Are your mood swings just that, or a sign of something else?

Bipolar disorder is a mental health condition in which a person experiences unusual mood swings, ranging from extreme highs (mania) to extreme lows (depressive episodes).

The World Health Organization estimates that there are 40 million people living with this mental health condition worldwide, but due to poor mental health reporting in Kenya, statistics on the exact number of people suffering from bipolar disorder are not known as mental illnesses were previously recorded collectively.

To mark the 4th National World Bipolar Day celebrations held in Nakuru County, Brygettes Ngana spent time with people living with bipolar and they share their experiences and challenges in accessing mental health care in the country.

Patrick Boruett, Founder of The Bipolar Heroes Foundation

"The thing about being a doctor living with bipolar is that sometimes my colleagues in the profession think I have an idea of what's going on with me, when in fact I don't.

It started in 2011 and I was leading a project at work. I was putting all my energy into it, not knowing that I was slowly falling into this state. I hardly slept. In meetings, I was very firm with my proposals and could not see my colleagues' points of view, which made my boss realise that something was wrong with me. I was diagnosed in June 2011, but I was in denial until 2016. 

A lot happened between 2011 and 2016. I struggled to make sure I attended my medical appointments, which affected my recovery. It cost me a lot. I could not progress in my career. I lost finances and relationships. I felt really low, but then I decided to research bipolar disorder and at that time I accessed information online, mostly from Europe, Australia and North America. I was encouraged by people with lived experience of bipolar, and that helped me move from denial to acceptance.

In 2019, I started the Bipolar Heroes Foundation and for the first time in Kenya, we celebrated World Bipolar Day at the Nairobi Arboretum. This was really a turning point for me because it was the first time I met people in our local environment who were going through the same thing as me.

I believe in amplifying the voices of people with lived experience of bipolar disorder because when we share, we are able to help others use our experiences as survival skills to get out of the difficult situations that bipolar disorder can bring. It is a treatable condition, it can be managed and our vision is a world where people with bipolar disorder can reach their full potential.

We have online support groups and physical meetings with carers, people with lived experience and we were able to celebrate World Bipolar Day for the 4th time here in Kenya. This was our landmark event to bring stakeholders together to raise awareness and fight the stigma associated with bipolar disorder.

The biggest gap was in terms of human resources. We do not have enough psychiatrists at consultant level and at the lower levels of psychiatric nurses and clinical officers.  The same goes for psychologists, and the concentration of mental health professionals is in the cities and not in the rural areas, which means that access to services in rural areas is not optimal.

In the Rift Valley region, where I work as Director of Preventive and Promotive Health, in Baringo County. Only two hospitals have in-patient psychiatric services, Nakuru Teaching and Referral Hospital and Gilgil Subcounty Hospital.  Initially there was a challenge of overcrowding in these two hospitals, but I must acknowledge that in the last few years the facilities have been expanded and there is less overcrowding now.

We have challenges with access to medicines. Mental health conditions are treated with first and second line drugs. First-line treatment is generally available, but second-line drugs as defined in the Kenya Essential Medicines List are not available. It's frustrating to go to these hospitals and not get full treatment.

Another key gap is awareness raising, where the focus is more on prevention of mental illness. I am glad that Community Health Promoters now get a stipend from the government. We need to invest in CHPs to identify these conditions early. Community-based organisations have been instrumental in bridging the information gap on mental health. I look forward to seeing where support groups can grow to provide group counselling and sharing of experiences, as this support helps to ease the journey, especially for the newly diagnosed. I look forward to when counties can provide mental health services when and where they are needed.

Stigma is a challenge, on a personal level I have to say it's a double-edged sword. If you are unwell, you are a patient who is not seen by doctors, people tend to think I know what I am going through. I am now able to recognise the early warning signs of a manic or depressive episode. For me, lack of sleep is a big trigger, if you are not on medication you become very vulnerable to the stresses of life and managing stress is really a key step, very important step and getting good family support. I have appreciated that.

Let us continue to rally the public and everyone to appreciate that mental health does not discriminate, it is okay not to have a mental health condition and it is treatable and you can manage these conditions".

Robert Kinyua, Accountant

" I was 30 years old when I was diagnosed with bipolar disorder.  I was newly married and we had a lot of arguments with my wife. It was only when I was admitted to Nakuru Teaching and Referral Hospital that the doctors at the psychiatric ward diagnosed me with bipolar 2. I was hospitalised for 3 months and then discharged to go home. But over the course of a few years, I was frequently admitted to hospital.

It took a while for me to be diagnosed because I was treated for many other illnesses before a psychiatrist was able to recognise that I was bipolar. My triggers then were lack of sleep, lack of appetite, irritability and I was paranoid. My mind was flooded with thoughts of people thinking I was crazy. I would also be overly talkative and walk around a bit too much.  When I was happy, I was over the top, and when I was angry and sad, I was also on the extreme end. There was no balance in my feelings and emotions. 

When it comes to stigma, I feel that some people stigmatise because they do not know what bipolar is. In the past, my wife used to get help from other neighbours to take me to hospital. I can imagine how difficult it was for her and the children to see me vulnerable. But now I am able to take my medication without supervision and I also go to my appointments by myself.

I would like people to know that bipolar disorder is like any other illness and needs to be managed throughout life. Sometimes bipolar is hereditary and many factors can trigger it, such as stressful situations.

My wife and children have been my support in the 30 years I have lived with bipolar disorder. I don't think I would have made it this far without their support. They used to visit me when I was in hospital and they always keep me in check when they see me on the verge of a manic or depressive episode.

I am also grateful to my employer. I work in a school and the headteacher has been very supportive. I am about to retire and I am looking forward to my future.

According to Lydia Nyaga, Nakuru County Mental Health Coordinator, stigma is a major barrier to mental health treatment. Nakuru County is one of 15 public health facilities currently taking part in a pilot programme that will see the country change the way mental illness is reported.

"What we report as mental illness at the national level is not specific to mental illness. Once this pilot programme is adopted by the Ministry of Health, it will be very easy to get statistics on different mental illnesses," says Lydia. 

Nakuru County has also started training Community Health Promoters to identify mental illnesses in their area and refer patients for treatment in time.

"There are conditions that affect children mentally like autism, there are conditions that affect the general population like bipolar and some are due to substance abuse. There are conditions that affect the elderly, such as dementia, so we come up with an action plan to know what needs our attention most," Lydia adds.

Medication for any mental illness is not cheap, but Lydia says patients can register with the social health insurance fund and also register as a person living with a disability to get tax relief on the medication.

There is still no medical explanation for what causes bipolar disorder.