Beyond Awareness: Building a Mental Health System That Works for Every Kenyan By Dr. Catherine Syengo Mutisya, Consultant Psychiatrist

On October 10th this year, Kenya joined the world in commemorating World Mental Health Day. Across the country, there were various sponsored walks, different social media platforms abuzz with pictures and clips highlighting the day and heightened print and television media coverage and discussions. The campaign focusing on the urgent need to support the mental health and psychosocial needs of people affected by humanitarian emergencies resonated deeply. But as a psychiatrist working on the frontlines, I must ask what happens after the banners come down? We have made progress in reducing stigma resulting in more Kenyans now willing to talk about depression, anxiety, and trauma. But awareness without access is a hollow victory. Take for instance, many counties, have very few mental health clinicians, no psychologists and also lack a specialised mental health unit in the background of chronic ongoing endless doctors strikes. For the last four months, patients from Kiambu County have continued to desperately look for mental health services in other counties due to the ongoing doctors strike. The situation got worse when recently the Nairobi county also joined the doctors strike, This, results into extreme long waiting time at Mathari National Teaching & Referral hospital (MNTRH) resulting into frustrated and extremely burnt out patients and doctors who have to handle the long waiting hours. Even in counties where Mental health clinics are available, they are avaunderfunded, understaffed, and often treated as an afterthought in public health planning to the extend that attempts to refer patients from MNTRH to the counties is met with extreme resistance by the patient and their relatives

In my opinion, our mental health infrastructure is fragile. MNTRH remains overwhelmed by huge numbers in the psychiatry outpatient clinics, overstretched bed capacity with overcrowding because most ccounty hospitals lack trained personnel and specialised mental health units. Medication stockouts are also very common in the counties and patients often say that the drugs prescribed at MNTRH which often work for them are unavailable in other counties. And while private care exists, it is priced far beyond the reach of most Kenyans who pay out of the pocket because SHA isn’t covering outpatient care for all and private medical covers are out of reach by most Kenyans. We therefore need a system that doesn’t just recognize mental illness but treats it with urgency, dignity, and equity. In my practice, I am also seeing more young people than ever before. College students battling substance use disorders, gambling and other mental health conditions. Teenagers who have been brought for assessment after self-harm and some with suicidal thoughts resulting into their parents being summoned to pick them from their school and take them for treatment. Social media appears to have amplified both connection and comparison, leaving many feeling inadequate and isolated. This therefore calls for further investments in school and college based mental health programs in addition to training teachers and lecturers to spot early signs, and create safe spaces for youth to speak up. We also need to Integrate mental health into primary care resulting into every health centre being equipped to screen and support basic mental health needs. More psychiatrists, psychologists, counsellors, and psychiatric nurses are needed in every county. Community outreach should also be funded and supported. And because Mental health isn’t just clinical but also influenced by the culture, we must engage elders, faith leaders, and local influencers and no Kenyan should be denied care due to poverty, gender, or geography. My call to action is therefore that World Mental Health Day must be more than just a moment but more of a movement. As psychiatrists, we will continue to advocate. But we need policymakers, educators, and citizens to join us because Mental health is not a luxury but a right to be enjoyed by all Kenyans The writer is a distinguished holder of MBChB, MMed Psychiatry and a licenced Medical Specialist