Mental Health Services Expand to Meet Needs
When Dr. Edith Kwobah presented a one-page concept paper to AMPATH’s Dr. Joe Mamlin about her dream to provide mental health services everywhere that AMPATH is providing chronic disease care, he had a brief response.
“We have been waiting for you.”
Dr. Edith Kwobah
Kwobah, a psychiatrist and head of mental health at Moi Teaching and Referral Hospital (MTRH), has been a tireless advocate for community mental health, stigma reduction and increasing access to mental health for all since joining MTRH in 2014. Her work builds on the foundation created by Professors Gakinya, Mengech and Atwoli.
With funding from the Fogarty International Center, in 2016 Kwobah and her colleagues completed a community survey of 400 people in Mosoriot to establish the prevalence and the socio-demographic factors associated with mental and substance use disorders. They found that 45 percent of the participants had a lifetime diagnosis of at least one mental disorder including anxiety disorder, depressive disorder, alcohol and substance use disorder, psychotic episode or suicide attempt.
Despite the high prevalence, only 1.7 percent of the people in the study had received a mental health diagnosis which highlighted the extreme treatment gap in western Kenya. There are fewer than 200 psychiatrists in Kenya, according to Kwobah.
Additionally, the impacts of COVID-19 are exacerbating mental health care needs.
“Persons with mental disorders are much more at risk for COVID-19 as they may not adhere to the preventive measures,” said Kwobah. “This also increases the risk of them being arrested as law enforcers assume that they are knowingly flouting the rules, hence increasing the risk further,” she continued.
Although the pandemic has necessitated some program alterations, Kwobah and her colleagues, including Dr. Matthew Turissini, associate field director for population health at AMPATH, are determined to reach their goals of scaling up and improving mental health services. In addition to integrating mental health care into AMPATH’s non-communicable disease care, other goals include building pharmaceutical supply chains, establishing electronic health records, integrating mental health services into community-based groups and establishing specialized mental health Centers of Excellence at county hospitals by improving psychiatric training within primary care physician training programs.
MTRH CEO Dr. Wilson Aruasa breaks ground on the transitional housing facility.
In 2019, the Astellas Global Health Foundation awarded a $1.35 million grant over three years to AMPATH to provide 400,000 people with access to mental health programming in western Kenya and for AMPATH to build group transitional housing and care for patients with severe mental health disorders.
Groundbreaking for the transitional housing, located on the grounds of MTRH, occurred in August. When completed, it will serve as a home for up to 16 people after hospital discharge. Residents will receive mental health services and have a safe place to live for up to three months while working on coping skills and long-term plans with their families.
“Access to mental health care is a worldwide issue with a particularly significant lack of proper diagnosis and treatment among low- and middle-income populations,” said Moyra Knight, president of the Astellas Global Health Foundation. “The important work AMPATH is doing in western Kenya will help to provide essential mental illness treatment at such a critical time, and we are pleased AMPATH is able to dedicate a portion of the funding to specifically support mental health needs due to the COVID-19 pandemic.”
Due to COVID-19, social distancing has limited in-person interactions and put plans to scale up substance abuse groups on hold. However, the AMPATH team created remote options for mental health clinical and community-based care, and new needs for mental health related to the COVID pandemic. “We created two call lines for the program to provide follow-up and phone clinical encounters with patients needing mental health care who were unable to get to hospitals,” said Dr. Turissini.
The program also supported a COVID-19 quarantine facility in Eldoret. The team provided 657 mental health screenings to diagnose a variety of mental health disorders. They provided counseling and care to individuals while in the facility and linkage to care when they were leaving. The initiative also led to new partnerships with the county government and the opportunity to work with the local police department to provide awareness about mental health disorders and screening police officers for PTSD and linking them with care as well.
Training of nurses and clinical officers has also continued using Zoom videoconferencing services. While Dr. Kwobah says that role-playing, an important element of training, via Zoom has been challenging, she is committed to empowering healthcare workers at lower level healthcare facilities to provide care. “If you can take care of HIV and hypertension, you can take care of depression with support,” she said.
The prevalence of mental health challenges during COVID-19 has brought much-needed attention to the burden of mental health disorders in Kenya and the national government has formed a national task force as well. “The silver lining of COVID is attention on mental health challenges,” said Dr. Kwobah optimistically.
Dr. Aruasa and Dr. Kwobah disucss the mental health transitional living home on their way to the August 2020 groundbreaking.