Depression: A State Of The Mind

The place is Thika Road, the year is early 2000, passengers are inside a matatu (mini bus) heading towards the city of Nairobi. As the public transport vehicle approaches Mathari Rehabilitation Hospital, two smartly dressed men position themselves with the aim of getting off. They indicate to the conductor their intention to alight with a casually dressed man Juma (not his real name). Unbeknownst to Juma, the men use hand gestures (pointing to their heads) to signifying that he is crazy or mad thus difficult to deal with. Once the mini bus stops at the hospital stage, Juma is bundled out forcefully wailing and kicking as the rest of the passengers watch silently. Some even shake their heads in pity. As the matatu takes off, the victim Juma, is robbed under the guise of being taken for a mental check up. Stigma in our society encourages such scenarios and as a result drives the depression prevalence up as well as that of other mental illnesses.

According to the Kenya National Commission on Human Rights (KNCHR) report “Silenced Minds: The Systemic Neglect of the Mental System in Kenya” of 2011, stigma has hindered the realisation of the right for persons with mental illnesses to attain high standards of mental health. The leading cause of disability as listed by the World Health Organization (WHO) is not a physical disease but a mood disorder, a situation that informed this year’s world health day theme which was “Depression, Let’s Talk” with the aim of having a year long campaign to address this issue. Globally, around 350 million people suffer from depression leading to 800,000 deaths annually due to suicide. This alarming figure is a wakeup call for countries to rethink their mental health approaches according to WHO Director General, Margaret Chan.

Writer Ted Malanda in a past Standard Newspaper brings out the African attitude towards mental illnesses and specifically depression. In his article about the death by suicide of famous comedian Robin Williams, Malanda asks “What is this depression thing?” and further states that “we are stressed and depressed all the time! In fact, it is such a-none issue that African languages never bothered to create a word for it.” To lend credence to his argument is an African proverb that says “every market place has a madman”. For the mental illness patients, their case is closed due to “an accept and move on” attitude once one is diagnosed. In our society, depression is not categorized as an illness in the first place, thus there cannot be a medical cure for it.

At its worst, depression can lead to suicide with 80% being victims of this disorder. Over 7000 Kenyans commit suicide annually with most being within the age bracket of 15 to 30 years. However the statistics may not be exact due to cases that go unreported, since suicide is a crime in the country thus concealed. Women are twice more prone to depression, although this doesn’t mean that it’s a one sided gender disorder. Despite this, men are more likely to commit suicide. Dr Pius Kagwama says “Women attempt suicide many more times than men but death by suicide is higher and more violent in men. There’s a finality in the mens decision.”

A 2014 report by WHO estimates 24.4 males and 8.4 females in every 100,000 committed suicides. Dr. Kagwama explains why men are more prone to suicide “Majority of psychiatric patients are women because men have more problems in processing and reaching out for help.” Ted Malanda the writer gives conditions viewed as ‘African’ under which he can embrace ideas of suicide, “I accept it when a man hangs himself because his wife left him, or he is jobless, or the neighbour bewitched him or he is caught red-handed kissing his mother in law. But committing suicide because you are suffering from depression is simply not African.”

The Kenya National Commission on Human Rights (KNCHR) report states that mental illness is not a priority to politicians and policy makers leading to an under resourced and underfunded system unable to offer quality inpatient and outpatient care for those who need it. The budget has depression written all over it with government spending less than 1% in this area, against a huge population with little access to mental healthcare. Some experts feel that mental health issues are given low priority because this illness is not contagious as are most non communicable diseases. Thus there’s no risk of grave danger to masses as is the case with cholera, malaria or HIV/AIDS.

Patients with mental health problems are often left at the mercy of traditional or unqualified health care givers, since there is only one psychiatrist for every 500,000 patients in the country. In February 2016, Aljazeera media reported about an acute shortage of staff at the Mathari National Teaching and Referral Hospitals. Dr. Julius Ogato Of the same institution said the hospital didn’t meet the international ratio standards, besides the staff being overwhelmed by their work. It was also established that there were 146 mentally ill male patients attended to by only one female nurse at that time. Some of these patients were hardcore criminals in a maximum security ward who often assault the staff.

Ted Malanda in his article echoes another negative African perception on mental disorders. That if depression was an illness, more doctors would be training in psychiatry. “But as a friend pointed out, hospitals have more gynecologists and one miserable shrink.” Students enrolling in psychiatry are declining, while there’s poor infrastructure in the name of psychiatric wards which does not provide a proper environment for management of mental health problems.

There are 88 psychiatrists and 427 nurses qualified to handle illness in the 14 mental health hospitals in the country. To reach the standards set by the Kenya Ministry of Health, 70,000 more nurses are needed. According to Dr. Kagwama more than 50% psychiatrists are based in Nairobi with the rest spread out in different counties. Aproximately there are 10 in Eldoret, Kisumu has 4, Mombasa 5, and Kakamega 2. “With a population of around 40 million, 80% is in the rural areas, so the person treating these patients is not a psychiatrist.”

The Mental Health Bill 2013, advocates not only for prevention of this illness, but also for its treatment, care and rehabilitation. There has been unavailability of the expensive drugs that cure mental disorders especially at the grassroots and among the poor. Dr. Kagwama commends a revamped curriculum training started a few years ago for nurses, clinical officers and doctors in order to address the mental healthcare gap, however he still feels that a lot more has to be done ” There’s a need for investment in more mental health specialists and community health workers, training them as well as provision of appropriate medication and rehabilitation services that work.”

A raft of measures was recommended in the KNHCR report which included development of a clear roadmap for mental health in the country to be done by, reviewing the Mental Health Act which is defunct and finalizing The Mental Health Policy 2015 – 2030 which provides for a framework on interventions for securing mental health systems reforms in Kenya. These include the removal of discriminatory terms such as mental infirmity, mental incapacity or unsound mind from the legislation. An example of how this law can be beneficial is the case of rebranding in name of the lunatic asylum in the early 1900s to Mathari Mental Hospital in 1924 to Mathari Hospital in 1964 and currently Mathari teaching and referral hospital, to help fight stigma.

Others are their right to getting national identity cards as well as legal representation. Injustices such as judicial restriction to legal capacity as enshrined in Article 12 of the United Nations Conventions on the Rights of Persons with Disabilities have led to cases where properties of those with mental disabilities can be controlled by members of their families. Thus a need to create awareness on administration and care of property for those with mental illness as well as ensuring they are supported in making decisions. Systems that deny them avenues to make their own decisions should be discarded.

Experts and stakeholders in the mental health sector feel that a health board to oversee mental health care should be established. Society is urged not to restrain and seclude people with mental health problems. At the same time hospitals have been implored to end forced sterilization of women without their consent. The government should ensure their right to access in education as well as opening up of psychiatric clinics in all major hospitals. Persons with mental illness also need insurance to make access to treatment easier. Three insurance companies that declined to be named were interviewed over the cellphone on the issue of covering patients with mental disabilities and all had a commonality; they would offer insurance cover excluding the mental condition.

Modern society has been hyped as being open minded, digital and knowledge based. Yet despite this, we could as well be living in Neolithic times or in the era of the Renaissance, if how we treat people with mental illnesses is anything to go by. There still exists stigma and lack in understanding of mental health and illnesses in our society. While prejudice against race, religion, gender and even sexual orientation in many parts of the world is no longer acceptable, there’s still stigma when it comes to dealing with psychiatric conditions.

Dr. Pius Kagwama stresses the need to educate the public about how to support persons with mental disorders as well as reduce obstacles that hinder them from seeking or receiving treatment for their illness. Pius says “Stigma is caused by lack of knowledge and inaccurate information. We are doing a campaign to empower people so that they can realize that depression and other mental conditions are like other illnesses.”

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