Kenya Launches Mental Health Policy for the year 2015-2030
The Government has through the Ministry of Health developed a comprehensive, multi-sector Mental Health Policy for the years 2015-2030, providing a framework for reforms and interventions in the Mental Health systems in conformity with the Constitution of Kenya 2010, Kenya Vision 2013, and the Kenya Health Policy and Global commitments.
Article 43 (1)(a) of the constitution provides that every person has the right to the highest attainable standard of health which includes the right to health care services – Mental Health care included.
The policy developed with support from the World Health Organisation, Resolution WHA65 that calls for a comprehensive coordinated response from both the Health and social sector at country levels was adopted during the 65th World Health Assembly.
This was followed by adoption of Resolution WHA66 adopted at the 66th World Health Assembly which called on member states to develop comprehensive mental health action plans in line with the Global Comprehensive Mental Health Action Plan 2013-2020.
According to World Health Organisation (WHO), Mental Health is ‘a state of well-being whereby individuals recognise and realise their abilities, and are able to cope with the normal stressed of life, to work productively and fruitfully, thus make a contribution to the (welfare of) their communities.
In a 2009 document, WHO states that positive mental health includes emotions, cognition, coherence and social function; it plays a key role in overall health and social-economic development because it influences a variety of outcomes for individuals and communities.
Positive mental health brings in effect healthier lifestyles, better physical health, improved recovery from illnesses, and fewer limitations in daily living; it also leads to attainment of higher education, greater productivity, employment and earnings, better relationships both at the market place and at the home levels. It also plays a major role in bringing social cohesion and engagement, thus the overall quality of life.
The Ministry of Health Action Plan says that ‘mental health and mental disorders result from many determinants; these include on one hand one’s ability to manage their thoughts, emotions, behavior and interactions with other people.
But on the other hand, are social, cultural, economic, political and environmental factors such as national policies, social protection living standards, working conditions and community social support (systems). “Exposure to adversity at a young age is an established, preventable risk factor for mental disorders,” says the MHA Action Plan.
The Kenya Mental Health Policy (KMHP) 2015-2030 indicates that these Mental Health disorders, if left untreated cause great suffering, leading to economic loss, disability or both.
“Mental Disorders have an impact on individuals, families, communities and nations with people with mental disorders experiencing disproportionally higher rates of disability and Mortality,” says a 2003 WHO report.
One hidden aspect of mental disorders that often goes unaddressed is homelessness and inappropriate jail terms for individuals living with mental disorder.
“Mental disorder, more often does affect a family’s sole breadwinner, or the medical care depleting the family’s income, thus sinking the whole family into abject poverty,” notes the KMPH 2015-2030.
Sadly, mental disorders also exacerbate the marginalization and vulnerability of this segment of the population; quite often, their human rights are violated due to discrimination and stigmatization.
“Many people living with mental disorders are denied economic, social and cultural rights –these include among others the right to education and work, the right to marry and establish a family, reproductive rights, and worse the right to the highest attainable standard of Health,” state the KMHP 2015-20130.
It notes that even governments and society at large are culpable in denying these individuals their civil and political rights – such as the right to marry and found a family, personal liberty, right to vote and participate in public life, the right to exercise their legal capacity on issues including their treatment and care.
The policy states that due to these and other factors, individuals living with mental disorder are often subjected to unhygienic and inhumane living conditions, physical and or sexual abuse, neglect as well as harmful and disgraceful treatment practices in health facilities.
Thus, the Ministry of Health (MHA) Action Plan, in reference to the Convention on the Rights of Persons with Disabilities that is binding on State Parties that have ratified/acceded to it, aims to protect and promote the rights of all persons with disabilities, including persons with mental and intellectual impairments.
It also aims to promote their full inclusion in International cooperation, including International Development programmes. The policy states that it was developed to address a number of issues which include: the alignment of health services with the constitution of Kenya, the national and global health agenda; address the mental health systemic challenges, emerging trends and also to mitigate the burden of mental disorders.
It also aims to integrate health services with the Kenya Essential Packages for Health (KEPH), and finally to promote, respect and observe the rights of persons with mental disorders in accordance with national and international laws.
In the situational analysis, the policy cites a 2001 WHO report “mental, neurological and substance use disorders are common and affect 25 per cent of all people at some point in their lifetime, while 10 per cent of the adult and child populations at any given time suffer from at least one mental disorder”.
A report by the International Statistical Classification of Disease and Related Health Problems reveals that 20 per cent of all patients that are attended to by Primary Health Care professionals have one or more mental disorder.
It is projected that by 2020, the burden of mental, neurological and substance use disorders will be 15 per cent of the total Disability-Adjusted Life Years (DALYs), a rise from 12 per cent in 2001.
In 2008, World Health Organization estimated that 60 per cent of all people attending primary care clinics have one or other diagnosable mental disorder.
“Mental disorders are important risk factors for other diseases, as well as unintentional and intentional injury because by their very etiology, they increase the risk of contracting other illnesses such as Human Immuno-deficiency Virus (HIV) infections, cardiovascular disease, Diabetes and vice versa,” says the policy.
The policy also indicates that stigma and discrimination against individuals with mental disorders and their families often prevent individuals from seeking mental health care.“Human rights violations of people with mental and psychological disability are routinely reported in many countries, even though the reported cases are way below the actual numbers,” it notes.
However, a major challenge is the huge inequity in the global distribution of skilled human resource for the provision mental health care.
“The Shortage of Psychiatrist, psychiatric nurses, psychologists and social workers are among the many barriers in the provision of treatment and care for mental disorder in low and middle income countries which have 0.05 psychiatrists and 0.42 nurses per 100,000 people respectively,” it adds. It adds that in high income countries, the rate of psychiatrist is 170 times higher, while that of psychiatrist nurses is 70 times higher.
“However, in low income countries, there are great internal inequities in the distribution of those already low numbers of mental health professionals, with the available human resource concentrated in cities and teaching hospitals to be found in major urban centers, with rural areas having to do with very few or none.
Kenya has only three major mental health hospital vis Mathari National Referral Hospital in Nairobi, Moi Teaching and Referral Hospital (MTRH) in Eldoret and Gilgi Sub County Hospital serving 45 million people.
Sadly, at the Gilgil Hospital, the only psychiatrist left for further studies, living the patients under the care of a few Psychiatric nurses, yet it runs a daily mental health clinic.
Alan Lopez in Disease Control Priorities Project: Global Burden of Disease and Risk factors 2006 says that four out of every five people with serious mental disorders living in low and middle income countries do not receive the mental health services that they need. “Neuropsychiatric disorders are estimated to contribute to 13 per cent of the global burden of Disease,” says the report.
The policy says mental health problems affect outcomes, impacts and goals and cuts across health programmes and projects, therefore the need for collaboration in terms of co-programming of various health projects and programmes across the board and thus add value and enhance the overall impact of such programmes.
“The extent of the global use of psychoactive substances is 2 billion alcohol users, 1.3 billion tobacco or nicotine smokers and 185 million illicit drug users. Considering the resulting social and health consequences for individuals, families and communities, there is need to enhance the accessibility of quality drug dependence treatment worldwide,” says the WHO report.
These should of a necessity, include the establishment of a wide variety of services, which take into account the culturally sensitive needs of different target group such as the youth, women, people with co-occurring mental health disorders and commercial sex workers.
“This places a heavy burden on public health systems in terms of prevention, treatment and care of drug use disorders and their health consequences because the quality of drug dependency treatment and care services play a key role in reducing the demand for illicit and licit drugs, HIV transmission amongst drug users, drug related crime, incarceration and relapse,” it notes.
By Njambi E. Mbuthia