One in four Kenyans is likely to suffer from a mental illness at some point in their life and they will find it difficult to get the healthcare they need, reveals a Nation Newsplex investigation.
The review of mental health data also finds that the suicide rate for men is three times higher than the rate for women. Figures from the World Health Organization (WHO) show that the suicide rate per 100,000 people in Kenya is seven, with the rate for men being 11 and women three.
Kenya’s rate is below Africa’s average of nine deaths per 100,000.
Psychiatrist Lukoye Atwoli says men die by suicide more often than women because men use more lethal methods compared with women when attempting suicide.
Psychologist Job Watene also attributes the difference between male and female suicide rates to the many support systems and relationships women have among themselves and their willingness to seek help from friends and medical experts.
“Women talk more between themselves about health and other issues than men. They are also more willing to seek medical assistance as compared to men. A great number of the patients we have are women,” he says.
Depressed people lose five hours and 36 minutes of productive work every week compared with one and a half hours for the non-depressed.
In 2016 there were 99,840 outpatient hospital visits for mental disorders, an eight per cent increase over the previous year, according to the Statistical Abstracts 2017. Of these, one in seven or 15,223 visits occurred in Nairobi County, which has a population of 4.5 million. Nairobi recorded the most outpatient visits for mental illness. It was followed by Muranga (5,575), Nyeri (4,881), Kiambu (4,371) and Mombasa (3,915). Each of the top five counties has a population of more than one million people.
Sparsely populated Isiolo and Samburu (each with a population of less than 300,000) had the least number of suicides, at 189 and 336 respectively.
About 40 per cent of in-patients in health facilities suffer from mental disorders, according to the Kenya Mental Health Policy (2015-2030).
Though mental disorders are common and widespread, a majority of Kenyans who suffer from these illnesses do not get the care and treatment they need. A Kenya National Commission on Human Rights (KNCHR) audit of the mental health system in Kenya estimates that out of six people with a mental illness, five do not receive any treatment.
Anne (not her real name) is one of the few Kenyans who got the help they needed when they suffered from a mental illness, even though for her it took several attempts. She became depressed after she got vitiligo, a skin condition that causes loss of skin colour in patches.
“I was a teenager then, seeking love and approval from my peers. I would cut myself in any part of the skin that a patch appeared. As it spread all over my body, I stayed indoors for days, and when outside, people would throw at me all manner of insults.”
Her condition even affected her studies. “I was selected to go to Moi University but I opted out because I was afraid of the attention I’d receive there. So I enrolled for a bachelor’s degree in business administration at Kenya Methodist University and chose evening classes because I didn’t want people to see me during the day. I graduated, though I performed very poorly due to lack of focus. It was very stressful,” she recalls.
Her family was supportive and took her to hospital, where a doctor prescribed antidepressants, which only made things worse for her. “I would get terrible nightmares every time I took the drugs.”
She later visited a psychologist and started to recover after several therapy sessions.
Depression is the most common mental illness, affecting more than 300 million people worldwide, according to WHO. It is also the leading cause of disability. When not attended to, it can lead to suicidal thoughts.
WHO estimates that about 800,000 people commit suicide every year and it is the second leading cause of death among youth age 15 – 29 globally.
There are more than 200 classified forms of mental illness and many people suffer from more than one mental disorder at a given time, states the American Psychological Association. Besides depression, some of the more common disorders are bipolar disorder, dementia and schizophrenia, which globally affect about 60 million, 48 million and 21 million people respectively.
Dr Atwoli rejects the notion that the political and economic environment are to blame for the high number of people battling depression, saying there is no one specific cause of depression.
“The causes are many and they range from biological factors such as genetic makeup, pregnancy complications and certain illnesses in childhood. The psychological issues include the personality of the person and other risk factors such as how they behave and think. Finally, there are social factors such as how you are brought up, where you live and the state of your environment.”
These factors combine to determine whether a person will get mental illness or not. Biological factors give you the risk of getting the illness while psychological and social issues determine when it will appear. Environmental and social stressors such as unemployment and bereavement can trigger depression.
With about two million cases of depression annually, Kenya ranks second in East Africa after Tanzania (2.1 million cases), according to WHO data. There are concerns that the number could be higher since there are people who are depressed yet do not seek treatment.
Nigeria, the most populous country in the continent, leads with seven million cases, followed by Ethiopia (four million) and the Democratic Republic of Congo (three million). Seychelles recorded the lowest number of cases in the world at 3,722.
Annually, depression costs Sh101 trillion in lost productivity globally. A US study of the cost of lost productive work time among US workers by epidemiologist Walter Stewart reveals that depressed people lose five hours and 36 minutes of productive work every week compared with one and a half hours for the non-depressed.
Psychologist Watene urges employers to factor in the mental welfare of their employees by providing them with mental treatment services.
Kenya launched the first mental health policy in 2016 in a bid to ensure patients get quality healthcare through expanding the financial and human resources. In an effort to develop adequate human expertise in the mental health sector, the policy recommends training community health workers and general staff in hospitals on mental health. Currently, Kenya has 62 psychiatrists registered with the Kenya Medical Practitioners and Dentists Board. A least 16 hospitals offer mental health services, with Mathari Mental Hospital being the only specialised mental health public facility.
Kenya is also among 54 of the 194 WHO member states that do not have a separate budget for mental health. This renders the mental health policy inefficient, because there are limited resources to facilitate treatment and awareness efforts. Dr Atwoli calls for mental health to be placed at the top of the national agenda.
The Mental Health Act 2014 criminalises any insurance provider that discriminates against people with mental illness. The National Health Insurance Fund fully covers mental illness treatment in any hospital that has a psychiatrist.
A mental illness is a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines. Mr Watene advises people to be self-aware and to pay attention to sudden changes in thoughts and behaviours. He encourages people who suspect that they or someone they know have a mental illness to seek early treatment and to keep tabs on any changes in their general health to minimise any chances of relapse.