One out of four people who seek healthcare in Kenya has a mental health condition, and there are increasing rates of substance and alcohol use disorders. Yet, few people seek and receive treatment until their illness is severe. This can be attributed to two intersecting, systemic factors: a lack of accessible services and continuing stigma around mental illness.
With fewer than 100 practicing psychiatrists in a population of 50 million, there is a significant gap between supply and demand when it comes to specialist mental healthcare especially at primary and secondary level healthcare facilities. This gap is exacerbated by negative cultural beliefs around mental illness, which prevents many healthcare providers from even undertaking mental health training.
To help close this gap in mental healthcare, Kamili Organisation has been providing scholarships to nurses, clinicians and community health workers to specialize in diagnosing and treating patients with mental illness in line with the Kenyan government’s Mental Health Action Plan. The organization also worked with the Kenya Medical Training Centre to develop a user-friendly curriculum for a one-year higher diploma on mental health, with input from the National Nurses Association of Kenya, the Nursing Council of Kenya, the Dedan Kimathi University School of Nursing and the Ministry of Health.
Supported by the Johnson & Johnson Foundation, Kamili aimed to sponsor at least 150 nurses to train for a higher diploma in psychiatry over three years. They surpassed this target, with almost 200 nurses having completed the program since 2020.
“The program is becoming a word-of-mouth success and is actively helping to break down stigma around mental health,” says Lydiah Wachira, Program Manager, Kamili. “When the trained nurses return to work after completing the diploma, their colleagues realize that the training hasn’t led to negative effects, such as the nurse “catching” a mental illness. This then helps them shake off their fear and often leads them to apply for the scholarship themselves.”
As most of these nurses are already employed by the government, they have more leverage with their employers to offer mental health clinics in public hospitals after they graduate, adds Wachira. Kamili has also started working with private hospitals to train their nurses in an effort to make affordable psychiatric services even more accessible across Kenya in the near future.
Embedding mental healthcare services at the community level
In addition to focusing on capacity building in national facilities, Kamili is also working to improve mental health services at the community level as higher level facilities are often out of reach both geographically and financially for most Kenyans.
By promoting a preventative approach, Kamili aims to strengthen the capacity of primary healthcare facilities to provide basic mental health services to local communities and offer referrals for more serious cases. This includes providing mental health training to community health workers to assist nurses, referring patients for treatment and following up with home visits. The organization piloted the community health program in 2022 with 30 community health workers and is now working to scale it up across counties.
Training health workers to diagnose and treat mental illness is only half of the story, Wachira notes. Local populations also need to be aware that mental health support is available and that they won’t be stigmatized for seeking it. To that end, Kamili works with nurses on the ground to understand the best approach in individual communities. Often, they engage religious leaders as they already have the community’s trust and are the first point of contact when a person is suffering from the symptoms of mental illness.
Kamili also runs awareness campaigns on specific days of the year, including World Mental Health Day and World Suicide Prevention Day. Alongside the training and awareness campaigns, Kamili offers a number of programs aimed at helping individuals recovering from mental illness reintegrate into their community. The Occupational Therapy program equips patients with livelihood skills they can use to generate income, such as beadwork and baking, while the Loaning and Savings Scheme gives patients access to financial support to help them grow their business.
“Many patients are at a severe level by the time they receive treatment for their illness and often they never finished school or don’t have a job,” explains Wachira. “When you help them learn new skills it gives them self-worth and they are able to move forward with confidence.”
From the program’s inception, Kamili has made a concerted effort to raise the profile of mental health as a profession across Kenya. The organization has met with chief health officers and other key stakeholders across the majority of Kenya’s 47 counties with the goal of formalizing the partnership between Kamili and the county governments. Currently, the sponsored psychiatric nurses are distributed in 44 out of the 47 counties.
“We are focused on proving the value of our model to both the national and county governments,” adds Jackson Amanya, Administrator, Kamili. “By integrating mental health clinics into the primary care system, we aim to bring affordable mental health services to every Kenyan citizen.”