Making mental health services accessible for rural Kenyans

May 01, 2013
Esmé Lanktree with contributions from Gyde Shepherd
For people living in sub-Saharan Africa, psychiatric services are not always accessible. Those with mental health issues often live their lives without a diagnosis or treatment.

New research from the Africa Mental Health Foundation (AMHF), funded by the Global Health Research Initiative, a partnership between IDRC, the Canadian International Development Agency, and the Canadian Institutes of Health Research, could help many to access care through healers and health workers already active in their communities.

Professor David Ndetei, AMHF’s founder and a psychiatrist at the University of Nairobi, has trained most of the psychiatrists currently working in Kenya. His efforts have helped Kenya achieve the second highest psychiatrist-to-population ratio in the region, after South Africa. Yet Ndetei realized that mental health services were not accessible to most Kenyans, particularly the most vulnerable. In 2004 he founded AMHF to address this gap in services. Since then, AMHF has been mentoring mental health researchers to carry out high-quality research on issues of relevance to the region, complete doctoral programs and research fellowships, and conduct their own studies in mental health. Dr Victoria Mutiso, who was mentored by Ndetei, is now a co-principal investigator on this GHRI-funded project.

New ways to access mental health care

Training a sufficient number of psychiatrists to treat all those in need is not feasible in the short term, so the AMHF team began investigating new ways to make mental health services more accessible to the average Kenyan.

In the absence of professionally trained mental health practitioners, Kenyans have sought out other options to alleviate the psychological or physical symptoms of mental illness. Whether faith healers, traditional healers, community-based health workers, or health facility personnel, AMHF saw these actors as potential points of access to reach those suffering from mental illness, since they are already known and accepted by the community.

With this GHRI grant, AMHF staff are investigating whether training these local people is an effective way to expand mental health care to vulnerable populations across the country. Staff are training them to conduct basic tasks, such as identifying symptoms, diagnosing conditions, and most importantly, referring patients to mental health services.

The team is carrying out the research in a rural area and in an informal urban settlement to determine whether this strategy for mental health service delivery works in these contexts. Intervention and con­trol groups at each site will allow the team to compare results.

Access could increase significantly
If successful, this research could have an important impact on the health and quality of life of those suffering from mental illness in Kenya. With some psychiatric tasks shifted to community-based health workers, faith healers, traditional healers, expert patients, nurses, and clinical officers who are present throughout the country, the service coverage has the potential to increase significantly.

These principles are applicable not only to Kenya, but also in other low-income countries seeking to increase access to mental health services.

This article was written by GHRI Program Management Officer, Esmé Lanktree, with files from Gyde Shepherd and Marie-Danielle Smith.

 
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Photo (right): IDRC/ E. Lanktree
Victoria Mutiso, Project Principal Investigator, Africa Mental Health Foundation