Mental health awareness week falls annually in May. Lynda Keeru and Inviolata Njeri kick off ARISE conversations on mental health with this blog about our work in Kenya

Despite of the continual gains and advances in mental health awareness, research and treatment, there is still a lot to be done and covered. To this end, mental health week is an effort to promote a more efficient and proactive approach to addressing mental health issues and creating more visibility.

ARISE are aware that mental health influences people’s quality of life just as much as physical health. On account of this, it needs to be prioritized and this is best done through joint community efforts. Communities are essential for mental health management as they provide support, belonging and purpose among many other functionalities.

Inviolate Njeri, a senior research and learning officer at LVCT Health, reflected on her interaction with community members, “Working in Korogocho and Viwandani slums in Nairobi in the course of implementing the ARISE project, has opened my eyes to people’s daily experiences that one can only learn by interacting with people living and working in these areas.”

Mental health issues can remain concealed in vulnerable communities only to manifest themselves through alcohol use, violence, unsafe sexual practices and crime that include robbery with violence. Our work using the photovoice method identified mental ill health as a key community challenge.

Unsurprisingly, the vulnerable, who include, child headed households, older people and persons living with disability bear the greatest brunt of mental ill health. Both sub-County and community-level groups conducted root cause analyses using the fishbone technique and developed a change plan to address mental health in the informal settlements.

“Child headed households had the concern of how their peers viewed them, this led them to avoid some type of friends who would make them feel out of place. Older persons regretted their past and felt sorry for themselves having to take care of their adult children who were irresponsible or grandchildren; occasioned by death of their parents. Persons with disability felt stigmatized through exclusion from public and social facilities due to how they have been designed or equipped,“ shared Inviolata.

Communities have created Work Improvement Teams to act on mental ill health and, with support from the counties and sub counties, they have trained at least sixty Community Health Volunteers (CHVs) on mental health issues. This included how to record mental health data and how to conduct referrals for further care. On account of this, there are now referrals for mental health issues to primary health facilities in both informal settlements. In addition to this, as part of the change management plans, a Mental Health Clinical Officer was posted in Ruaraka sub-County to address mental health referrals.

“As I listened to the discussions among community members, I realized abject poverty was indeed the bedrock for most mental health problems faced by residents of Korogocho and Viwandani. This is manifested in high stress levels experienced by the people and families. The high stress experienced, over time results into depression and eventually, a hopeless attitude in life,” explained Inviolata.

One of the participants explained, “When a father or mother has nothing to offer the children looking up to them, the hopelessness often results in an uncontrolled anger, which then translates into violence and the break of families. Parents who resort to alcoholism and abandon their children, are the starting point of households headed by children. Child headed households are subjected to very heavy burdens of care despite their limited capacities. They shoulder care for their incapacitated parents and/or younger siblings which exposes them to high levels of stress and anxiety.”

Due to the poverty that faces many in these informal settlements like Korogocho, people spend long hours in search of their livelihood. Consequently, the communal spirit is eroded and people have not time to identify and spot the struggles of fellow community members.  This means that individuals carry their own problems the best way they know how; including adoption of unhealthy coping mechanisms.

“Now that there is a community health center and a community health unit with CHVs drawn from the area, there is need to vigorously continue the process of building their capacity. This is a critical pillar in addressing mental health challenges among the residents given that they are in touch with the people. The health facility within Korogocho ought to strengthen its capacity to handle referred mental health services by investing in the capacity of its health care providers and health infrastructure. Mental health awareness need to be brought to the fore through different for a such as local radios and theatre plays and groups,” said Inviolata as she signed off.  

Image credit: Photo by nantonov is licensed by iStock.