Mental healthcare to start at your doorstep

Kenya is banking on community health promoters to tackle mental health, amid concern about the high number of people suffering from mental illnesses.

Dr Salim Ali Hussein, Head of the Division of Primary Healthcare at the Ministry of Health said community health promoters have been taught about the mental health aspects, and with remuneration and provision of equipment, they will revamp care.

"Promoters will handle basics like finding out why an active person all of a sudden becomes inactive, and have such cases referred for cross-examination and treatment," said Dr Hussein.

Also, the promoters will advocate to remove the stigma that deters people from accessing care.

Terry Rotich, Ministry of Health Legal Advisor, added that the Primary Healthcare Act 2023 will also improve mental healthcare.

The Act focuses on rehabilitative services as primary health care that has a mental health package.

"The Primary Healthcare Act highlights the importance of psycho-social support, rehabilitation and palliative care in the community, roles to be offered by community health promoters," explained the legal advisor.

However, experts have poked holes in the rate of implementation of policies saying it is sluggish.

Data by the Ministry of Health reveals that at least 25 per cent of outpatients and up to 40 per cent of in-patients suffer from respective mental illnesses.

Former President Uhuru Kenyatta was keen on mental health. In 2019, he appointed a task force in 2019 to look into the country's mental health crisis.

In June 2022, Mr Kenyatta further enacted the Mental Health Bill and mandated the Mental Health Board to oversee the implementation of the act was gazetted by former Health CS Mutahi Kagwe.

Before the signing of the Act which was drafted by Sylvia Kasanga, Kenya did not have a roadmap on mental health. The Act mandates the provision of quality healthcare, treatment, and rehabilitation of persons suffering from any form of mental illness.

Individuals in the law are guaranteed proper healthcare through the allocation of more resources to mental health but 17 months later after the enactment, Kasanga says its actualisation has been slow.

According to Kasanga, Kenya has been grappling with budgetary allocation, which was recently availed by Health CS Susan Nakhumicha.

The Mental Health Board has also not been operational, to oversee the implementation of the act.

"Apart from budgetary allocation, the movement has been slow. I have not heard of any progress among the council of governors despite health being devolved," said the former senator.

In the Act, county governments were to establish mental health boards with a budget to run county local programs on mental health, but progress has yet to be attained.

"Mental health has to start from a preventive and community-based approach, and this is what the Mental Health Act envisioned. At the county level, programmes would include information dissemination, fighting stigma, educating the youth on mental health, and have mental health put in the curriculum at ECD levels run by counties," she added.

Further, she said in the Act, community health workers should be trained on mental health by going door to door, talking to people giving them information about mental health, and helping them to identify those who are mentally ill and refer them for help.

"The gap we have in mental health is so big, considering we have never had budgets for mental health both at national and county level," she said.

"We've also not given mental health priority it requires at governance level," she said adding that the gap ranges from lack of practitioners at Level 4, 5, and 6 hospitals.

Kasanga said the National Mental Health Board should draw policies and make sure county governments are able to roll out awareness and information programs.

Through the policies, she said it will be easy to identify people who are sick within their homes and have them seek treatment and counselling.

Apart from the Act, President Kenyatta established a Mental Health task force led by Dr Frank Njenga, which recommended having mental health be declared a national emergency.

According to the task force report, 75 per cent of Kenyans are not able to access mental healthcare, despite the heavy burden of mental illness in the country. In the report, it was documented that about 475, 633 Kenyans suffer from severe mental illnesses.

However, Dr Catherine Syengo Mutisya a consultant psychiatrist, and also a secretariat to the task force working for the Ministry of Health at Mathari National Teaching and Referral Hospital says the country is yet to fully implement the task force recommendations.

For example, mental health illness is yet to be declared a national emergency of epidemic proportions.

"Whenever something is declared a national emergency, there is allocation of funds for action, which we haven't seen yet," said Mutisya.

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