Grey areas in mental health campaigns proving too costly

Mental health is a crucial component of our overall well-being. According to the WHO, mental health is more than the absence of mental disorders, it is a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, work productively and contribute to his or her community. The WHO goes on to say that mental wellness is ‘fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life.’ 

However, mental health issues are on the rise. According to statistics, one in four Kenyans is likely to suffer from a mental disorder at one point in their lives. How many of these Kenyans actually receive the adequate care that they deserve? Only one in six people. The rest continue to unnecessarily struggle with a disease that is largely treatable and manageable. Why is this the case? Don’t we have a framework within which people with mental health issues can seek help?

Good legislation

Notably, there is legislation that deals with mental health and persons with mental illness. First is the Kenya Mental Health Policy 2015 – 2030, which has provided a framework for interventions for securing mental health systems reforms in Kenya. Second is the Mental Health Bill 2014, which attempted to cure the shortcomings of the outdated Kenya’s Mental Health Act 1989.

However, a major challenge facing persons with mental disorders is the stigma associated with mental health issues. What causes stigma? The invisible nature of mental illness plays a big role. Because it cannot be seen, then it is easy to misunderstand what it is. For instance, it is not surprising for a teenager suffering from depression and anxiety to be perceived as ‘an attention seeker’ when she reaches out for having suicidal thoughts.

What’s more, in an African setting, persons suffering from mental illness are thought to be ‘possessed’ hence treated like outcasts in their communities. Because of the high price to be paid due to the stigma, many people, especially women and the youth, stay in denial of their mental health status because they cannot begin to imagine all the challenges they would have to go through if they admitted that they were indeed suffering from a mental health disorder. The consequence for this however, is much graver.

There is need therefore, to provide a holistic legislative framework that curtails the prevalence of stigma and create awareness in our communities. According to Nominated Senator Sylvia Kasanga, who is sponsoring the Mental Health (Amendment) Bill 2018, there is need for both the national and county governments to come up with programmes that deal with the stigma associated with mental health issues.

She reiterates the need for prioritizing community and family based intervention mechanisms before resorting to institutionalization. This way, persons with mental illness will receive mental care in dignity. She goes on to propose that county governments ensure that mental health issues are incorporated to the education curriculum so that people are sensitized from an early age.

Follow-up mechanism

The legislative framework provided for in the Bill encompasses mental health issues ‘before it happens, when it happens and after it happens’ meaning that there will be a follow-up mechanism to ensure that persons with mental illness go on to lead productive and quality lives.  

However, there is a heated debate around the Bill. First, there is the question of who makes decisions for a mentally ill person. According to the Bill, the decision-making power lies with the person; he/she has the right to participate in the formulation of their treatment plan, and will do so by consenting in writing.

Where the person is incapable of making an informed decision on the need for treatment, such consent shall be sought and obtained from the representative of that person. Some stakeholders seem to disagree with this approach. Doctors under the Ministry of Health feel the need to make some crucial decisions on behalf of their patients in the first instance, especially in cases where a mentally ill person may pose a danger to themselves or others around him.

Also under criticism is the definition of the term “mental health practitioner”. The Bill has expanded the aforementioned term to include psychiatrists, psychologists, clinical officers and counsellors. Some mental health experts have argued that psychologists, clinical officers and counsellors may not be qualified to deal with some mental health cases which require specialised psychiatric care.

Work in progress

The Sponsor of the Bills argues that not all mental health issues require this specialised psychiatric care, emphasising that there is need to expand the space of focus of mental health to include preventative measures as well as post treatment care, and that other medical practitioners can be incorporated into this expanded focus. She further argues that the spirit of the Bill is to recognise and refocus from mental illness only towards overall mental health and mental wellbeing.

The Bill is currently in the Senate Order paper for the second Reading. The Senate through The Committee of Health has also called for public hearing of the Mental Health (Amendment) Bill 2018 tomorrow at the Senate. This will be an opportunity for public participation and all key stakeholders to address the grey areas and tighten up the Bill.

Mr Mokamba comments on social issues