12 million Kenyans suffer mental disorders as harsh life pushes them over the cliff

By JOE KIARIE

Kenya: Bloody terror attacks, insecurity, economic hardships and broken relationships have led to a sharp increase in cases of mental illness, experts have warned.

They estimate that 12 million Kenyans could be suffering silently, with a vast majority unaware of their condition and thus yet to seek treatment.  Poor understanding of mental health and stigma could also be affecting many.

The situation at Kenyatta National Hospital paints a grim picture. Last year alone, some 6,582 patients, mostly youth aged between 18 and 24, visited the hospital with various mental problems.

Of the cases, 3,191 were attended at the Youth Centre, 1,976 at the Department of Mental Health and 1,241 at the Adult Psychiatry Clinic 23. A total of 174 inpatients were diagnosed with mental conditions. The figure marked a rise in mental health patients compared to previous years.  The number of clients at the Youth Centre at KNH for instance stood at below 2,500 from 2010 to 2012 before shooting up to more than 3, 000 last year.

“This is just a tip of the iceberg. It is hard to pull people, especially youths, to a mental health facility and many cases thus remain undetected, and untreated,” reveals Dr Margaret Makanyengo, who heads the Department of Mental Health at KNH. “Most of those brought here are also in denial.”

She says more than 30 per cent of Kenyans are suffering from mental disorders.

“Just look at the frequency of murders, suicide and violence within families; look at the frequency of road rage. All those drivers don’t know they are sick. What else would make a man dig his own grave and try to bury himself alive?” poses Makanyengo.

She was referring to a recent bizarre incident in Trans-Nzoia County where a man stunned his family when he woke up at night to dig his own grave. He said he was tired of frequent quarrels with his wife. However, he was rescued before he buried himself alive.

“The reality is that there are so many people on the streets who have given up on life but shun professional medical services due to the stigma associated with mental problems,” she explains.

Makanyengo says that while majority of the cases are attributed to traditional factors such as drug abuse, economic hardships, gender-based violence and family conflict, the wave of insecurity that has swept across the country in recent years is emerging as another key factor.

Neglected

“There are increasing cases of patients who have either been directly or indirectly affected by traumatising crime incidents or are too worried about their own safety. Mental disorders rise when there is widespread violence and this will get worse if the current situation is not controlled,” she states. She warns that with such a high proportion of mentally unhealthy people, the development of the country is bound to be affected.

And Mathari National Psychiatric Hospital, the only facility that specialises in mental illnesses, treated 60,155 outpatients last year.

Of these, 22,564 had psychiatric conditions while 4,340 were admitted at the referral facility with various mental disorders.

Dr Catherine Syengo Mutisya, the deputy medical superintendent at the hospital says they continue to record growing numbers of inpatient and outpatient cases.

“While our doctors used to attend to between 40 and 50 patients a day in the psychiatric outpatient unit in the past few years, they are now dealing with roughly between 70 and 80 cases daily,” she says.

Mutisya says the swelling number of patients overwhelmed the already strained staff and the administrators have requested for more doctors and nurses. Currently the hospital has 11 psychiatrists who attend to outpatients and inpatients and also do administration work.

The facility does not have a psychologist and psychotherapist employed by the government and relies on the doctors, volunteers and students.

Mental health remains largely neglected by the Government. Kenya has less than 100 trained psychiatrists for a population of 40 million and suffers an acute shortage of relevant facilities countrywide.

Psychologists, psychiatrists and counselors in private practice who talked to The Standard on Saturday concurred there is high prevalence of mental disorders in Kenya.

James Mbugua, a counseling psychologist at Africa Nazarene University, also puts the percentage of the population suffering from the conditions at 30 per cent.

He says frequent terror attacks in the country have aggravated the situation. “Terrorism is a major issue as people get traumatised by extension when they watch others suffer while not in a position to help. These scenarios are too regular today and have led to widespread post-traumatic stress disorder,” explains Mr Mbugua.

He says people involved or who witness the traumatic events such as robberies, carjacking, accidents, assault and violent clashes among other scary experiences rarely seek “psychological first aid”. They subsequently suffer re-experiencing of the events, lack of sleep, nightmares, fear and other emotions.

Mbugua has called on the government to treat mental health as a primary health issue. According to the Kenya Psychiatric Association (KPA), the burden of mental disorders continues to rise in Kenya.

Lukoye Atwoli, the association’s secretary, says current estimates show that between 10 and 15 per cent of Kenya’s population suffers from common mental disorders such as depression, anxiety and somatization, a condition where an individual with depression develops physical symptoms.

Another significant proportion suffers from substance-related disorders, including alcohol dependence.

Dr Lukoye states that while the 2007/08 post-election violence multiplied the number of those suffering from mental disorders, the situation remains largely unaddressed, especially among internally displaced persons.

Statistics from KPA show a shocking shortage of trained personnel in the area of mental health. Currently, Kenya has 99 trained psychiatrists, 20 of whom work in the diaspora. Out of the remaining 79, 26 are in private practice, 25 in the civil service and the other 28 in universities, KNH and the Moi Teaching and Referral Hospital.

There are 427 psychiatric nurses in the civil service, many of whom are also deployed in areas other than in psychiatric units.

This has led to severe understaffing ,best exemplified at KNH, East Africa’s largest referral hospital. Despite serving thousands of patients with mental disorders annually, the facility has just two psychologists, three psychiatrist for adult services, two for child and adolescent services and just one for the Youth Centre, who reports once a week.

The hospital does not have a single medical officer for gender-based violence while alcohol rehabilitation has just one psychiatric trained nurse and five nurse counselors.

“Nurses with just basic training in counseling have been forced to double up as counselors. We also rely on volunteers,” states Makanyengo.

According to Dr Lukoye, a consultant psychiatrist, meager funds are available for mental health programmes, research, human resource recruitment and infrastructure development, with the government’s fiscal allocation to mental health almost entirely going to wages.

Ignorance

This, he notes, has left the country with few facilities that can competently handle mental disorders. Yet according to CAP 248 of the Kenyan law, every hospital is supposed to have a mental unit with at least two beds.

At KNH, which lacks a specialised wing for patients with mental illnesses, such patients have to be admitted in the unsecured main wards when they have underlying medical conditions.

Despite their violent nature, they mingle with other patients while being handled by nurses who are untrained in the area.

Worse so, the hospital has been faced with a dilemma as all mentally ill patients with no underlying medical conditions have to be referred to Mathari Hospital in Nairobi.

“We have many cases of patients, who cannot afford services in private hospitals being taken to Mathari even when we feel that should not be the case. But with no beds for them, we have no option,” explains Makanyengo.

Dr Lukoye blames this situation on ignorance, saying most people not directly involved in mental health view mental illness as something strange that is to be shunned, instead of being dealt with.

A considerable proportion of patients who shun mental health facilities to avoid stigmatisation have ended up seeking solutions in religious institutions, and even witchdoctors.

Reverend Wellington Mutiso of the Evangelical Alliance of Kenya admits that a rising number of mental patients are seeking refuge in churches, which offer counseling and divine intervention.

“Clergymen have been faced with a challenge where they try to exorcise demons from worshippers they believe are possessed, only to later realize the person is suffering from schizophrenia (a mental illness) and needs medical treatment,” he says.

Bloody terror attacks, insecurity, economic hardships and broken relationships have led to a sharp increase in cases of mental illness, experts have warned.

They estimate that 12 million Kenyans could be suffering silently, with a vast majority unaware of their condition and thus yet to seek treatment.  Poor understanding of mental health and stigma could also be affecting many.

The situation at Kenyatta National Hospital paints a grim picture. Last year alone, some 6,582 patients, mostly youth aged between 18 and 24, visited the hospital with various mental problems.

Of the cases, 3,191 were attended at the Youth Centre, 1,976 at the Department of Mental Health and 1,241 at the Adult Psychiatry Clinic 23. A total of 174 inpatients were diagnosed with mental conditions. The figure marked a rise in mental health patients compared to previous years.  The number of clients at the Youth Centre at KNH for instance stood at below 2,500 from 2010 to 2012 before shooting up to more than 3, 000 last year.

“This is just a tip of the iceberg. It is hard to pull people, especially youths, to a mental health facility and many cases thus remain undetected, and untreated,” reveals Dr Margaret Makanyengo, who heads the Department of Mental Health at KNH. “Most of those brought here are also in denial.”

She says more than 30 per cent of Kenyans are suffering from mental disorders.

“Just look at the frequency of murders, suicide and violence within families; look at the frequency of road rage. All those drivers don’t know they are sick. What else would make a man dig his own grave and try to bury himself alive?” poses Makanyengo.

She was referring to a recent bizarre incident in Trans-Nzoia County where a man stunned his family when he woke up at night to dig his own grave. He said he was tired of frequent quarrels with his wife. However, he was rescued before he buried himself alive.

“The reality is that there are so many people on the streets who have given up on life but shun professional medical services due to the stigma associated with mental problems,” she explains.

Makanyengo says that while majority of the cases are attributed to traditional factors such as drug abuse, economic hardships, gender-based violence and family conflict, the wave of insecurity that has swept across the country in recent years is emerging as another key factor.

Neglected

“There are increasing cases of patients who have either been directly or indirectly affected by traumatising crime incidents or are too worried about their own safety. Mental disorders rise when there is widespread violence and this will get worse if the current situation is not controlled,” she states. She warns that with such a high proportion of mentally unhealthy people, the development of the country is bound to be affected.

And Mathari National Psychiatric Hospital, the only facility that specialises in mental illnesses, treated 60,155 outpatients last year.

Of these, 22,564 had psychiatric conditions while 4,340 were admitted at the referral facility with various mental disorders.

Dr Catherine Syengo Mutisya, the deputy medical superintendent at the hospital says they continue to record growing numbers of inpatient and outpatient cases.

“While our doctors used to attend to between 40 and 50 patients a day in the psychiatric outpatient unit in the past few years, they are now dealing with roughly between 70 and 80 cases daily,” she says.

Mutisya says the swelling number of patients overwhelmed the already strained staff and the administrators have requested for more doctors and nurses. Currently the hospital has 11 psychiatrists who attend to outpatients and inpatients and also do administration work.

The facility does not have a psychologist and psychotherapist employed by the government and relies on the doctors, volunteers and students.

Mental health remains largely neglected by the Government. Kenya has less than 100 trained psychiatrists for a population of 40 million and suffers an acute shortage of relevant facilities countrywide.

Psychologists, psychiatrists and counselors in private practice who talked to The Standard on Saturday concurred there is high prevalence of mental disorders in Kenya.

James Mbugua, a counseling psychologist at Africa Nazarene University, also puts the percentage of the population suffering from the conditions at 30 per cent.

He says frequent terror attacks in the country have aggravated the situation. “Terrorism is a major issue as people get traumatised by extension when they watch others suffer while not in a position to help. These scenarios are too regular today and have led to widespread post-traumatic stress disorder,” explains Mr Mbugua.

He says people involved or who witness the traumatic events such as robberies, carjacking, accidents, assault and violent clashes among other scary experiences rarely seek “psychological first aid”. They subsequently suffer re-experiencing of the events, lack of sleep, nightmares, fear and other emotions.

Mbugua has called on the government to treat mental health as a primary health issue. According to the Kenya Psychiatric Association (KPA), the burden of mental disorders continues to rise in Kenya.

Lukoye Atwoli, the association’s secretary, says current estimates show that between 10 and 15 per cent of Kenya’s population suffers from common mental disorders such as depression, anxiety and somatization, a condition where an individual with depression develops physical symptoms.

Another significant proportion suffers from substance-related disorders, including alcohol dependence.

Dr Lukoye states that while the 2007/08 post-election violence multiplied the number of those suffering from mental disorders, the situation remains largely unaddressed, especially among internally displaced persons.

Statistics from KPA show a shocking shortage of trained personnel in the area of mental health. Currently, Kenya has 99 trained psychiatrists, 20 of whom work in the diaspora. Out of the remaining 79, 26 are in private practice, 25 in the civil service and the other 28 in universities, KNH and the Moi Teaching and Referral Hospital.

There are 427 psychiatric nurses in the civil service, many of whom are also deployed in areas other than in psychiatric units.

This has led to severe understaffing ,best exemplified at KNH, East Africa’s largest referral hospital. Despite serving thousands of patients with mental disorders annually, the facility has just two psychologists, three psychiatrist for adult services, two for child and adolescent services and just one for the Youth Centre, who reports once a week.

The hospital does not have a single medical officer for gender-based violence while alcohol rehabilitation has just one psychiatric trained nurse and five nurse counselors.

“Nurses with just basic training in counseling have been forced to double up as counselors. We also rely on volunteers,” states Makanyengo.

According to Dr Lukoye, a consultant psychiatrist, meager funds are available for mental health programmes, research, human resource recruitment and infrastructure development, with the government’s fiscal allocation to mental health almost entirely going to wages.

Ignorance

This, he notes, has left the country with few facilities that can competently handle mental disorders. Yet according to CAP 248 of the Kenyan law, every hospital is supposed to have a mental unit with at least two beds.

At KNH, which lacks a specialised wing for patients with mental illnesses, such patients have to be admitted in the unsecured main wards when they have underlying medical conditions.

Despite their violent nature, they mingle with other patients while being handled by nurses who are untrained in the area.

Worse so, the hospital has been faced with a dilemma as all mentally ill patients with no underlying medical conditions have to be referred to Mathari Hospital in Nairobi.

“We have many cases of patients, who cannot afford services in private hospitals being taken to Mathari even when we feel that should not be the case. But with no beds for them, we have no option,” explains Makanyengo.

Dr Lukoye blames this situation on ignorance, saying most people not directly involved in mental health view mental illness as something strange that is to be shunned, instead of being dealt with.

A considerable proportion of patients who shun mental health facilities to avoid stigmatisation have ended up seeking solutions in religious institutions, and even witchdoctors.

Reverend Wellington Mutiso of the Evangelical Alliance of Kenya admits that a rising number of mental patients are seeking refuge in churches, which offer counseling and divine intervention.

“Clergymen have been faced with a challenge where they try to exorcise demons from worshippers they believe are possessed, only to later realize the person is suffering from schizophrenia (a mental illness) and needs medical treatment,” he says.