Mental Health in Kenya
Kenya is a lower-middle-income country with a population of about 52.5 million and a physician-patient ratio of 0.2 to 1,000 people. The psychiatrist-population ratio is 0.19 to 100,000. The most common mental illnesses in Kenya are depression, substance use disorder, bipolar disorder, schizophrenia and other forms of psychosis. It is estimated that of all persons seeking health services in Kenya, a quarter of the inpatients and almost half of all outpatients suffer from mental illness. Fortunately, health organizations are working to make mental health in Kenya a priority.

Kenya’s Mental Health Policy

According to the 1989 Mental Health Act, Cap. 248 of the Laws of Kenya, all general hospitals are required to treat and admit persons with mental illness. Kenya’s 2015-2030 Mental Health Policy outlines a strategy for achieving mental health reform in the country. Using a multidisciplinary approach and guided by the Ministry of Health, the policy underscores the need for collaborative interventions. The policy also recognizes human rights in treating persons with mental, neurological and substance use disorders. Finally, the policy aims to provide quality, accessible and equitable mental healthcare services in accordance with WHO standards.

Mental Health Services in Kenya

There are at least 14 general and provincial hospitals in Kenya offering mental healthcare and psychiatric services. Mathari Teaching and Referral Hospital is the national psychiatric hospital with a 700-bed capacity. There are also various private clinics and rehabilitation centers as well as professional bodies and organizations whose members work together to provide mental health services.

The Kenya Psychiatric Association (KPA) is a professional body for psychiatrists. Its mission is to promote mental health in Kenya through training, governance, empirical research and mental health services. The Association contributed to the 2015-2030 Mental Health Policy and the 1989 Mental Health Act and has established national and international networks in the field. It also continues to provide mentorship to upcoming mental health professionals.

Another organization regulating mental health services is the Kenya Counseling and Psychological Association, which governs counselors and psychologists. The organization seeks to offer professional counseling psychology services in the country based on set standards in training, practice, research and advocacy.

The National Authority for the Campaign Against Drug and Alcohol Abuse (NACADA) is an organization under Kenya’s Government that tackles drug and alcohol abuse in the population, particularly among the youth. To achieve its goals, NACADA uses public education and advocacy, undertakes research surrounding alcohol and substance use in the nation, regulates the alcohol industry and offers counseling and rehabilitation services. As of 2020, NACADA had established 100 accredited rehabilitation centers, offered 20 life skills training programs and saved 8,000 lives.

Mental Health Research in Kenya

In November 2019, a task force was set up to report on the status of mental health in Kenya; the report was released in July 2020. The team was drawn from healthcare professionals, cabinet members, security service providers, politicians and youth representatives around the country. The task force detailed recommendations for mental health reforms, citing changes in administration, legislation and criminal justice systems.

Recommendations include declaring mental illness a public health emergency and increasing funding for the mental health sector to make services more widely accessible. The report also proposed providing healthy workspaces and mental health services in learning institutions and incorporating mental health literacy across school curricula.

Moving forward, it is essential that the Kenyan government and other mental health organizations in the nation utilize this research to improve policies and practices. Through research, collaboration and informed interventions, mental health in Kenya will hopefully improve.

Beth Warūgūrū Hinga
Photo: Flickr

How Greece's Financial Crisis Led to New Mental Health AwarenessFor the past decade, Greece has been fighting an economic disaster. Beginning in 2009, Greece’s financial crisis resulted in a budget deficit of approximately 13% of the country’s GDP—four times more than the 3% mandated limit. Therefore, Greece was forced to borrow 289 billion euros and adopt austerity measures, placing an enormous burden on the population. In turn, these economic pressures led to one of Greece’s worst mental health crises to date.

Greece’s Financial Crisis Affecting Employment and Mental Health

The decade-long recession and tax increases left many Greeks unemployed. The rate of unemployment rose to 27% and one-third of the population is currently living in poverty. In 2012, during the peak of the financial crisis, Areti Stabelou, a college graduate, expressed her depression to be linked to the rise in unemployment—a sentiment common among Greece’s youth. In a BBC interview, Stabelou talks about the mental health stigma Greece had once suffered from, saying mental health “was very difficult to talk about in those early years.”

However, as years passed and more Greeks were experiencing the toll of the crisis, Stabelou points out that they “more openly began talking about it.” The country’s financial crisis gave rise to a new awareness of mental health, which had previously been labeled as taboo.

The population’s sentiment toward mental health had vastly changed. A study found that in 2009, 63.1% of Greeks believed that depression is a sign of weakness. By 2014, the study found that the percentage dropped to 36%.

According to the founder of Greece’s sole suicide prevention center, Klimaka, the Greek Crisis was able to bring “problems that were being ignored to the forefront.” In 2008, merely 3.3% of the population had depression. By 2013, this percentage had more than doubled, with 12.3% of the population suffering from depression. Depression was not a new illness; however, the rising rates simply allowed for a new direction of the conversation to shift toward the mental disorder.

Addressing Mental Health in Greece

Following the rising issue in the nation, the Greek Orthodox Church took on a more tolerant approach to mental health. The Greek Orthodox Church has always considered suicide a sin and therefore, they do not provide a burial service to those who take their own life. Because of this, many suicides go unreported in order to protect the family from shame. However, Klimaka, Greece’s non-profit suicide prevention clinic, believes that now the Church has an important role in alleviating the stigma around suicide and overall, suicide rates. As of now, if the doctor has diagnosed the deceased with a mental illness, the Church will provide a burial service.

The Greek Health Ministry has also planned suicide awareness campaigns and has taken action to ensure that their practitioners are better prepared to detect depression. Between 2010 to 2015, there has been a 40% increase in suicides, making the rise in visibility an extremely important cause.

While Greeks are becoming more open and tolerant toward mental health, obstacles prevent the nation from achieving the right care for those in need. The financial crisis had led to a rise in the demand for psychological services. Yet, in 2011, the country’s annual budget on mental health was halved and has been further cut every year since. These budget cuts have caused a shortage of staff and supplies, making it difficult for the population to receive adequate care.

Greece’s financial crisis has led to new mental health awareness. However, mental health initiatives must continue to effectively care for those in need, especially following the financial crisis and the high unemployment rate.

Maiya Falach
Photo: Flickr

Mental Health in India
The COVID-19 pandemic has brought the crisis regarding mental health in India to the forefront. COVID-19 has led to various versions of isolation and insecurities for many Indian citizens.

Amid this crisis, the Indian Psychiatric Society’s survey has noted a significant increase in reported mental illness since the lockdown. This is an opportunity for the country to rework its mental healthcare system for its diverse population. The pandemic has affected the poor the most. The World Health Organization (WHO) has stated that mental health illness and poverty have a cyclical relationship in that extreme poverty triggers mental illness, which leads to further financial crises.

Government Initiatives

The government of India launched the National Mental Health Programme (NMHP) in 1982 and the Mental Health Care Act in 2017. The National Mental Health Programme focused mainly on increasing the reach of minimum mental health services for the poor. This encourages social development in general healthcare. After a gap of more than 20 years, the Mental Health Care Act mandated affordable mental health care, the right to make decisions and informed consent, the right to live in a community and the right to confidentiality. This Act more importantly decriminalized suicide.

The Mental Health Care Act is a step in the right direction with the aim of bringing mental healthcare to those who cannot afford it. Yet, almost 14% of the population still suffers from mental health disorders. While stigma and social stereotypes play a major role in the aggravation of these numbers, the nation’s budget invests very little into mental health. India as a developing country, spends only 0.05% of its subtotal health care budget on mental health.

De-stigmatizing Awareness

A study from 2017 suggested that 87% of the population was aware of mental illness and that 71% inculcated terms that propagate stigma. In 2015, Bollywood and Hollywood actress Deepika Padukone talked about her battle with depression on Indian television. By speaking about her struggles, she started a conversation about mental health in the nation. She also founded the Live Love Laugh Foundation which facilitates research and outreach on various levels. The Live Love Laugh Foundation provides free mental health care to the rural poor, educates caregivers and creates a community of awareness in rural Karnataka and Orissa. As of now, close to 3,000 direct beneficiaries have received treatment through the Foundation.

Organizations like The MINDS Foundation, Manas Foundation, The Banyan and Aasra along with many others are key in de-stigmatizing mental health in India. They often work as gap-fillers in a system that is out of reach for many. The World Health Organization (WHO) noted in a report in 2017 that there are less than two mental health professionals for every 100,000 people in the country. The Banyan, with its branches in Kerala, Tami Nadu and Maharashtra is an NGO that focuses on holistic mental health solutions for those who live in poverty in these states. It has over 16 centers and has reached a population of over 100,000.

Tele-health Initiatives

Universities, nonprofits and several hospitals have facilitated workshops, online counseling sessions and helplines. Tele-health calls have helped to bridge the gap between those who would normally shy away from in-person visits. However, it has been detrimental to those who lack access to these online facilities. The rural poor in India do not own the technology to be able to access facilities like e-prescriptions or telehealth calls. The transition of online healthcare into rural areas in India is a promising developmental venture.

Community-based Approaches

India’s allocated mental healthcare budget and prevalent social stigma surrounding it have emerged as the two major problem areas. Encouraging studies have paved the way for a community-oriented approach to practicing psychosocial therapy in the country. This will entail training community-based healthcare workers to serve as supervised non-specialist mental healthcare workers by following standard protocols. Sangath, an NGO based in Goa, New Delhi and Bhopal, is implementing this model through its programs. Sangath provides affordable mental healthcare by strengthening state and private sector services by training the community. Sangath is also working with policymakers to further develop as well as implement this model of care.

Resources During COVID-19

The India Research Center of the Harvard T.H. Chan School of Public Health has recounted a few tips for mental well-being during the pandemic. Mindfulness, breathing exercises, meditation, limiting news consumption, generosity and empathy are practices that are effective along with other useful resources that the school emphasizes. Here is a list of numbers one can contact during a mental health emergency in India.

In a country as plural as India, innovative approaches are essential factors of growth. The nation has a long way to go in order to climb up on the mental health and well-being ladder. However, NGOs and foundations are paving the way toward improved mental health in India.

– Anuja Mukherjee
Photo: Flickr

mental health in haitiLocated on the island of Hispaniola is the Caribbean nation of Haiti. The country gained independence in 1804, becoming the first country led by formerly enslaved peoples. A long history of political instability and corruption accompanied by catastrophic natural disasters has devastated Haiti’s population and economy. Additionally, a lack of infrastructure and access to basic resources ranks Haiti as one of the world’s least developed countries. This has created a crisis for mental health in Haiti, which has only worsened during the COVID-19 pandemic.

The Humanitarian Crisis in Haiti

Haiti is now home to over 11.4 million people, and nearly 60% of the population lives below the poverty line. Income inequality and unemployment rates are high, while the country does not meet its citizens’ basic needs. In fact, nearly 90% of people in rural areas lack access to electricity and plumbing.

Several natural disasters have also damaged Haiti in the past decade. The 7.0-magnitude earthquake of January 2010 devastated the nation’s capital city of Port-au-Prince. Indeed, the earthquake was one of the worst natural disasters to strike an urban area. An estimated 250,000 people died, while 300,000 people got injured and over 5 million became displaced. Six years later, Hurricane Matthew wiped out trade roads and coastal infrastructure. Conversely, lengthy periods of drought have paralyzed local agricultural markets. This has resulted in the inflation of even the most basic foods and necessities.

Though Haiti has focused on efforts to recover from natural disasters, longstanding economic and sociopolitical crises remain. One often overlooked problem lies in how these humanitarian crises affect mental health in Haiti.

Mental Health in Haiti: Existing Services

The ongoing humanitarian crises in Haiti create an extraordinary psychological toll on people. In particular, poverty and socioeconomic disadvantage increase the crisis of mental health in Haiti. Following the earthquake, 25% of the population reported experiencing PTSD. Additionally, 50% experienced a major depressive disorder. Disasters have also caused many Haitians to experience trauma and the loss of loved ones and livelihoods.

Despite these negative psychological outcomes, mental health in Haiti remains neglected. This is largely due to the majority of Haitians attributing mental health problems to supernatural forces. Specifically, many Haitians rely on inner religious and spiritual strength to overcome mental health issues. This culturally important Haitian belief, in tandem with the country’s inadequate mental healthcare services, leaves vast numbers of the population neglected.

Many people in Haiti simply go without mental healthcare. For a nation of around 11 million people, Haiti has a mere 23 psychiatrists and 124 psychologists. Haiti’s investment in healthcare services has even declined from 16.6% to 4.4% since 2017. Additionally, even if Haitians could find mental health services, they may not be able to afford or access them. Available services are often costly and inaccessible for those who do seek care.

The Implications of COVID-19

During the pandemic, Haiti has seen a rise in the cost of mental health services and medication. The country’s two running psychiatric hospitals have stopped accepting patients. Other hospitals, many now at full capacity due to the pandemic, have become testing facilities for COVID-19.

The pandemic has further exacerbated mental health in Haiti. General anxiety and concerns relating to the coronavirus and its effects have skyrocketed. Additionally, quarantine mandates have increased rates of domestic violence and abuse. Fatigued health professionals and medical staff also suffer from increased rates of depression. In short, medical professionals as well as the general population are experiencing the devastating mental impacts of COVID-19.

Moving Forward

Humanitarian crises and the coronavirus pandemic persist in the small island nation of Haiti. The aftermath of natural disasters, trauma and continuing political and economic instability lead to a crisis of mental health in Haiti. The country needs attention to the mental health needs of its citizens, in the midst of current and past crises.

Thankfully, nonprofit organizations like Partners in Health are striving to improve mental health in Haiti. Based out of Boston, Partners in Health is dedicated to establishing long-term relationships with organizations in the world’s poorest developing countries. Through its partnerships with local governments and other organizations in Haiti, Partners in Health has helped to innovate mental healthcare delivery models that integrate cultural beliefs about health and current biopsychosocial knowledge. Mobile health clinics also help ensure ensure that patients living in even the most remote regions of Haiti have access to necessary mental health services.

In the years to come, continued funding and support of programs like Partners in Health and its partnership organizations will be vital to improving the mental health and overall well-being of Haitians. Only then can the country truly overcome its current crises and past history.

Alana Castle
Photo: Flickr 

CBT Eliminating Violence
Although humans’ basic needs must be met to set the foundation for healthy behavior and break the cycle of poverty, some have already been affected by various mental conditions. Due to the side effects and social stigmatization associated with many of these mental health issues, individuals can feel forced to engage in crime or violence to make ends meet. In the African country of Liberia, this is an issue facing thousands and it prompts many questions. How do these individuals gain access to care? What effect do these conditions have on future generations? How do we break the cycles of crime and violence already apparent in Liberia? To approach answers to these questions, it is essential to understand therapeutic options. Particularly, people can learn many lessons by observing CBT eliminating violence in Liberia.

What is CBT?

According to the American Psychological Association, Cognitive Behavioral Therapy (CBT) is a type of psychological treatment that aims to change behavioral and thinking patterns. CBT centers on the understanding that complications in psychological makeup can be a result of learned behavior — hindering the thought processes.

Recipients of Cognitive Behavioral Therapy work on improving self-confidence, adopt effective coping mechanisms and alter the thinking patterns that contributed to negative behavior. Clients also learn to modify their habits such as confronting, rather than avoiding difficult situations. Additionally, patients practice self-control and prepare for real-life scenarios they may find challenging.

One distinguishing factor of CBT is its focus on the current and future aspects of the patients’ life. While medical professionals take into account a person’s past, the main goal of this therapy is to create effective techniques to deal with the patients’ present issues.

Current Prevalence of Crime In Liberia

The Overseas Security Advisory Council’s (OSAC) 2020 Liberia Crime and Safety Report states that the country has seen increases in violent robberies and home invasions. The council also reports that “sexual assault and rape are the most commonly reported violent crimes.” In addition to this rise in crime, Liberia experiences greater social upheaval (than previously) due to escalating difficulties in the economy, healthcare and employment.

As urban poverty surges among Liberian cities, homelessness, pollution and deteriorating infrastructure have become increasingly concerning issues. Impoverished citizens face coinciding problems concerning lack of opportunity and inequality. Discrimination, poor education and epidemics such as Ebola all impact the poor most severely. Moreover, these unstable environments catalyze crime and violence rates in Liberia especially in young men.

CBT & Cash Impact Violence in Libera

One study in the nation’s capital of Monrovia revealed the benefits of CBT on eliminating violence in Liberia. More than 1,000 men participated in this experiment, all of whom researchers considered at-risk for crime and violence. Researchers placed the men in one of four groups. I.e., one that received only therapy, one that received only cash, one that received both, and one that received nothing. Notably, the cash incentive provided to designated participants was enough to start a small business.

Therapy alone improved behaviors significantly, decreasing many of the men’s objectionable behaviors. However, the most lasting effects were seen in the men receiving both therapy and cash. The men were able to practice what they learned in therapy while taking advantage of the opportunity to feel like a “normal” member of society. These men received means, motives and opportunities. However, this time, it was all in favor of improving their lives and their influence on the community.

CBT eliminating violence in Liberia is not the only approach necessary to ending poverty. Yet, it does offer promise for positive change and highlights the importance of the long-term measures needed for vulnerable communities.

Amy Schlagel
Photo: Flickr

The Africa Mental Health Research and Training Foundation
The need for physical necessities such as medical care and food security often overshadows discussions of mental health care in developing countries. However, stress, trauma, violence and poverty exacerbate the need for sufficient mental health services. This makes a lack of these resources even more problematic. The Africa Mental Health Research and Training Foundation is working to fill this unmet need.

The Africa Mental Health Research and Training Foundation (AMHRTF)

Professor of Psychiatry David Ndetei founded AMHRTF in 2004. In addition to teaching at the University of Nairobi, Ndetei has written more than 250 journal articles and six books on mental health. This NGO is based in Nairobi, Kenya. It aims to provide affordable and accessible mental health care to Kenyans who might ordinarily struggle to access services. The organization’s network of researchers and mental health professionals tackle a range of mental health concerns, including suicide prevention, substance abuse and PTSD. In addition to providing clinical services, AMHRTF conducts research to inform public policy and enact innovative, larger-scale projects to provide Kenyans with mental health care regardless of income level.

Services

Resources for mental health care in developing countries, like Kenya, are notoriously scarce. In higher-income countries, 5% of total health expenditures correspond to mental health services. In contrast, in lower-income countries, the expenditure is just 0.5%. However, deficits in mental health services have harsh fiscal consequences for nations already struggling with poverty. Low and middle-income countries lose approximately $870 billion each year, compensating for the effects of untreated mental health disorders, such as productivity loss.

One of the organization’s primary functions is providing Kenyans with affordable counseling services. Clients can book appointments with a network of mental health professionals for individual, couple, group and family therapy. These professionals provide services for anxiety, depression, family violence, personality disorders and PTSD. In addition, AMHRTF offers workshops and presentations to educate other companies and organizations.

Larger Projects

One of the primary challenges of providing mental health care in developing countries is a low concentration of professionals. As of 2016, there were a mere 100 psychiatrists in Kenya. Rural populations outside of Nairobi are especially underserved, with only one psychiatrist per 1 million Kenyans.

AMHRTF has facilitated other innovative, evidence-based solutions to broaden the reach of their organization. To combat a lack of accessible care, AMHRTF has partnered with the Columbia University Global Mental Health Program to form the TEAM initiative. Additionally, the innovative 2015 initiative was awarded nearly $1 million CAD in aid from the Canadian government. This bridges the influence of traditional healers with modern mental health car. Moreover, it works within preexisting structures as a way of reaching rural and underserved patients through trusted community leaders. Many Kenyans turn to traditional healers for help in times of distress. A referral program allows healers to identify and direct individuals to professional care.

Final Thoughts

Developing nations have a pressing demand for mental health services. However, these countries rarely have the resources to deliver sufficient care. To meet this demand, the Africa Mental Health Research and Training Foundation provides affordable mental health services for those in need, conducts research and initiates innovative projects that maximize Kenyans’ existing resources.

Stefanie Grodman
Photo: Flickr