Stigma continues to be a major barrier in schizophrenia care

Schizophrenia, a complex and often misunderstood mental health disorder, remains a significant public health concern in Kenya and across the African continent. This debilitating condition, characterised by a disconnection from reality, hallucinations, and disrupted thought processes, affects an estimated one in 300 people worldwide. In Kenya alone, a recent survey by Comprehensive Psychiatry found that the rate of schizophrenia was 46.3 per cent in males and 44.8 per cent in females.

About 4.6 per cent of the general adolescent and young population in Kenya have been found to have significant psychotic symptoms.

These studies found that the lifetime prevalence of psychiatric disorders in Africa ranged from 3.3 per cent to 9.8 per cent for mood disorders, 5.7 per cent to 15.8 per cent for anxiety disorders, 3.7 per cent to 13.3 per cent for substance use disorder (SUD), and 1.0 per cent to 4.4 per cent for psychotic disorders. Out of the 36 studies identified, only 17 of them investigated the prevalence among adolescents and adults.

Psychotic disorders, such as schizophrenia have been associated with increased psychiatric comorbidity across multiple studies globally.

Despite the prevalence of this disorder, it continues to be shrouded in misconceptions and stigma, hindering access to proper diagnosis and treatment.

Dr Zul Merali, Founding Director of the Brain and Mind Institute at Aga Khan University says the public often attributes the symptoms of schizophrenia to supernatural causes, such as witchcraft or possession by spirits, rather than recognising it as a medical condition. “The symptoms, such as hallucinations, delusions, and disorganised behaviour, are very visible and disruptive, leading to the misconception that it is a supernatural phenomenon rather than a medical condition,” explains Dr Merali.

This misunderstanding can have devastating consequences, as individuals with schizophrenia are often ostracised, beaten, or even accused of being witches in rural areas.

The challenges faced by those living with schizophrenia in Kenya extend beyond societal attitudes. The National Institute of Mental Health (NIMH) in the United States has long recognised the multifaceted nature of this disorder, which can impact an individual’s cognitive, emotional, and behavioural functioning. In Kenya, however, the diagnostic tools and treatment approaches used are often ill-suited for the local context. “The methods that we are using to diagnose people with mental ill health have all been brought in from North America, and sometimes, they’re not relevant,” says Dr Merali.

For example, a common test for cognitive impairment that involves drawing a clock face may not be applicable to individuals who have never seen a traditional clock.

Furthermore, the lack of access to mental health services in Kenya exacerbates the problem. “We don’t have enough psychiatrists and psychologists. We never will,” says Dr Merali.

“How can you expect somebody from the rural areas, who is into farming, for example, to come to an urban setting for therapy that they can’t afford? They don’t have transportation. They have many demands on their plate,” he adds.

The implications of this healthcare gap are far-reaching. According to NIMH, individuals with schizophrenia often face significant challenges in maintaining employment, stable housing, and healthy relationships, leading to a higher risk of homelessness and financial instability.

In Kenya, where access to mental health resources is limited, these challenges are compounded, leaving many vulnerable and struggling to find the support they need.

Despite these formidable obstacles, there are glimmers of hope in the horizon. Emerging trends in mental health care in Kenya, such as a growing recognition of the importance of prevention and early intervention, offer a path forward. “We have a major study going on right now dubbed Fingers Africa where we’re trying to use and identify what are some of the important modifiable risk factors, so then we can mitigate them, and we want to show what impact that is having on the prevalence of dementia in Kenya,” says Dr Merali.