SEATTLE — Current mental health policy in East Africa is outdated and lacks the resources to be effective. This has a widespread effect on perpetuating poverty and limiting socioeconomic development.
The strong correlation between poverty and mental illness is often cyclical: a mental health condition often decreases a person’s productivity and income, which decreases their ability to get the help they need. In addition, they may have less social support because of stigmatization. Together, these factors can exacerbate a person’s mental condition. Furthermore, the stressors of life in poverty increase the risk for mental disorders. So the very people who do not have physical or financial access to decent healthcare are the ones most likely to be suffering from a mental health condition.
Kenya and Uganda Struggle with the Continued Stigmatization of Mental Illness
Kenya has some of the highest rates of depression in Africa; at the end of 2016, there were 1.9 million diagnosed cases of clinical depression. The number of suicides has also increased; on average, 7,000 Kenyans between the ages of 15 and 30 commit suicide every year.
Depression and anxiety are common disorders that Anita Awuor sees in patients. Awour is a psychologist in Kenya with her own private practice. She has worked with low-income patients and told The Borgen Project that the costs associated with mental healthcare and misunderstanding of the field are significant barriers to getting much-needed help. Oftentimes, once patients start feeling better, they stop coming for sessions because they do not understand the need for continued care.
Mental health conditions are severely stigmatized and misunderstood in Kenya. Many believe that mental illness has supernatural causes and may be a punishment from God. These beliefs further alienate both the people struggling with the condition and their caretakers.
Human rights violations also plague the mentally ill. If they cannot afford to be taken to a mental health facility, those who suffer from mental health conditions are often locked up and hidden from the community. But being institutionalized does not always mean better care. These same abuses and neglect have been recorded in psychiatric facilities.
There is only one specialized psychiatric hospital in Kenya, Mathari Hospital, but it is severely understaffed and underfunded. The shortage of mental health professionals means the staff are incredibly overworked and are not able to adequately provide the care patients need. One nurse had to care for 146 mentally ill patients.
There are also financial barriers to receiving treatment. Many low-income people cannot afford the costs of consultation or treatment, transportation to and from the facility or to miss a day of work. This makes accessibility of mental health services one of the biggest challenges in Uganda.
Efforts to Improve Mental Health Policy in East Africa
Many of these issues in mental healthcare stem from inadequate attention and funding from the government. Most of the focus in both the health and development sectors is placed on other socioeconomic problems. As Awuor lamented, “mental health is not a priority”, and is often ignored to address what some see as more immediate needs. She told The Borgen Project that although a mental health bill was passed several years ago, it has yet to be implemented.
In Kenya, mental health accounts for less than 0.5 percent of the entire overall public health budget. Corruption and ineffective governance further limit the resources for mental health policy in East Africa. The lack of data on current programs makes it difficult for governments to accurately assess the needs of the mental health community and to fully understand the severity of the problem. There is also little pressure from the public or NGOs to make mental illness a higher priority, largely because of the misunderstanding and stigmatization surrounding mental disorders.
However, governments are starting to recognize the importance of having an effective mental health policy in East Africa, as it benefits the overall health and economic development of a country. The World Health Organization has been influential in conducting reports on the current status and providing guidance on developing these policies. Its 2001 report helped raise awareness about the state of mental health in Uganda and initiated the development of a mental health policy.
The Ugandan government developed a mental health policy between 2000 and 2005. This policy had several strengths, emphasizing crucial elements such as integration between mental health and broader healthcare, the need for evidence-based mental health practice and addressing issues of prevention and rehabilitation.
Unfortunately, the Ugandan policy does not address the issue of financing mental health programs. In addition, it was not always clear when it was discussing goals and aspirations versus actions the government was committed to taking. Both of these gaps will likely present challenges as they implement the policy. The Ugandan government is continuing to make revisions and has begun moderate implementation.
With this increased emphasis on mental health policy in East Africa, it provides an opportunity for these countries to develop solutions that fit the unique needs and culture of the country. One proposed solution to the inaccessibility is retraining traditional healers to be able to address basic mental health conditions and refer the patient if the condition requires professional help. A study in Kenya looked at the feasibility of using these informal health practitioners and illustrated several challenges, primarily a lack of resources for both the practitioners and the patients. However, it concluded that if the capacity of the informal practitioners can be strengthened, their commitment to the program makes it a viable model.
One report stressed the importance of not replicating the Western mental healthcare model. Because of cultural differences, importing the Western model into countries such as Uganda will not see the same results. As mental health policy in East Africa continues to be reevaluated, it is an opportunity to develop a more comprehensive approach to addressing mental health.
– Liesl Hostetter