The Other Side of “Kenya’s Terrible Secret”

Last Saturday, CNN broadcast a special feature, “Locked Up and Forgotten,” looking at the situation of people with mental disabilities in Kenya. Previews for the show spoke of “Kenya’s terrible secret” and showed disturbing images of people in dire living conditions.

While it’s great that finally the international media is paying some attention to people with mental disabilities, it is a shame that coverage is almost always sensationalistic and further dehumanizes people who are already relegated to the fringes of society.

The stigmatization of people with mental disabilities runs very deep, and it is very difficult for them to shed it. Sensationalist media coverage does everybody a disservice because it reinforces the message that disabled people are hopeless, pathetic burdens to society and that if only they received more charitable assistance, perhaps society could take a breath and forget about them—again—at least until the next scandalous story breaks.

A few years ago in Croatia, a number of people with intellectual disabilities living in an institution died of food poisoning. The media published scandalous stories about the deaths. Though the deaths were never investigated, and no criminal charges were ever brought, the government’s knee jerk reaction to making the scandal disappear was to pour money into renovating the institution’s kitchen. This move set back the progress that had been made to reform the social welfare system and move people out of institutions. Instead of investing in the real solution—community-based housing and social support services—the government chose to continue segregating people with intellectual disabilities in a large institution, but this time with a fancy kitchen and a new paint job.

Similarly, the CNN program devoted significant coverage to Mathari Hospital, Kenya’s only psychiatric facility. CNN filmed people drugged into oblivion, shuffling about the place with nothing to do and no way out. One could not help but notice the absolutely appalling physical conditions and the overwhelming, oppressive atmosphere of hopelessness. An interview with the Minister of Medical Services revealed that “there is no money” to improve the hospital. The message was clear: let’s pour as much cash as possible into renovating and equipping Mathari so that it isn’t so hideously scary looking and sweep the real solution under the carpet.

Investing in Mathari (except in things that are urgently required to prevent injury or loss of life) is the worst possible thing that could happen for people with mental disabilities in Kenya. There is a great advantage in developing community-based services in Kenya: there are no institutions other than Mathari, so there is no system to dismantle. Investment in bricks and mortar to perpetuate the segregation of people in Mathari would be an enormous mistake and a very poor investment. Pouring money into Mathari can, of course, make it more comfortable. But it can never make in into a place of freedom and participation.

Only a fraction of the people in Kenya in need of support services end up in Mathari, thankfully. But most of the rest are isolated at home without the support they need. Given that there is vibrant civil society engagement in the mental health field in Kenya, it is disappointing that CNN’s program focused on touring with one NGO representative, going from village to village, peering into the dark rooms where disabled people spend their lives, then moving onto the next to do the same. Why just the misery and not the real solutions? Would the story be less scintillating if viewers know that there are real solutions? Would it force viewers to think about their own prejudices about people with disabilities? Would it be too boring to find out that there are real solutions being implemented right now in Kenya, and these solutions are actually cost-effective?

A number of organizations are providing support to families in Kenya so that people with mental disabilities can live with dignity in the communities to which they have always belonged—as equal citizens—not “locked up and forgotten.” There are NGOs supporting self advocacy and mental health service user groups to grow into strong advocacy movements, and one organization has obtained access to education and other services for people with autism. There are NGOs helping vulnerable communities to help themselves with poverty alleviation programs.

The real solutions are already happening in Kenya. But the work is far from over. There is an urgent need for real political will to invest in these efforts so that support and services are available to all people who need them. It’s that simple. But we cannot be distracted by the horror stories or be led to believe that renovating buildings and buying equipment are the solutions. The media can play a critical role in helping societies reform the way we see people with mental  disabilities. I hope that they take up this challenge.

10 Comments

Great blog Judy. i like the idea of exploring solutions rather than focussing on the misery in a most sensational manner.

Great post. Very insightful. Would love to hear more on what a community level solution would look like to implement.

Pity i didn't watch the programme. I would like to make the following points.
1. Mathari hospital is the only PUBLIC mental health hospital but in every government provincial hospital, there are mental health wards.
2. There are at least 2 fully equpped private medical facilities in Mairobi for medical health and several private clinics mainly for drug rehabilitation
3. I believe the problem in Kenya is lack of trained personnel, exorbitant costs in the private clinics and lack of public awareness.
4. I do not think there are more than 70 psychiatrists in Kenya which has a population of nearly 40 million.
5, I am not a medic but i feel strongly that some psychological cases are treated as psychiatric cases which is a sad affair.
I am one very frustrated Kenyan about the regulation of psychologists and lack of psychiatrists.

I concur with you about the fact that the authors just choose to depict a one sided story- the negative side. What parents want is information, education and adequate, sensitive affordable accessible and inclusive support services to effectively continue with their caring. The authors should have clearly differentiated mental illness ( medical condition) from intellectual disability( developmental). Most of the persons with intellectual disability are living with their families.It is true that persons with intellectual disability are more prone to mental health problems, however the general population is also prone to the same and constitute the majority. Mental illness is treatable however intellectual disability is a life long condition and the person needs support and services to lead a normal life in the community. The continued portrayal of parents as violators of human rights and persons with disability is a disservice and this approach to winning public sympathy should be discarded.
I agree with the Minister for Health services Prof Anyang Nyongo and Dr. Njenga that the problem is that as country we have not built the institutional capacity to bring about the requisite change. The later was explicit that the only way to bring this much desired change is through social action by the people themselves and not proxies. We need to empower persons with intellectual disability and their families so that they can take charge of their lives and say no to this state of affairs.
Stephen Kaboi Burugu

Judy,

I am glad you are raising this. The broader issue though is the way international media especially Western media treat issues about Africa, always focusing on the negative side. This is very sad!

Judy,
The notion that Africa can't 'get right' even after succesfully hosting the World should be discontinued forthwith, balanced report of issues by media organisations, especially from the West, will go a long way in helping solve most of the problems confronting the continent

Trying to understand Kenyan customs and traditions,I perused Thomas Hodgkin's 'Nationalism in Colonial Africa' Libr.of Congr.Card No.57-8133 and George Delf's 'Joko Kenyatta' Libr.of Congr.Card no.61-10348 regarding 'occultism and superstitions. The Kikuyus in Kenya and the Nubians in northern Sudan adapted themselves rapidly to town life and town jobs. There were cases of Believers who withdrew to caves and holes on ground for meditation,experiencing possession and shaking (watu wa Mngu)trembling the sign of Holy Ghost (Roho Motheru)entering in them.For the Kikuyus,Bantus and MasaisWhite Magic (Mundo Mugu)(=visionary,doctor,general advisor,magician).There were no prisons or 'lunatic asylums' in Kikuyuland; many mentally unstable Kikuyu seemed to have fallen within the sphere of the Black Magician (Murogi)-black magic used superstition to poison and to kill - its practioners were greatly feared and when caught often burned to death after an elaborate trial and ceremony. Tribal custom was female circumcisionn-the Victorian Brits were too prim to want to know and when missionaries interfered their schools closed- that was the original start of the Mau Mau movement.(1924)Joko Kenyatta resided in Great Britain and married an English governess in 1943- their son Peter- Kenyatta left for Kenya in 1946,imprisoned in 1952- killing oaths first in 1954.60-65 yrs later there might still be token superstitions in rural areas and certain customs.....The Colony of Gheel (Belgium)since the 13th century The Gheel Shrine- its work in modern times,over 2,000 certified mental patients live in private homes,work with inhabitants and suffer few restrictions other than not using alcohol. Schizophrenia,affective disorder,antisocial personality patients remain in Gheel until they are considered recovered by the supervising therapist. This great humanitarian work of this colony and the opportunity Gheel affords to study the treatment of mental patients in a family and community setting,it is unfortunate that this has received so little recognition.Since depression is part of the same, I learned that WHO (World Health Org)is talking about Depression -the Silent Epidemic.Psychiatrist Lena Baklund (Chief Dr.with affective illnesses in Huddinge sjukhus (hospital)is partaking in it and if my memory serves me correct,Huddinge is part of Roslagstulls sukhus affiliated with Karolinska Institutet and Karolinska sjukhuset in Stockholm.Sweden,for contact Malin Nordgren (malin.nordgren@dn.se)

I think its important to stress that Mental illness is a psycho-social disability because it affects a person occassionally not always - its temporary or on/off depending on person to person and case to case - its important to note that mental illnesses are "invisible" Non Communicable Diseases that are only detectable by changes in thoughts (rationale or cognition), emotions (feelings) and behavioral factors

The problem is that for some reason globally we have chosen to separate the concept of Mental Health from Physical/physiological health yet a healthy person possesses a healthy mind and a healthy body as an inseparable package - the solution to this problem not just in Kenya is to integrate mental health into primary health care - each hospital should have a mental health ward - takes the pressure off mathari.

The other solution is for the government(s) to provide incentives for medical students to pursue further studies in psychiatry and psychology to cater for the shortfall in trained staff. In line with that - Community Health Workers, Social workers also have to be brought in to the care of the population to bridge the treatment gap currently existing so that the basic illnesses are resolved and the complex ones are referred or escalated for management

Further to that is to get all medical staff (ER, Casualty, surgeons, cardiologists, neurologist etc)by rota to take Psychiatric medicine refresher courses occasionally or seminars so that they can provide "first aid" as points of contact to patients who require basic to complex cases - its very common for comorbidity to occur - i.e. occurence of a physical illness while suffering from a mental illness. There are some mental illnesses that present as physical illnesses - psychosomatic - this will ensure that we have the psychiatrist doing their jobs with the support of the other medical staff to provide health care.

For all that to happen it will require that the civil society groups build capacity among the population and lobby for legislative and policy reforms that will safeguard the rights and well-being of its citizens - to intergrate Mental Health and Physical Health - there must be a policy framework that governs the relationship of human rights with regard to the Law, Employment, Housing, treatment options etc - the policy will cater for how Law Enforcement deals with person's with mental illness, Judiciary in the execution of the law on property management, broken laws etc, Prison system for those affected - an intersectoral and multidiscipline approach that cuts through the whole system to cater and strive for healthy minds and prevention of the same especially in the screening of mothers who might have mental health issues or under treatment with no knowledge of how the pregnancy might be affected - National Essential Drug list of basic and essential psychotropics should be guaranteed by policy - or lobbied for by civil society under the policy and legislation

Kenya spends 0.01% of its total budget on Mental Health of all Kenyans - we have about 77 Psychiatrists in Kenya. 1 in 5 adults globally will be affected by a mental illness in their lifetime - thats 20%. 40% of those who go to seek medical attention (physiological) suffer from some form of mental illness as well.

Psychotropics/antidepressants by law (Mental Health Act) specify that government hospitals in provinces to have the medicines (usually the shortage is so bad that almost everyone goes to Public Mental Health Care goes to Mathari. Please note that with the current situation very few people go to the district hospitals for care as the medicines are not always stocked and majority of Kenyans access health care at clinic and dispensary levels where no basic antidepressants are available as such

Mathari may not be the best run hospital but they do the best they can with what they have.

In Nyahururu Kenya, we have adopted the L'Arche model of responding to the cry of people with interllectual disabilities.We live together as family and involve each other in virtually everything with the people with interllectual disabilities. L'Ache is an international federation which aims at giving voice to these people in society and for 47 yrs has been existent in the developed countries.We are just two years old but we are seeing good results and i can say that probably hospitals will not do much as what is required for their livelihood is both medical as well as personal social aspects which can enable these people to live their life normally as other human beings. It is not a question of hospitals but of humanity. Our challenge in kenya is lack of trained and available psychologists. The psychiatrists available are so few. To have a view of what we do and how we involve Pwds log onto www.larchekenya.org

can we approach our problem from an inclusion basis where solutions can be worked at from a community based aspect.

if we can all agree that this is the possible way forward, then Mathare will be streamlined to only serve those that need attention away from home.
What we need are ideas from us in this field and possible implementation initiatives

Add your voice