Nairobi, Kenya - Workers in Kenya’s health sector describe it as a "wake-up call" for a country that they say is failing to treat its citizens who suffer from mental illness.
Patients rioted over conditions in the nation’s biggest secure mental unit, Mathari Hospital, on May 12. They overpowered guards, broke free and fled through the slums of north Nairobi. On Friday, police were still seeking 16 of the 40 escapees.
According to the World Health Organisation (WHO), conditions in Kenya’s psychiatric units are not unique. The body warns of a “global human rights emergency” for the estimated 450 million suffers of mental illness, three-quarters of whom live in poor countries.
Mentally ill people in the developing world can often only get treatment from "witch doctors", rather than trained physicians, and they often suffer from stigma and abuse, the WHO says. Some are manacled in public. Others are padlocked behind steel doors in overcrowded wards.
Those breaking out of Nairobi’s mental clinic said they had received poor treatment, police told Al Jazeera. A senior clinician appeared on local television and bemoaned cash shortages at the “old, dilapidated buildings” he manages.
“The place is overcrowded and the patients inside are unhappy and sedated,” said Joyce Kingori, a manager for Britain’s mental health charity BasicNeeds, who visits the clinic regularly. “Not even our prisons look like that.”
The breakout is not Mathari’s first scandal. In 2011, a television crew filmed an inmate locked inside a cell with a corpse. It prompted a probe by the Kenya National Commission on Human Rights that declared services “woefully under-resourced”.
A recent study from Kenya’s Independent Medico Legal-Unit showed that 39 percent of Kenyan mental health patients suffered abuse while in hospital. Victims described assaults by staff and other inmates, sex-attacks, canings and forced labour.
Also, 58 percent of those surveyed said they were mistreated even before admission to hospital. This often involved being caned by schoolteachers as punishment for bad behaviour or because they failed at maths and reading.
Sitawa Wafula, 28, attests to the misery of mentally ill Kenyans. She started experiencing “full-blown seizures” while at boarding school in Nairobi and felt the isolation and shame that is common among sufferers.
Classmates who witnessed violent fits, in which Wafula repeatedly slapped herself, shunned the 17-year-old. Although her family sent her to trained physicians, others blamed the hysterics on demons and supernatural forces.
“The first thing anybody tells you is that it’s a curse from God, an act of witchcraft or that you’ve wronged someone and need to make it right,” she said. “Friends of my parents suggested a witch doctor. Few people have information about mental illness, blaming witchcraft is the easy way out.”
More than a decade after diagnosis for bipolar manic depression and powerful drug treatments, Wafula is an outgoing blogger on mental health issues who also makes jewellery, writes poetry and runs an events business.
Dr Shekhar Saxena, head of WHO’s mental health unit, laments funding shortfalls, particularly in poor countries. While mental sickness account for 14 percent of health problems, it receives less than 1 percent of poor countries’ health budgets.
'Matter of shame'
Almost half the world’s population lives in countries where there is only one psychiatrist for every 200,000 people. Between 76-85 per cent of mental health sufferers in developing economies have no access to treatment.
“It’s really a matter of shame that in the year 2013, the vast majority of people in developing countries, and a large number of people in developed countries, do not receive the treatment that would improve their condition,” said Saxena.
Chris Underhill, the founder of BasicNeeds, which helps sufferers of depression, epilepsy, schizophrenia and other maladies in impoverished slums and rural backwaters, said aid funding is equally scarce from international health donors.
“The lack of mental health care in developing countries is one of the 21st Century’s great scandals,” he said. “Communicable diseases like HIV/Aids and malaria attract huge sums of money; but, when it comes to mental health problems that also affect many millions of people, you would think there would be more funds available.”
The lack of mental health care in developing countries is one of the 21st Century’s great scandals.
The economic cost of people staying out of the workplace through depression and other debilitating mental conditions is rising, studies show. A World Economic Forum report from 2011 calculated a $16.1 trillion drain on the global economy over two decades.
A recent study from the University of New South Wales, in Australia, found that such conditions as depression, anxiety and Alzheimer’s are on the rise, and that mental illnesses combined are the most significant (23 per cent) cause of disability globally.
Despite a misconception that depression blights wealthy nations, Saxena said rates of mental sickness are higher in the developing world. Violence, disease and unemployment in Nairobi’s slums exacts a toll on the minds of ghetto-dwellers, added Kingori.
“Depression is caused by a set of well-known stresses,” said Underhill. “I can think of nothing more worrying than facing hunger, losing your child in an earthquake or living a traumatic life as a woman in a feudal society.”
Underhill’s charity runs drop-in clinics for the mentally ill in poor areas, improving access to treatment and training family members and neighbours basic skills for dealing with depression, anxiety and other afflictions.
A weekly clinic in Nairobi’s Kangemi slum has diagnosed more than 8,000 patients since 2006. Services expanded and currently assist 21,000 mentally ill Kenyans through 40,000 volunteer carers. The annual cost per patient is only $45.
Vikram Patel, co-director of the global mental health unit of the London School of Hygiene and Tropical Medicine, says “task-shifting” mental illness care to semi-trained relatives and neighbours in poor areas has a big impact.
He points to gains in rural Pakistan and India, and a project by Paul Bolton, from Johns Hopkins Center for Global Health, where Ugandan villagers counselled depression-afflicted townsfolk. Some 90 per cent of sufferers recovered, compared to 40 per cent in comparison villages, Patel said.
The WHO’s mental illness chief, Saxena, agrees that “treatments that don’t cost much have a large amount of benefit”. But some clinicians in poor countries say that grass-roots training is no panacea for a growing health menace.
“It helps to break down the stigma, isolation and the exclusion felt by sufferers,” said Fiona Herbert, a consultant at the Nairobi Child Protection Team. “But without funding for medication, poor patients won’t be able to afford their drugs. Without professional follow-ups and home visits, sufferers will relapse.”