OPINIONPeople Daily

Overhaul mental health services delivery system

Michael Njenga and Elizabeth Ombati

Earlier this year, a national newspaper published a story in which men who were said to have mental illnesses were chained and said to be recuperating in a church in Kisumu. It was not the first time this was reported of the same church.

In its latest report (2017) titled The right to Health: A case study of Kisumu County, the Kenya National Commission on Human Rights (KNCHR) highlighted that provision of mental health services in the county are yet to fully meet the four key elements of health including accessibility, availability, acceptability and quality.

Unfortunately this is the case in most counties in Kenya where mental health service delivery continues to face numerous challenges. As a result we see an increase in violation of human rights of persons with mental illnesses who end up being locked up either in their homes, in psychiatric institutions or even in places of worship.

The KNCHR report further noted that drugs given to patients had serious side effects including sedation or drowsiness and restlessness. A facility meant for 20 patients sometimes housed 50, and patients were forced to share beds.

There is need for us, as a society that upholds human rights of all people, to be concerned that despite the fact that the Constitution under the Bill of Rights guarantees every citizen equal rights to access the highest attainable standard of health, the practice on the ground in the area of mental health is wanting.

We continue to witness systematic neglect of persons with mental disabilities in accessing quality health care. This has not been made easy by a society where stigma and discrimination directed towards persons with mental disabilities is rife.

We appreciate that health has been devolved to the counties governments, thus opening up opportunities for enhancing health services through, among other initiatives, establishing community-based services that respect the dignity of persons with mental disabilities.

However, various researches, including the KNCHR report, show that comprehensive mental health services is still lacking. The report shows that five out of six people with mental illness do not access treatment. Recovery plans for persons with mental illness mainly focus on medical treatment and there are users of mental health services who are concerned by the absence of options.

Persons with mental illness “consent” to forced treatment as this is the only available alternative. The KNCHR report found that more staff were required at the facility including psychologists, psychotherapists among other professionals, not necessarily psychiatrists.

Another alternative to recovery for persons with mental illness includes peer support groups to provide support geared towards recovery. Peer support groups also offer support systems to persons with mental illness who often face stigma, human rights violations and social exclusion.

As a signatory to the Convention on the Rights of Persons with Disabilities (CRPD), the CRPD Committee made recommendations to Kenya on its status in the implementation of the Convention.

On health, the Committee recommended that the State “develops a wide range of community based services that respond to the needs of persons with disabilities, and respect the person’s autonomy, choices, dignity and privacy, including peer support and other alternatives to the medical model of mental health.”

As a country, we continue to rely on archaic laws that discriminate on the basis of disability and emphasise on an outdated medical model towards provision of mental health services. The Mental Health Act 1983 which permits non-consensual treatment and detention in hospital continues to be enforced.

As the current guiding legislation, the Mental Health Act 1983 fails to meet the standards set by the Convention on the Rights of Persons with Disabilities in relation to the right to health.

We urge the State to increase funding for mental health services and provision of alternatives to medical treatment. Such include community health services to provide among others counselling services for users and survivors and peer-led respite centres.

Kenya as a signatory to various human rights instruments is obligated to ensure that all persons realise all their human rights and fundamental freedoms. It is therefore critical that as a country we rethink how we deliver mental health care services that meet the key elements of health including accessibility, availability, acceptability and quality. — Njenga is the executive director Users and Survivors of Psychiatry in Kenya while Ombati is the programmes officer

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