Mental Health Services
A research team in Kenya, led by Dean Lukoye Atwoli and Dr.
Edith Kwobah at Moi University School of Medicine recently
conducted a study (Kwobah et al, in preparation) in western Kenya
to determine the community prevalence of a number of mental
disorders. Almost half of those interviewed had at least one mental
disorder at some point in their life, and only about two percent of
these had ever been formally diagnosed. Almost 13% of the
population had suffered from depression (the most important risk
factor for suicide) in their lifetime. Sadly, 16% of the population
had attempted suicide in their lifetime, from this typical rural
community in Kenya. Over 98% of the respondents with a lifetime
history of mental illness had never been diagnosed or
obtained treatment, highlighting the massive diagnostic and
treatment gap for these disorders.
Often, health care practitioners and community members mislabel mental health symptoms as cerebral malaria, stress, witchcraft and evil spirits. This lack of knowledge, stigma, cost, and distance are a few of the barriers to treatment. These barriers are present in urban areas as well, and so it is likely that the estimates of this study are conservative, and the problem of mental illness and suicidal behavior is greater than these findings suggest.
Further, access to medications is quite limited and there is no provision for supportive psychotherapy. In an effort to address these barriers to treatment, mental health care has been integrated with HIV care in four sites-one urban (Eldoret), and three rural (Mosoriot, Turbo and Burnt Forest), under the AMPATH program.
Implementing Mental Health Care in Western Kenya
In one of the rural sites (Mosoriot), four community health workers have been trained to screen for mental health and link patients with depression, psychosis, and alcohol dependence to care. Since May 2016, about 1,000 persons have been screened and 79 new patients are in care. Nurses and clinical officers have been trained to manage mental disorders using the World Health Organization (WHO) Mental Health Gap intervention guide (mhGAP-IG). Several support groups have been established for those suffering from alcohol dependence. This work is taking place parallel to continuous community education and engagement through meetings and educational materials.
An essential component of building the AMPATH mental health program is to continue to train future leaders in the area of psychiatry. At present in Kenya, there are approximately 84 psychiatrists for a population of 44 million. There are no child psychiatrists in western Kenya and only three in Kenya, all in Nairobi; which is consistent with the misconception in Kenya that children and adolescents do not suffer from mental illness and the fact that such illnesses are rarely diagnosed and treated in Kenyan youth.
A goal of Moi University's medical school is to increase matriculation to the psychiatry residency program from two to six for each year of the four-year residency program. Moreover, the AMPATH program, Moi University, and Brown University, established a psychiatry training group in 2009. Faculty from collaborating institutions have been traveling to Kenya for several months per year with US psychiatry residents and fellows on a training exchange program, and in addition as many as three Kenyan second year residents come to Brown University Medical School once per year for two months to complete their residency rotations in child and adolescent psychiatry, geriatrics, and neurology-specialties which have limited opportunities for training in Kenya.