By LUKOYE ATWOLI
Sunday Nation 06 September 2009
There has been heated debate about President Kibaki’s decision to reappoint Mr Justice Aaron Ringera to head the Kenya Anti-Corruption Commission.
Some of the arguments have focused on the fact that he ignored the provisions of the law that stipulates that the director and his assistants should be appointed on the advice of the advisory board.
Attempting to unravel the legal implications of the President’s decision would be an exercise in futility for, in Kenya, it has become clear in recent history that anything goes.
It may be more useful to interrogate the nature of the cacophony being generated on behalf of a body many Kenyans treat with indifference at best.
Since the formation of the anti-corruption authority, questions have continually been raised about commission’s efficacy in combating corruption, with many insinuations being made about the big fish going free while the occasional small fry get caught and punished.
It is common talk that in many corruption scandals, the real masterminds go scot-free. But where do the so-called “big fish” go? It does not take a genius to see where they are. The who is who in Kenya’s corrupt past currently populate the highest echelons of governance in this country, as well as being celebrated “captains of industry”.
Indeed they are cheered whenever they show their faces, and many of them only need to whisper a few incoherent sentences before they are offered tribal chieftainships and political leadership.
Some even occupy prime positions in our religious organisations, and get healthy chunks of airtime in the mass media with their crusades for righteousness and repentance.
The same Kenyans that fete those they allege stole their birthright are the loudest noisemakers when it comes to condemning the anti-corruption bodies in this country and enumerating their perceived failures.
Another interesting observation to be made in our peculiar country is that once a prominent individual is accused of corrupt practices, he often retreats to the safety of his tribal homeland and proceeds to issue threats to the rest of the country and the government in particular about the dangers of targeting his “community”.
The spectre of bloodshed is often invoked at this point, and often the threats prove to be quite effective because the accusers quickly fall silent and the status quo remains unchanged.
It is, therefore, highly duplicitous for people who do not want justice to be done to their corrupt sons to turn around and accuse the government and its anti-corruption organs of doing nothing to rid the country of this malignant vice.
Many Kenyans do not stop to ask themselves what their role is in the perpetuation of corruption in this country.
It must be remembered that when the National Rainbow Coalition government snatched power from the vilified Moi administration, wananchi briefly styled themselves “Wenye Nchi” (owners of the country) and loudly demanded an end to business as usual. The result was a plethora of citizens arrest of corrupt government officials and exposure of corrupt deals at all levels of government.
The Kenya Anti-Corruption Commission was not even being mentioned at this time, yet corrupt officials found it much more difficult to demand bribes and kick-backs.
As the Narc government settled into place, however, it came face to face with the allure of grand corruption and found it irresistible. Citizens lapsed back to their bribing ways and the only thing left was the endless lamentations about the anti-graft commission doing nothing to fight corruption.
All over the country, Kenyans are perpetuating corrupt practices. For instance, many owners of defective vehicles are bribing traffic police officers to turn a blind eye to their faults and allow them to carry passengers, often to gory ends.
Parents are still struggling to bribe recruitment officers for the police and the armed forces during their recruitment drives. Voters are registering twice to vote in elections in order to influence the outcome in favour of their candidates.
Parents are even buying examination papers from unscrupulous education officials to help their children get ahead academically. Patients are colluding with corrupt hospital staff to inflate their bills so that they can pocket the difference from insurance companies.
In fact, crooks are even buying their freedom in our legal justice system! The examples of so-called “petty corruption” are legion, and yet all anybody talks about is the failure of the “Ringera team” to control and eradicate corruption from our midst.
It is time we all played our part in this fight; we must recognise that if all Kenyan citizens refused to bribe or steal other people’s property, there would be no need for Mr Ringera’s team in the first place.
Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine inbox@lukoyeatwoli.com
Sunday, September 6, 2009
Monday, August 31, 2009
Dare to Care: Stop the Exclusions!
Some insurance companies are making health policies in Kenya which exclude treatment for mental illnesses. As if to demonstrate further ignorance in this area, they are even naming suicide attempts (often a sign of severe mental illness and distress) as exclusions.
I have seen policies that specifically exclude depression, 'psychological problems', suicide attempts, alcohol related problems and other mental disorders from their cover.
Many Kenyans accept these exclusions
1) due to ignorance and
2) due to a stigma that presupposes that mental illness only affects the 'other' person, so the exclusion is not important.
For the second group, I have news for you: Mental illness is more common than you think! About 1% of most populations suffer from a serious mental disorder called schizophrenia. Twice that number suffer from Bipolar Disorder, another severe mental disorder. Studies have shown that upto 25% of the population have suffered an episode of depression in their lifetime.
Indeed, in Kenya, upto 50% (yes, half, or one in two!) of patients seeking health services in a general setting (casualty, outpatient, private clinics, etc) suffer from depression, ranging from mild to severe.
What this means is that a large proportion of the population is at risk of developing one mental illness or another, and therefore insurance coverage will come in handy for their treatment.
It is for this reason that the Mental Health Act, Cap 248 of the Laws of Kenya, specifically provides for insurance cover for persons with mental disorders.
Which brings me to the first group above. To address their ignorance, I attach below (In quotes) the full text of s46 of the Mental Health Act (1989):
"46. Insurance for treatment of persons suffering from mental disorder.
46. (1) Every person in Kenya shall, be entitled, if he wishes, to insurance providing for his treatment as a person suffering from mental disorder and no insurance company shall make any insurance policy providing insurance against sickness, which excludes or restricts the treatment of persons suffering from mental disorder
(2) An insurance company which makes any insurance policy which expressly excludes or
puts restrictions on the treatment of any person suffering from mental disorder shall be guilty of an offence."
Please be informed, and insist on your right of coverage for mental disorder. Indeed, even if a company has an explicit exclusion for mental disorders, the exclusions are illegal, non-binding, and may attract prosecution!
For representatives of insurance companies, all I can say is : Dare to Care! Stop the Exclusions!
I have seen policies that specifically exclude depression, 'psychological problems', suicide attempts, alcohol related problems and other mental disorders from their cover.
Many Kenyans accept these exclusions
1) due to ignorance and
2) due to a stigma that presupposes that mental illness only affects the 'other' person, so the exclusion is not important.
For the second group, I have news for you: Mental illness is more common than you think! About 1% of most populations suffer from a serious mental disorder called schizophrenia. Twice that number suffer from Bipolar Disorder, another severe mental disorder. Studies have shown that upto 25% of the population have suffered an episode of depression in their lifetime.
Indeed, in Kenya, upto 50% (yes, half, or one in two!) of patients seeking health services in a general setting (casualty, outpatient, private clinics, etc) suffer from depression, ranging from mild to severe.
What this means is that a large proportion of the population is at risk of developing one mental illness or another, and therefore insurance coverage will come in handy for their treatment.
It is for this reason that the Mental Health Act, Cap 248 of the Laws of Kenya, specifically provides for insurance cover for persons with mental disorders.
Which brings me to the first group above. To address their ignorance, I attach below (In quotes) the full text of s46 of the Mental Health Act (1989):
"46. Insurance for treatment of persons suffering from mental disorder.
46. (1) Every person in Kenya shall, be entitled, if he wishes, to insurance providing for his treatment as a person suffering from mental disorder and no insurance company shall make any insurance policy providing insurance against sickness, which excludes or restricts the treatment of persons suffering from mental disorder
(2) An insurance company which makes any insurance policy which expressly excludes or
puts restrictions on the treatment of any person suffering from mental disorder shall be guilty of an offence."
Please be informed, and insist on your right of coverage for mental disorder. Indeed, even if a company has an explicit exclusion for mental disorders, the exclusions are illegal, non-binding, and may attract prosecution!
For representatives of insurance companies, all I can say is : Dare to Care! Stop the Exclusions!
Count should have data on place of ‘usual residence’
By LUKOYE ATWOLI
Sunday Nation 30 August 2009
This past week, over a hundred thousand enumerators have criss-crossed the country in an effort to establish just how many people there are in this country.
There does not seem to have been any serious problem with the census itself, and all indications so far are that any reported hitches in the process have not significantly affected its integrity.
Indeed, even the emotive issue of tribe seems to have been handled relatively well, with the enumerators in most cases employing tact and respect for their clients’ views. In some cases where the enumerators seemed unsure of codes for certain items on the questionnaire, they entered the data exactly as given, promising to confirm the codes later.
That said, an interesting phenomenon was observed in many urban centres just before the census began early last week. There was a sizeable exodus of some urban dwellers to their rural homelands ostensibly in order to be “counted at home” together with their tribal kin. Many people closed shop on Monday afternoon and made a beeline for their rural homes, and the presidential declaration of a public holiday on Tuesday in fact served to facilitate this movement.
Innocuous as this phenomenon may seem, it offers a window into the mind of the ordinary Kenyan as far as the meaning of a census is concerned.
It would seem that many treat the census in much the same way as they do an election. A similar exodus occurs in this country on the eve of any election, and many city-dwellers are registered to vote in their rural areas.
The “being counted at home” mentality therefore indicates clearly that as a nation we are unaware of the true value of a census as a planning tool, and are more preoccupied with perpetuating our ethnicised politics. In this sense, therefore, we lose the right to harangue our leadership about nepotism, tribalism and all other “isms” that continue to drag the country away from its development goals.
Statisticians have told us that the role of the census is to provide data that is crucial for planning and resource allocation. The data will be used to determine infrastructural needs, health facilities, education and other services. This being the case, the unit of planning will not only be based on raw numbers, but also on geographical dispersal of the population.
Presumably, these services will be concentrated in areas with greater populations than those that are sparsely populated.
Unfortunately, we also know that when the numbers are released later this year or some time next year, many will hold their collective breaths for the ethnic composition of our population and start making plans for new ethno-political alliances in order to win the next General Election.
In the absence of clear tribe data, others will use a proxy such as provincial and district figures for political bargaining, always assuming ethnic and political homogeneity in these provinces and districts.
Rushing to our rural homes for the census, and even for an election, only serves the interests of our political elite, and we should not raise a finger when they use the numbers arising from census and voter registration data to trade for political positions. Such use is indeed more appropriate than any planning use the data may be put to.
Due to the census and election “migrations”, the data on population densities is inaccurate and of little use for decision-making purposes. For instance, a health centre may be sited in some rural area due to the reported large numbers of people in the area when, in fact, majority of the reported “residents” only show up during public holidays, elections and censuses.
Conversely, an area in Nairobi or Mombasa may be neglected due to reportedly low population figures when, in fact, it holds a huge population of “up-country” people who are never counted during the census.
Simplistically, this anomaly may be said to be responsible for the lack of accountability among our politicians and especially among the ever-fighting councillors in our urban areas during mayoral elections.
Politicians in urban areas do not owe allegiance to all the residents, while those in rural areas were installed by urbanites who are never present to hold them to account!
Several strategies may be employed by the statistics bureau if the statisticians are truly interested in accurate data for planning purposes. The most useful one, in my view, would be to redesign the questionnaires to include a question on the place of usual residence regardless of where one is found on the night of the census.
Indeed, short of banning travel in the days leading up to the census, this seems to be the only effective way that would ensure that data is captured on true population density and distribution across the entire country.
Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine www.lukoyeatwoli.com
Sunday Nation 30 August 2009
This past week, over a hundred thousand enumerators have criss-crossed the country in an effort to establish just how many people there are in this country.
There does not seem to have been any serious problem with the census itself, and all indications so far are that any reported hitches in the process have not significantly affected its integrity.
Indeed, even the emotive issue of tribe seems to have been handled relatively well, with the enumerators in most cases employing tact and respect for their clients’ views. In some cases where the enumerators seemed unsure of codes for certain items on the questionnaire, they entered the data exactly as given, promising to confirm the codes later.
That said, an interesting phenomenon was observed in many urban centres just before the census began early last week. There was a sizeable exodus of some urban dwellers to their rural homelands ostensibly in order to be “counted at home” together with their tribal kin. Many people closed shop on Monday afternoon and made a beeline for their rural homes, and the presidential declaration of a public holiday on Tuesday in fact served to facilitate this movement.
Innocuous as this phenomenon may seem, it offers a window into the mind of the ordinary Kenyan as far as the meaning of a census is concerned.
It would seem that many treat the census in much the same way as they do an election. A similar exodus occurs in this country on the eve of any election, and many city-dwellers are registered to vote in their rural areas.
The “being counted at home” mentality therefore indicates clearly that as a nation we are unaware of the true value of a census as a planning tool, and are more preoccupied with perpetuating our ethnicised politics. In this sense, therefore, we lose the right to harangue our leadership about nepotism, tribalism and all other “isms” that continue to drag the country away from its development goals.
Statisticians have told us that the role of the census is to provide data that is crucial for planning and resource allocation. The data will be used to determine infrastructural needs, health facilities, education and other services. This being the case, the unit of planning will not only be based on raw numbers, but also on geographical dispersal of the population.
Presumably, these services will be concentrated in areas with greater populations than those that are sparsely populated.
Unfortunately, we also know that when the numbers are released later this year or some time next year, many will hold their collective breaths for the ethnic composition of our population and start making plans for new ethno-political alliances in order to win the next General Election.
In the absence of clear tribe data, others will use a proxy such as provincial and district figures for political bargaining, always assuming ethnic and political homogeneity in these provinces and districts.
Rushing to our rural homes for the census, and even for an election, only serves the interests of our political elite, and we should not raise a finger when they use the numbers arising from census and voter registration data to trade for political positions. Such use is indeed more appropriate than any planning use the data may be put to.
Due to the census and election “migrations”, the data on population densities is inaccurate and of little use for decision-making purposes. For instance, a health centre may be sited in some rural area due to the reported large numbers of people in the area when, in fact, majority of the reported “residents” only show up during public holidays, elections and censuses.
Conversely, an area in Nairobi or Mombasa may be neglected due to reportedly low population figures when, in fact, it holds a huge population of “up-country” people who are never counted during the census.
Simplistically, this anomaly may be said to be responsible for the lack of accountability among our politicians and especially among the ever-fighting councillors in our urban areas during mayoral elections.
Politicians in urban areas do not owe allegiance to all the residents, while those in rural areas were installed by urbanites who are never present to hold them to account!
Several strategies may be employed by the statistics bureau if the statisticians are truly interested in accurate data for planning purposes. The most useful one, in my view, would be to redesign the questionnaires to include a question on the place of usual residence regardless of where one is found on the night of the census.
Indeed, short of banning travel in the days leading up to the census, this seems to be the only effective way that would ensure that data is captured on true population density and distribution across the entire country.
Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine www.lukoyeatwoli.com
Monday, August 24, 2009
Harness revolutionary moment for positive change
By LUKOYE ATWOLI
Sunday Nation 23 August 2009
Last week, I spent some time with a poor family on the outskirts of Eldoret town in Kenya.
The first time I met the family they were the most politically opinionated group I had ever met.
They were optimistic that the 2007 General Election would bring real change to the country at last, and they would not hear of any argument running counter to their expectations.
They were ecstatic whenever they heard their candidate speak, and would switch off the television set or radio whenever they heard his opponent speak.
They would have done anything to ensure their candidate won and, indeed, they did do everything in their power to campaign for him. Suffice it to say that despite the war that broke out after the General Election, their candidate is today one of the principals in the grand coalition government.
The above family represents most Kenyan homesteads in the run-up to the last General Election. Only a minority managed to stay away from the euphoric mood preceding the most closely contested election in our independent history, and the subsequent events have affected all Kenyans.
Last week when I sat down with some members of this family, the mood was decidedly different. There was a sense of dejection that was informed by a perception of betrayal by “their” principal.
Reminded of their enthusiasm before the General Election, most of them just shrugged their shoulders.
They claimed that they had hoped for better things than they have experienced since the election. They had hoped for constitutional change, better infrastructure, improved governance and a sense of pride in being Kenyan.
Instead they had been rewarded with post-election violence, famine and hunger, political instability, water and electricity rationing and rising unemployment.
This disillusioned family is a microcosmic representation of the state of the Kenyan nation at this point in time. Disillusioned youth all over the country’s shopping centres are hankering after anyone peddling hope, but are instead coming away with more hopelessness and despondency.
People are vowing never to vote again, and even the chair of the Interim Independent Electoral Commission was recently heard lamenting about the apathy attending the forthcoming by-elections.
The rulers of the land are tottering from crisis to crisis, appearing singularly uncoordinated in their interventions, and promising special funds for one proposal after another.
As has been argued eloquently by others before me, the land is ripe for revolutionary change. Those of us that dismiss this talk of revolution are only expressing our comfort with the status quo and fear the unknown consequences of radical change.
One thing we learn from history is that change is inevitable, and those that stand in its way are often swept aside and replaced by those that prepare for it and ride it to a new dispensation.
The tragedy with unmanaged change is that it often develops a life of its own, and is prone to being hijacked by diverse forces with interests ranging from the truly altruistic to completely personal ones.
My visit with this family on the outskirts of Eldoret town left me convinced that unless something drastic happens, this country is headed into such a dark hole that it may not manage to emerge from it whole.
Urgent measures must be taken to start tackling the root causes of the huge gap between the rich and the poor. Long-term plans to tackle hunger and unemployment must be activated, and the results must begin to be felt sooner rather than later.
The recent frantic efforts by the two principals to deal with the famine in the country, though laudable, are in fact a continuation of old thinking and approaches.
Most of their actions betray a certain difficulty appreciating novel realities that demand new approaches in dealing with the challenges of the 21st century.
Continuing bickering over matters of national importance such as environmental conservation, health care and even taxation demonstrates a dangerous insularity on the part of our political class, and the consequences to national well-being are obvious to any observer.
Those that have coined the phrase “Round hii si mchezo” (This time it’s no joke) have no idea just how far the movement they are unleashing may be willing to go for real change in the country.
It is useful to remember that most of those that participated in the post-election violence were youth who felt they had no stake in the national economy and were, therefore, willing to destroy the very infrastructure that supports it.
Unless the coming revolution is harnessed and used to introduce a radically new order in this country, it will inevitably be hijacked by blood-thirsty brigands who will not hesitate to destroy whatever they can lay their hands on in the name of correcting “historical injustices”.
Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine
www.lukoyeatwoli.com
Sunday Nation 23 August 2009
Last week, I spent some time with a poor family on the outskirts of Eldoret town in Kenya.
The first time I met the family they were the most politically opinionated group I had ever met.
They were optimistic that the 2007 General Election would bring real change to the country at last, and they would not hear of any argument running counter to their expectations.
They were ecstatic whenever they heard their candidate speak, and would switch off the television set or radio whenever they heard his opponent speak.
They would have done anything to ensure their candidate won and, indeed, they did do everything in their power to campaign for him. Suffice it to say that despite the war that broke out after the General Election, their candidate is today one of the principals in the grand coalition government.
The above family represents most Kenyan homesteads in the run-up to the last General Election. Only a minority managed to stay away from the euphoric mood preceding the most closely contested election in our independent history, and the subsequent events have affected all Kenyans.
Last week when I sat down with some members of this family, the mood was decidedly different. There was a sense of dejection that was informed by a perception of betrayal by “their” principal.
Reminded of their enthusiasm before the General Election, most of them just shrugged their shoulders.
They claimed that they had hoped for better things than they have experienced since the election. They had hoped for constitutional change, better infrastructure, improved governance and a sense of pride in being Kenyan.
Instead they had been rewarded with post-election violence, famine and hunger, political instability, water and electricity rationing and rising unemployment.
This disillusioned family is a microcosmic representation of the state of the Kenyan nation at this point in time. Disillusioned youth all over the country’s shopping centres are hankering after anyone peddling hope, but are instead coming away with more hopelessness and despondency.
People are vowing never to vote again, and even the chair of the Interim Independent Electoral Commission was recently heard lamenting about the apathy attending the forthcoming by-elections.
The rulers of the land are tottering from crisis to crisis, appearing singularly uncoordinated in their interventions, and promising special funds for one proposal after another.
As has been argued eloquently by others before me, the land is ripe for revolutionary change. Those of us that dismiss this talk of revolution are only expressing our comfort with the status quo and fear the unknown consequences of radical change.
One thing we learn from history is that change is inevitable, and those that stand in its way are often swept aside and replaced by those that prepare for it and ride it to a new dispensation.
The tragedy with unmanaged change is that it often develops a life of its own, and is prone to being hijacked by diverse forces with interests ranging from the truly altruistic to completely personal ones.
My visit with this family on the outskirts of Eldoret town left me convinced that unless something drastic happens, this country is headed into such a dark hole that it may not manage to emerge from it whole.
Urgent measures must be taken to start tackling the root causes of the huge gap between the rich and the poor. Long-term plans to tackle hunger and unemployment must be activated, and the results must begin to be felt sooner rather than later.
The recent frantic efforts by the two principals to deal with the famine in the country, though laudable, are in fact a continuation of old thinking and approaches.
Most of their actions betray a certain difficulty appreciating novel realities that demand new approaches in dealing with the challenges of the 21st century.
Continuing bickering over matters of national importance such as environmental conservation, health care and even taxation demonstrates a dangerous insularity on the part of our political class, and the consequences to national well-being are obvious to any observer.
Those that have coined the phrase “Round hii si mchezo” (This time it’s no joke) have no idea just how far the movement they are unleashing may be willing to go for real change in the country.
It is useful to remember that most of those that participated in the post-election violence were youth who felt they had no stake in the national economy and were, therefore, willing to destroy the very infrastructure that supports it.
Unless the coming revolution is harnessed and used to introduce a radically new order in this country, it will inevitably be hijacked by blood-thirsty brigands who will not hesitate to destroy whatever they can lay their hands on in the name of correcting “historical injustices”.
Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine
www.lukoyeatwoli.com
Sunday, August 16, 2009
Opportunity to define place of mental health in Kenya
Opportunity to define place of mental health in Kenya
By LUKOYE ATWOLI
Sunday Nation 16 August 2009, Page 31
This week, the Kenya Psychiatrists Association (KPA) holds its first annual scientific conference in Mombasa from 21 to 23, 2009. The theme of the meeting is “Transforming Mental Health Services in Kenya: Challenges and Opportunities”, and various sub-themes run the entire gamut of mental health theory and practice.
Historically, mental health has been narrowly defined in the context of psychiatry, which deals mostly with disorders of the various mental functions and how to treat them.
Within this narrow definition, mental health has been characterised as the poor relation of “more important” medical specialties including internal medicine, paediatrics and surgery. This has led to a false dichotomy between “mental health” and other areas dealing with the human mind such as counselling, psychology and even drug rehabilitation.
Contrary to this narrow definition, mental health deals with all functions of the human mind and their behavioural and social correlates. The World Health Organisation in fact defines mental health as “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.
By holding the first meeting of its kind in this country, KPA is signifying the coming of age of mental health as a super-discipline encompassing all the areas of human existence.
This meeting will be attended by specialists from all fields of mental health, and not just psychiatrists, indicating a convergence of all the positive forces that are struggling with limited resources to deal with problems that would eventually overwhelm the fabric of the state.
An indication of the role mental health has played in our history comes from an unlikely source. The colonial government was once so peeved by the challenges to its power that it declared some freedom fighters “insane” and dealt with them as such. One Elijah Masinde of Dini ya Musambwa was said to be delusional for stating that the white man would not rule Kenya forever, and for his troubles he was “admitted” to the Mathari Hospital!
Some of the people who were incarcerated in concentration camps in the 1950s are still alive today, and a recent study found that over two-thirds of them have suffered a severe mental disorder (post-traumatic stress disorder) as a result of their detention experience.
Due to the official neglect of these individuals, they continue to suffer without any hope of succour, and their offspring enter the same vicious cycle of poverty and despondency.
Violence and mental health have been demonstrated to have an intricate relationship. Exposure to violence, as in the case of the concentration camp survivors, increases the risk of development of mental disorders. Indeed this is the rationale behind offering counselling and other mental health services to survivors of rape and other forms of interpersonal violence.
On the other hand, certain mental illnesses can also increase the probability of an individual becoming violent or even inciting violence. It is a fair bet that at least some of the perpetrators of the violence that rocked this country last year had some sort of mental disorder that made it easier for them to contemplate violence rather than other means of conflict resolution.
Poverty also enjoys a dual relationship with mental illness in that it may act as a stressor, precipitating mental illness in a vulnerable individual, or it may occur and worsen as a result of mental illness.
The productivity of mentally ill people drops drastically unless the illness is treated, and mental illness remains very expensive to treat in this country given that most of the treatment is covered by out-of-pocket expenditure by families.
It can thus be powerfully argued that poverty will be that much more difficult to eradicate as long as the mental health of the population remains unaddressed.
One of the greatest barriers to achieving mental health in this country is the overwhelming stigma attached to people with mental disorders and those that care for them. This stigma not only emanates from the lay population, but also from well-educated professionals, including medical personnel. It stands in the way of people seeking timely mental health services, resulting in unnecessary complications and loss of productivity.
The people and the Government of Kenya owe it to themselves to start thinking about innovative ways of dealing with this stigma among other challenges that face the country today. The KPA meeting later this week will therefore provide an important forum to initiate an action plan leading to the development of a mental health policy that will help propel this nation to the greatness it aspires to.
Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine www.lukoyeatwoli.com
By LUKOYE ATWOLI
Sunday Nation 16 August 2009, Page 31
This week, the Kenya Psychiatrists Association (KPA) holds its first annual scientific conference in Mombasa from 21 to 23, 2009. The theme of the meeting is “Transforming Mental Health Services in Kenya: Challenges and Opportunities”, and various sub-themes run the entire gamut of mental health theory and practice.
Historically, mental health has been narrowly defined in the context of psychiatry, which deals mostly with disorders of the various mental functions and how to treat them.
Within this narrow definition, mental health has been characterised as the poor relation of “more important” medical specialties including internal medicine, paediatrics and surgery. This has led to a false dichotomy between “mental health” and other areas dealing with the human mind such as counselling, psychology and even drug rehabilitation.
Contrary to this narrow definition, mental health deals with all functions of the human mind and their behavioural and social correlates. The World Health Organisation in fact defines mental health as “a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.
By holding the first meeting of its kind in this country, KPA is signifying the coming of age of mental health as a super-discipline encompassing all the areas of human existence.
This meeting will be attended by specialists from all fields of mental health, and not just psychiatrists, indicating a convergence of all the positive forces that are struggling with limited resources to deal with problems that would eventually overwhelm the fabric of the state.
An indication of the role mental health has played in our history comes from an unlikely source. The colonial government was once so peeved by the challenges to its power that it declared some freedom fighters “insane” and dealt with them as such. One Elijah Masinde of Dini ya Musambwa was said to be delusional for stating that the white man would not rule Kenya forever, and for his troubles he was “admitted” to the Mathari Hospital!
Some of the people who were incarcerated in concentration camps in the 1950s are still alive today, and a recent study found that over two-thirds of them have suffered a severe mental disorder (post-traumatic stress disorder) as a result of their detention experience.
Due to the official neglect of these individuals, they continue to suffer without any hope of succour, and their offspring enter the same vicious cycle of poverty and despondency.
Violence and mental health have been demonstrated to have an intricate relationship. Exposure to violence, as in the case of the concentration camp survivors, increases the risk of development of mental disorders. Indeed this is the rationale behind offering counselling and other mental health services to survivors of rape and other forms of interpersonal violence.
On the other hand, certain mental illnesses can also increase the probability of an individual becoming violent or even inciting violence. It is a fair bet that at least some of the perpetrators of the violence that rocked this country last year had some sort of mental disorder that made it easier for them to contemplate violence rather than other means of conflict resolution.
Poverty also enjoys a dual relationship with mental illness in that it may act as a stressor, precipitating mental illness in a vulnerable individual, or it may occur and worsen as a result of mental illness.
The productivity of mentally ill people drops drastically unless the illness is treated, and mental illness remains very expensive to treat in this country given that most of the treatment is covered by out-of-pocket expenditure by families.
It can thus be powerfully argued that poverty will be that much more difficult to eradicate as long as the mental health of the population remains unaddressed.
One of the greatest barriers to achieving mental health in this country is the overwhelming stigma attached to people with mental disorders and those that care for them. This stigma not only emanates from the lay population, but also from well-educated professionals, including medical personnel. It stands in the way of people seeking timely mental health services, resulting in unnecessary complications and loss of productivity.
The people and the Government of Kenya owe it to themselves to start thinking about innovative ways of dealing with this stigma among other challenges that face the country today. The KPA meeting later this week will therefore provide an important forum to initiate an action plan leading to the development of a mental health policy that will help propel this nation to the greatness it aspires to.
Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine www.lukoyeatwoli.com
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