KPA Dr. Catherine Syengo Mutisya discussion on insomnia

Dr. Catherine Syengo Mutisya "All work and no play makes Jill a dull girl"

THE IMPORTANCE OF SLEEP by Dr. Catherine Syengo Mutisya

Many of us will struggle with inadequate sleep at some part of their life but because the problem doesn’t affect their daily functioning, they may not get to consult a doctor or a therapist or seek treatment for the problem. insomnia (inadequate sleep) in adults with symptoms lasting for 3 or more nights per week for a prolonged period and whose daytime functioning is considerably affected should be treated. Such treatment can range from talk therapy(psychotherapy) or medication or a combination of both. Insomnia is a sleep disorder which consists of inability to fall asleep or stay asleep or getting up early in the morning for a prolonged life. It is indeed a very common disorder, that affects up to about 6-40 percent of the population. Insomnia (inadequate sleep) can affect the quality of life just like disorders like depression and heart failure and so it shouldn’t be left unattended. Untreated insomnia also leads to or worsens other mental disorders and also impacts physical health like increasing predisposition to accidents and increasing appetite Inadequate sleep(insomnia) should be thoroughly investigated. Issues like the duration and frequency of the sleep, schedule for bed time, time taken to get asleep, awakenings, rise time, sleep environment, triggers in form of stress, shift work etc, behaviours during Sleep, past medical history and past treatment history should be assessed. Medication like caffeine can last up to 6hrs and so history of coffee use and use of other caffeinated products should be clarified. Nicotine also impacts sleep and so that history should also be investigated. Physical Sleep disorders like apnoea and obstruction should be ruled out by ideally a specialists in Ear Nose and Throat (E.N.T.) specialists. Ideally the first option for treatment of Insomnia is psychotherapy and specifically cognitive behavioural therapy for insomnia. Some treatment guidelines recommend that cognitive behavioural therapy for insomnia (CBT-I) be the first-line treatment for chronic insomnia, offered either face-to-face or via digital platforms. For adults where CBT-I is unsuitable or ineffective, they recommend medication treatment for long-term chronic insomnia, provided that the use of medication is only for the shortest possible duration and reassessed within three months. CBT-I (Cognitive Behavioural Therapy for Insomnia) is a proven and recommended treatment for insomnia. It uses different methods, like learning about sleep, changing habits, and changing thoughts. CBT-I works well for people with or without other health problems and so it would be good for the person who has insomnia to be assessed by qualified professionals. If someone suspects that they have insomnia they should seek assessment by the nearest medical provider, or the nearest counsellor. We should know that untreated insomnia can result in both physical and psychological complications, can complicate existing medical conditions and Insomnia can also be the pointer that there is indeed another medical condition It is therefore wrong to buy over the counter medication for treatment of insomnia or use substances like alcohol or other substances of abuse to manage insomnia. It is also important for counsellors and other front-line workers to refer cases of insomnia which are not improving for further investigations by the relent specialists. Use of “herbal” products has become rampant yet it is difficult to know what is contained in those herbs. Use of such products without professional involvement is therefore strongly discouraged. The writer is a mental health advocate with 25 years of medical practice experience

Is a suicidal attempt a sin, a crime, a curse or a mental health Problem?

To some it’s a sin, to others a crime and to us a mental health struggle! Dr Catherine Syengo Mutisya

“Ni kwa nini uliona Maisha haina maana?” Why did life feel so bad? Do you get suicidal thoughts? Have you thought of ending your life? These are some of the question’s psychiatrists and other mental health specialists who treat depression, alcohol and other drugs of use, those living with chronic illness or extreme life crisis. The stigma associated with suicidal thoughts and suicidal attempts is immense and sometimes can make survivors determination to succeed in their next attempt relentless. Yet suicidal ideation marked by thoughts of self-harm or ending one’s life is a major mental heal emergency and if untreated leads to significant deaths. Suicide affects people of all ages with an estimate of one person dying every 40 seconds. Also, from a public point of view, criminalising suicide makes it hard to collect data which is key in planning for future suicide prevention strategies. Kenya is among the countries that have decriminalized attempted suicide as a result of decades of mental health advocacy. Other countries which Kenya emulated include India, Ghana, and South Africa. The World Health Organization (WHO) has consistently called for the decriminalization of suicide, noting that such laws are counterproductive and exacerbate mental health crises. And so, in January 2025, when a Kenya’s High Court ruled that criminalising attempted suicide is unconstitutional, there was a glimmer of hope that the door to accessing the highest attainable standard of mental health with less stigma was beginning to open. This marked a significant shift toward compassionate, health-focused approaches to mental health care rather than the archaic punishment way. It is therefore expected that more people struggling with suicidal thoughts would be able to seek treatment and help researchers develop further more effective treatment options and prevention strategies. Furthermore, research has also demonstrated that talking openly about one’s challenges including any possible suicidal thoughts can give an individual various option or the time to rethink decisions, thereby preventing suicide People who die by suicide are said to have deliberately killed theselves yet on the other hand their thoughts constantly remind them that life is not likely to get better. Such persons are also filled by certain religions as having committed a sin and in some African cultures as disgrace and a sign of bad omen. Now that Kenyans have accepted that that those who survive suicidal attempts should be supported and not punished by the law, the next steps include dealing with the cultural and religious undertones by public and targeted campaigns that aim to make the clergy gate keepers. Improving household financial security would also go a long way in preventing suicides. Indeed, financial difficulties in Kenya is a big contribution to mental health crisis. Efforts to reducing access to the common means likely to be used by persons at risk of suicide for example pesticides and substances of abuse and at the same ensuring access to mental health care for all is also a big strategy for preventing suicides. Promoting healthy connections in the communities boosts easy connection, communication and caring for each other hence building strong communities with low levels of loneliness. Training young people on life skills, problem-solving skills, together with social and emotional learning increases resilience which is key to adjusting to life’s ups and downs. As an early life start up pack for babies, parents need to be trained on effective parenting skills and strategies and in return improving family relationships In conclusion, a lot of work needs to be done for Kenya to actualise the desire to improve mental health to be at par with physical health. Preventing suicide requires more commitment and huge investment bearing in mind that there is no health without Mental Health. Decriminalising suicide was the therefore the starting, point and it will require county governments and the national governments to invest more in mental health because for every shilling allocated to mental health there is increased productivity, and savings in economic burdens accrued to mental illnesses The writer is a mental health advocate

Rwanda’s Parliament recently passed a new law granting adolescent girls the right to access Sexual and Reproductive Health (SRH) services—particularly family planning—without requiring parental consent. Should Kenya follow suit?

 The Standard - 25TH AUGUST 202

Dr. Catherine Syengo Mutisya

About 20 years ago, my colleagues and I were involved in a nationwide program spearheaded by the Centre For British Teachers (CBT) for a nation wide campaign for teachers and pupils emphasising on either Abstinence, Being faithful to one uninfected mutually faithful partner or correct use of the Condom (ABC) for prevention of Human Immunodeficiency Virus (HIV)

Kenya first diagnosed the first case of HIV in 1984. This came with extreme fear and stigma similar to what we recently experienced during the early stages of Covid 19 pandemic. It therefore required a lot of concerted efforts to prevent new infections and prevent development of Acquired Immunodeficiency Syndrome (AIDS) in those already infected and by the early 2000 we had learned how to prevent new HIV infections and also prevent or manage HIV Acquired Immunodeficiency Syndrome (AIDS)

My take as a psychiatrist is therefore that the best family planning method to be offered to the adolescents is the proper use of the condom because there is no any other family planning method that will prevent acquiring HIV infection as well as prevent pregnancy. By the time an adolescent needs a family planning method it means that they are sexually active and therefore every responsible Kenyan must not forget that we had to fight HIV-AIDS by all strategies to reach where we are now. Dishing any other family planning method other than the condom liberally and not emphasising particularly on the proper use of the condom will therefore be a sure way of preventing pregnancy yes but also allowing HIV prevalence rates to raise again!

The question as to whether Kenya should follow suit and pass a law like the one Rwanda passed on granting adolescent girls the right to access Sexual and Reproductive Health (SRH) services—particularly family planning should be analysed with caution. Kenya should instead continue to raise the efforts for creating awareness on the proper use of condoms to prevent both pregnancy and HIV-AIDS for those who can’t abstain or be faithful to one noninfected mutually faithful partner regardless of their age. Strategies to have adolescents access condoms would therefore be a great investment.

For Rwandese legislators to passed such a law is a confirmation that Africans have forgotten where HIV- AIDS took us to and they are only myopically concentrating on prevention of pregnancy without targeting prevention of HIV as well. Such a myopic view will fuel the trend medical practitioners are now currently witnessing of increased rates of HIV related acquired immunodefiency syndrome which had significantly reduced because there were public campaigns that had emphasised on prevention of HIV infection and early testing and treatment for those found to be infected

My call is to all African countries is therefore not to drop the ball and assume that we have eliminated HIV AIDS and that the only problem to deal with is prevention of Teenage pregnancy

 

The Author is an influential Mental health advocate with 25 years of medical practice experience

The Silent Battle: Unmasking Depression in Kenya

The latest World Health Organization’s Atlas ranking of Kenya as the 5th in terms of the number of people living with depression in Africa reveals a silent epidemic.

What’s deeply troubling is not just the number of people affected, but the layers of denial, stigma, and lack of awareness that continue to fuel the crisis.

Many are suffering in silence, unable or unwilling to seek help because of the shame attached to mental illness. Depression is far more than just a passing emotion. It often shows up as persistent sadness, a loss of interest in previously enjoyable activities, overwhelming guilt, and changes in sleep and appetite. In its most severe form, it can lead to suicidal thoughts. Depression is therefore not a character flaw or spiritual weakness but a real medical illness

 

In addition, social Media posts can depict changes in the tone and behaviour online and rapid, overwhelming posts or shifts in language can indicate distress. Coded suicide messages for example Online “farewell” notes are often calling for help, not just final goodbyes.

 

In high ffunctioning Depression, People may appear “okay” externally and even be productive and social until they burn out. Final ccancelling of plans, sudden withdrawal, or exhaustion can also be a warning sign.

The fact that women are often caregivers at times with no rest and culturally pushed to be “strong woman” leaves little space for vulnerability and can to quiet breakdowns. Indeed, studies have shown that women are more likely to be depressed than men because of hormonal fluctuations and other factors such as economic vulnerability, societal pressure and reproductive life changes like after child birth and during menopause. Women are also at a greater risk of being sexually or physically violated and are also more likely to ruminate and to seek emotional harmony with greater perfectionism in balancing work and domestic duties

On the other end men may also mask up depression resulting into higher rates of depression related suicides and more alcohol and other substance use. Indeed, in Africa men are more likely to experience stigma when they open up about their mental health problems making it harder for them to access to mental health care

The youth are also not left behind because WHO reports that suicide is the third leading cause of death among 15-29-year olds. Economic stress, social media and cyber bullying are unique challenges being faced by the youth in Kenya. Africa therefore needs to rise and protect the majority of its population who are youth and shape the future.

We all therefore need to know that depression is a treatable mental health problem and not a form of weakness. Communicating connecting and caring can break the silence and lead to more people of all ages and gender accessing the mental health care they need. The internet is also an asset that can and has been used to find the necessary screening tools, access online therapy and consultation but of course not a substitute to in person care especially for severe depression. Our mental health therefore starts with each one of us taking their responsibility in their capacity to improve the nations mental health.

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Why is the minimum age of drinking alcohol proposed to be 21 years and not 25years

 

The 2025 National Policy for the prevention, management and control of Alcohol, Drugs and Substance Abuse sparked a lot of hullabaloo as soon as it was released resulting into the National Authority for Campaign against Alcohol and Drug Abuse (NACADA) issuing a clarification statement hours later.

One of policy statements that provoked the public debate was raising the minimum legal age for purchasing, consuming and selling alcohol in Kenya from 18 years to 21 years

I actually support this policy direction based on the proven fact that alcohol can seriously affect a young brain. Research has consistently shown that drinking before the brain fully matures can mess with memory, learning, and decision-making resulting in noticeable problems with attention and memory. In addition, starting to drink alcohol early also increases the risk of alcohol addiction later in life.

In actual fact the part of the brain responsible for decision making, judgment and impulse control continues to develop up to mid years of 20s and so from a purely scientific point of view we should be leaning towards raising the minimum age of drinking from 18 years to 25 years and not just 21 years. 21 years is therefore not a magic number but it is chosen because many societies have come to accept it. Societies have therefore had to balance the science and social acceptance.

Alcohol is also a gateway to using other substances and so waiting until 21 years of age to use substances like alcohol, nicotine, and marijuana therefore protects brain development, reduces addiction risk, and promotes long-term well-being.

The other policy direction was on easy access of alcohol. It is clear that for example online sale of alcohol and home delivery significantly weakens the ability to verify age making it easy for underage and those with addiction problems to easily access alcohol. Further, the 2022 WHO report indicated that digital programs and delivery services negate face to face verification of age hence making it easy for under age to access the alcohol

The reason the society should put more effort in reducing access and therefore use of alcohol throughout the ages and especially in the age when one is likely to get addicted easily is that; it is now confirmed that alcohol even if taken in moderation is not only toxic, interferes with the brains executive function, causes addiction and also predisposes one to cancer in proportions similar to asbestos, radiation and tobacco. In fact, alcohol has specifically been strongly associated with predisposing one to bowel cancer and female breast cancer. Kenyans should also know that any beverage containing alcohol, regardless of its price and quality, is a risk of developing cancer. This should therefore dissuade Kenyans from thinking that if a brand is very expensive then it is safe. We should therefore reduce the middle-class culture of show casing the most expensive brands when they through a party deluded that just because it is licit and expensive, it is safe.

All this said and done, let’s not forget that most people use substances to try and heal their unhealed trauma wounds. We should know that people with alcohol use disorder would go to all length to access alcohol regardless of the policies, laws and the level enforcement. We should therefore also put effort in parent training, training in life skills among pupils and students and higher learning institutions and teach problem solving to increase resilience. Economic empowerment is also key in reducing alcohol use disorders. Childhood and later life trauma healing therapy is also key in ensuring we have a healthy nation. Above all let us support and not punish those who end up with alcohol use disorder but instead link them up for treatment.

For those dealing with alcohol use disorder, proper assessment by qualified mental health provider, correct diagnosis and effective holistic management is available.