even at the top levels of our many governments it is possible that some leaders are mentally ill but are unaware of this fact.

Most people think that mental illness is so obvious that it is easy to identify an individual suffering from such an illness. Unfortunately this is not the case. Mental illnesses run the entire gamut of human experience, from mild forms of anxiety disorders through moderately severe depressive episodes to the more obvious psychotic episodes that many identify with the term “madman”. It is, therefore, unfair to target an individual and label them negatively simply because they suffered a severe episode of mental illness and displayed their symptoms in public.

Obviously we need to articulate a policy on employment for people with mental illnesses. Such a policy must be careful to avoid falling short of the constitutional injunction against discrimination on the basis of one’s health status. Such a policy may prescribe, for instance, that a person suffering from mental illness is entitled to equal opportunity when seeking employment based on their ability and experience.

The only caveat that may be employed is that such a person must produce evidence of continued treatment and follow-up by a mental health specialist in order to ensure that their mental illness does not interfere with their work. This would mean that even after employment, should an employee develop a mental illness, they would be entitled to receive treatment and continue working once the treating physician gives the green light. Assuming that one is unable to work by virtue of having a mental illness is abusive, discriminatory and downright inhuman.

Should we decide that people with mental illnesses should not occupy certain posts in government or elsewhere, we must begin by conducting a mental status evaluation of everyone in those positions to ensure that they do not have a mental illness that interferes with the execution of their duties.

Only after doing this would we be justified to lock out any fresh applicants with mental illness. 

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

Why it is healthy to encourage dissent

By Lukoye Atwoli
Sunday Nation 26 January 2014

In Kenya, there is always a scandal involving huge sums of taxpayer money going on. There is no doubt in my mind that this has been happening every year since independence, and perhaps even before. It is also very clear to me that if this were not the case, our country would be soaring in the league of developed countries, lending money to our poorer neighbours and helping others make good choices that would make them prosper like us.

Does this failure make Kenyans a strange breed among humans? I would argue that it does not. Human beings are by nature selfish and accumulative, and the few who overcome these base instincts are knighted and sainted, depending on the circumstances. Most of those that actively seek and attain positions of power do so for purely selfish reasons, despite the clothes of altruism they wear for public consumption.

Even for those who seem to “have it all” before they go for leadership positions, Abraham Maslow created a hierarchy of needs at whose apex he placed the most selfish need of all, self-actualisation. This selfish and accumulative need is a by-product of the survival imperative that has been with us since our ancient predecessors rose to their feet and began their journey across the then unexplored world. We needed to survive first, before we could be of any use to anyone else. 


Evolutionary psychologists argue that even apparent acts of altruism are often driven by a completely unconscious trade-off for future gain or survival. That is an attribute that is common among all things that are considered “living”, and humans are no exception.

How then do some countries prosper while others lag behind, mired in obscene corruption and impoverishment of the majority in favour of a privileged minority? Working on the assumption that all people are selfish and, given a chance, they would mortgage the entire country for their personal gain, prosperous countries ensure that no single individual has unfettered powers or the opportunity to make such decisions.

They ensure that every decision a person in power makes is second-guessed and discussed endlessly and often negatively. And whenever evidence emerges that this person has misused state resources or attempted to fleece the nation, the punishment is swift and unrelenting. They lose office and lose face, and spend a huge amount of resources to rehabilitate themselves, serving as an abject lesson to their successors and others in power.

This is the story of any country we look up to, any society we consider “successful”. And this is the reason Kenya seems to have stagnated and even retrogressed in some areas. The dominant voice in public discourse in this country is the silencing voice of Big Brother.

Whenever anyone expresses doubts about a decision by senior government officials, they are reminded to be patriotic, and often asked what a “nobody” like them has done for this country. They are asked to mind their own business, and in the past, we have even been asked, “Whose goat has he stolen?”

If we intend to prosper as a republic, we must encourage dissent, and urge our leaders to deal with the issues raised by the dissenters, however obnoxious, rather than demonising the dissenters themselves. A nation of meek sheep cannot roar like a pride of lions, no matter how loud they bleat! 

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