|Year : 2023 | Volume
| Issue : 1 | Page : 82-83
Bridging the Mental Health Gap using the Already Available Resources: The Kenyan Experience
David M Ndetei1, Victoria Mutiso2
1 Department of Psychiatry, University of Nairobi; Africa Mental Health Research and Training Foundation; WPA Collaborating Centre for Research and Training, Nairobi, Kenya
2 Africa Mental Health Research and Training Foundation; WPA Collaborating Centre for Research and Training, Nairobi, Kenya
|Date of Submission||03-Mar-2023|
|Date of Acceptance||06-Mar-2023|
|Date of Web Publication||26-Apr-2023|
Prof. David M Ndetei
Africa Mental Health Research and Training Foundation, Nairobi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ndetei DM, Mutiso V. Bridging the Mental Health Gap using the Already Available Resources: The Kenyan Experience. World Soc Psychiatry 2023;5:82-3
The 85% mental health treatment gap in low- and middle-income countries (LMIC), Kenya included, is unacceptable and needs urgent attention. It is true Kenya faces challenges in the attempt to lower this treatment gap, hopefully toward 40% of the treatment gap in high-income countries (HIC).,
These challenges include scarcity of human resources (mental health specialists) and acute shortage of financial resources (a reflection of low incomes), poor health systems and infrastructure, and lack of appropriate policies and legal frameworks. Despite all of these, there is hope that there is much we can do using what we already have in our hands, even as we continue to improve our current resources. This calls for innovative interventions that are context appropriate, available, affordable, and accessible to the consumers within their communities, and, above all, are appropriate, i. e., evidence based.
The mental health treatment gap-intervention guidelines (mhGAP-IG) developed by the World Health Organization for use in LMICs advocates a task-sharing model that loops in a wide range of community service providers who can be trained, supervised, and supported to provide services at grass-root level. These include traditional service providers and the clergy, who are often the first contact in the service system at the community level. They are in plenty. Then, we have service providers in the formal health system sector, also found at the grass-root level service facilities, i.e., community dispensaries, health centers, and, in Kenya, the increasing numbers of community hospitals. These are manned by nurses and clinical officers and occasionally by general practitioner doctors. The community health volunteer workers are the link between communities from the family level to the community facilities. They are hired in consultation with the communities, live in the communities, and know all family members within their catchment areas. Furthermore, in the communities are teachers, opinion leaders, people with lived experience, etc. We have demonstrated in Kenya that all of these can be trained to effectively apply the mhGAP-IG.,
We may not have sophisticated meeting places and in any case, these are not critical for meetings. There are conventionally used meeting places ranging from community halls, waiting places at health facilities, schools, churches, airy shades under trees, etc. These can be used for dialogues on mental health to increase awareness and decrease stigma and in the process, promote health-seeking behavior to already empowered community health services. Research has demonstrated that trained peers can be trained on inexpensive interventions that are effective. Thanks to competition within the pharmaceutical industry – the costs of psychotropic drugs have dropped significantly. As we embrace all these, technology is on our side – with telemedicine and therefore, the concept of “hard to reach” communities is no longer a big issue. Social and formal media can and indeed are looped in.
From the above, it is apparent that the approach to mental health is multi-stakeholder and cross disciplinary. This calls for mutually respectful dialogue across the various players outlined above, from the family level all the way to the policy level. From our experience in Kenya, this is feasible and promotes very rich social capital and community connectedness around mental health.
What we are advocating for does not preclude cooperation between HIC and LMIC. Rather, we should collaborate in research for better and more effective interventions. That way, we shall all be moving forward to inclusive global mental health in the not-too-distant future.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ndetei DM, Mutiso V, Osborn T. Moving away from the scarcity fallacy: Three strategies to reduce the mental health treatment gap in LMICs. World Psychiatry 2023;22:163-4.
World Health Organization. MhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings: Mental Health Gap Action Programme (mhGAP). Geneva, Switzerland: World Health Organization; 2016.
Mutiso VN, Musyimi CW, Rebello TJ, Gitonga I, Tele A, Pike KM, et al.
Patterns of concordances in mhGAP-IG screening and DSM-IV/ICD10 diagnoses by trained community service providers in Kenya: A pilot cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2018;53:1277-87.
Mutiso VN, Gitonga I, Musau A, Musyimi CW, Nandoya E, Rebello TJ, et al
. A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: A case study of Makueni County, Kenya. Int J Ment Health Syst 2018;12:57.
Osborn TL, Venturo-Conerly KE, Arango GS, Roe E, Rodriguez M, Alemu RG, et al.
Effect of Shamiri layperson-provided intervention versus study skills control intervention for depression and anxiety symptoms in adolescents in Kenya: A randomized clinical trial. JAMA Psychiatry 2021;78:829-37.