A total of 17 counties in Kenya have no single psychiatrist on its medical staff, denying thousands of Kenyan patients the much-needed treatment they require.
The Kenya Psychiatric Association listed Tana River County, Lamu, Taita Taveta, Garissa, Marsabit, Isiolo, Nyandarua, Kirinyaga, Turkana, Samburu, Uasin Gishu, Nandi, Narok, Busia, Homa Bay, Migori and Nyamira as the affected counties.
The association’s chair, Dr Chitayi Murabula, says even those with psychiatrists in their staff, the situation is still deplorable, as one or two psychiatrists serves up to 1.3 million people.
Dr Chitayi spoke on Friday during the second Nation Media Group (NMG) Health Summit that was held at the Nairobi Hospital Convention Centre.
“We have to remember that access to mental health is a right as health is a right enshrined in the constitution. Mental illnesses lead to poverty and poverty is a contributing factor that leads to mental illnesses,” Dr Chitayi highlighted.
The tragedy of the 17 counties with no single psychiatrist is despite the fact that the Kenya Mental Health Taskforce which was put in place by former President Uhuru Kenyatta but ceased operations in 2020 giving 15 recommendations while urging the government to prioritize building capacity to address mental health issues.
The taskforce highlighted mental illness as an emerging epidemic due to the rising trend of suicide, gender based violence and other mental health conditions that it said are indicative of the unmet needs domiciled in society.
According to the mental health policy 2015-2030, Kenya is among the 28 per cent of World Health Organization (WHO) member states countries that do not have a separate budget for mental health.
“Mental health is an area of massive concern across the world and participants made clear that Kenya is no exception. A staggering one out of four persons who seek healthcare in Kenya have a mental health condition,” WHO highlights.
The recent performance audit report on provision of mental health services in Kenya by the office of the auditor general examined whether the Ministry of Health (MoH) and county governments have put in place measures that are effective for provision of mental healthcare services agrees with Dr Chitayi.
“Psychiatric units are only available in 25 out of the 47 counties indicating that 22 counties do not have mental health care facilities. The patients in the 22 counties that do not have mental health care facilities have to bear the cost of seeking services in the nearest county that has a psychiatric unit and the cost may be high for the patients and relatives,” it highlights.
The report states that besides Mathari national teaching and referral hospital, mental healthcare services are only available at 29 of the 284 hospitals in Level 4 and above of the referral chain.
“This represents just ten per cent of the total facilities in Level 4 and above and 0.7 per cent of the 3,956 government-owned health facilities. This indicates that patients seeking services at all health facilities in levels 1 to 3, and in 255 facilities that are in level 4 and above of the referral chain have no access to mental healthcare services,” the auditor general noted.
Additionally, all mentally ill law offenders who require in-patient services can only be admitted in Mathari Hospital regardless of severity of their condition.
According to the report, mental healthcare service delivery at the counties that have psychiatric units have also not been adequately managed.
“15 out of 19 psychiatric units visited lacked all the basic equipment while 4 units had at least one machine with only 2 units having functional Electroconvulsive Therapy (ECT) machines. Four psychiatric units only provided outpatient services while in the 15 units that had psychiatric wards, the average number of beds was 23 against an average number of 28 patients leading to sharing of hospital beds,” the auditor general noted.
Also, 11 units lacked critical drugs while most units were short of the different professionals that offer mental healthcare services.
“For example, the ratio of psychiatric nurses to patients in 7 of 12 units that provided data on inpatients indicated that the ratio is below WHO recommended ratio of 1 psychiatric nurse to 6 patients,” the report highlights.
While addressing the cost of mental illness treatment, Dr Chitayi urged insurance companies to follow the law and stop looking at drug and substance abuse as ‘self-inflicted’.
He further noted that depression is now much more common in the country and there are increasing rates of substance and alcohol use disorders.
“The law states that it’s illegal to discriminate against persons with mental illnesses. Covering them should be similar to covering other illnesses, “he noted.
The head of department urged the government to take the lead by the work it is doing with the National Hospital Insurance Fund(NHIF) soon to be Social Health Authority(SHA) and ensure that there’s more allocation for mental health insurance from the Sh 60,000 that is currently allocated which he says is not enough.
“I was looking at the recent benefit package proposed by SHA, it is worse than the previous package. Why would you bring a proposal that is worse than what is there?” He posed.
“Even when it comes to substance abuse disorders, we have done calculations of what it costs to cover patients and have come up with close to accurate estimates of which NHIF is aware. Why is the health ministry not taking this up?”
Dr Chitayi further disclosed that there is a proposed clause on mental health by the government health insurer that discriminates against persons with mental health illnesses in the country.
