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Health

Mental illness: The silent battle for millions of Kenyans

An estimated 450 million people worldwide have a mental disorder and the number is likely to be higher due to common underreporting. PHOTO | FILE
An estimated 450 million people worldwide have a mental disorder and the number is likely to be higher due to common underreporting. PHOTO | FILE 

Do you feel stressed up? You may as well be suffering a silent mental illness that requires medical attention before it worsens.

For three years, Salome Wanjiru was stressed. It appeared typical since she had lost her husband of 10 years.

She is now a widow with four children to take care of all by herself at their Dagoretti Corner home, south of Nairobi.

After the bereavement Ms Wanjiru avoided social activities only to lose her friends. Her business of exporting cosmetics to Sudan went to the dogs as she slept and confined herself in her bedroom — for weeks.

To make matters worse, her 12-year-old daughter was almost raped one chilly morning on her way to school. She survived with multiple stab wounds from her cruel attackers.

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She was hurt in the process and was admitted for about three months to the Melchizedek Hospital after efforts to seek treatment at the Kenyatta National Hospital proved slow.

“I used all my money to clear her medical bills because I just wanted to see her back to normalcy,” says Ms Wanjiru.

From ‘normal’ stress, her condition escalated to depression. “I would sleep throughout from Monday to Sunday yet my children were depending on me.

“I could go for days without taking a simple bath. I forgot I had a business to run and cared less about my children aged between 21 and four. My husband left them under my wings — but those too were broken after his demise,” she adds.

As Ms Wanjiru went about her business trying to pick up the broken pieces in her life for the sake of her dependants, World Vision officials approached her with help after they got wind of her condition through the Health ministry. However, it took her time to agree to be enrolled in a treatment and counselling programme.

Ms Wanjiru has since found a new lease of hope in life and she is getting better now.

“I feel I can go on with life now. I have improved…They took me through an exercise of breathing in and out to calm my nerves — it really helps. Something one of the ladies (World Vision officials) told me and it got stuck was that I should keep moving — I should keep going — no matter what. I am not looking back,” she says.

Ms Wanjiru has since helped enrol a neighbour who had undergone a similar experience into the treatment programme.

Another victim, Samuel Mbuyo, a jewelry seller in Nairobi had been suffering in silence for ages before he was diagnosed with bipolar disorder. He was properly diagnosed a decade after five years of fighting a mental illness unknowingly.

Suicide attempts

Bipolar disorder is characterised by extreme mood swings marked by alternating periods of elation and depression. It causes high-risk behaviours such as impulsive sex, drug or alcohol use, and eventually suicide attempts.

After diagnosis, Mr Mbuyo immediately started treatment at the Mathari National Teaching and Referral Hospital, which later proved a challenge due to congestion.

The facility is the country’s only referral hospital for psychiatric care. “Getting medication is costly. I would hassle for money and would only afford a day’s dose meaning I have to skip treatment when I don’t have money but I have managed to stay positive in life,” he said.

Stigma from relatives and friends hit him hard and he once contemplated suicide.

“They would call me mwenda wazimu (Swahili for an insane person). It was like I was dead but medication has helped.”

Ms Wanjiru and Mr Mbuyo are not alone in fighting mental ailments, which in extreme cases may turn suicidal.

An estimated 90 per cent of the one million suicides globally are associated with some form of mental disorder namely stress, depression, bipolar disorder and schizophrenia.

Statistics show that about 11 million Kenyans suffer some form of mental illnesses that are not taken seriously and are more often discriminated against.

Up to 40 per cent of in-patients in health facilities and another 25 per cent of outpatients suffer from mental conditions, Ministry of Health data shows.

Health secretary Cleopa Mailu says that many of mental cases go unnoticed by health workers because most of the patients do not know how well to express themselves.

“Most of those who go to hospital do not express themselves well making it difficult for an attendant to make the right diagnosis.

“This means we need to create more awareness on mental health, which can have serious repercussions on people’s lives if not attended to early enough,” he said at the launch of the Kenya Mental Health Policy 2015-2030 in Nairobi.

Impromptu visit

Dr Mailu said mental health programmes would be given more prominence in public health programmes.

“When I hear about the statistics I get scared. We want to achieve the highest standards in mental health, which we can as a country. We are relooking into introducing second generation drugs because we cannot continue to use mainstream drugs when we know we have a better option,” he said.

Dr Mailu urged county governments to establish mental health units to decongest and ease burden on health workers who are overwhelmed in established hospitals such as Mathari.

“Mathari Hospital, against all odds, is doing a good job. I was surprised to find neat beds better than in other facilities after an impromptu visit,” said the Cabinet secretary.

Besides piling pressure on the few established public health facilities, there is a major shortage of specialist personnel to handle cases of mental health.

Data by the Health ministry shows that Kenya currently has 88 psychiatrists, short of the recommended 4,200.

Ideally, there should be one referral mental health unit per county with each having a bed capacity of 450 but the current capacity of 14 has around 15 to 25 beds per unit.

Dr Catherine Syengo, deputy head of the mental health unit, says that currently only 14 counties have in-patient mental health units.
Nairobi and Eldoret have two mental health rehabilitative units, she says.

Dr Syengo added that two methadone treatment clinics for heroin users are set to be opened in Kisauni (Mombasa) and Kisumu due to the prevalence in addicts in the two counties.

Heroin addicts

Currently there are three operational ethadone clinics for rehabilitating heroin addicts. They are based at Mathari, which serves 600 heroin addicts daily, Malindi County Hospital and one at Coast General Hospital.

“In fact the two new methadone clinics are fully stocked it’s just a matter staffing. Most heroin users are at the Coast and Nairobi. Central has high level of alcohol dependency,” says Dr Syengo. She adds that the clinics are licensed by the Poisons and Pharmacy Board.

Dr Syengo urges the government to increase allocations to the mental health budget which at the moment gets 0.01 per cent of the total health budget. The health budget currently stands at Sh60 billion.

She also pointed an accusing finger to insurance companies for discriminating against mental health victims.

Health officials say neurological and substance use disorders have become common affecting more than 25 per cent of people, which is one in every four Kenyans at some point in their lifetime.

Traumatic events

By 2020, it is projected that the burden of mental, neurological and substance use disorders will be 15 per cent of the total disability-adjusted life years higher than the 12 per cent in 2000. This is an enormous burden in the healthcare system and socioeconomic development.

Outgoing World Health Organisation representative to Kenya, Custodia Mandlhate, says that mental health is determined by a range of socio-economic, biological and environmental factors.

An estimated 450 million people worldwide have a mental disorder and the number is likely to be higher due to common underreporting, she says.

Traumatic events such as the 2007 post-election violence and similar conflicts play a significant role in development of post-traumatic disorders and anxiety, among others.

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