According to WHO, one in eight people worldwide live with mental health issues. This year’s World Mental Health Day that will be marked on the 10th of October will draw focus on the need to prioritize mental wellbeing. In this blog Faith Munyao and Lynda Keeru reflect on our work in Kenya to improve mental health and psycho-social wellbeing.

All actors, governments, global health institutions, development partners, civil society, communities and individuals need to join efforts to prioritize a reduction of the factors known to present and increase people’s mental ill health. This year’s World Mental Health Day theme is, “Make mental Health and wellbeing for all a global priority.” The day offers an opportunity to reflect on the progress made and renew commitments on mental health efforts.

More often than not, mental health issues present themselves stealthily. People living in informal settlements face a range of mental health issues. Unfortunately, they have limited access to mental health services, information and few opportunities to shape decisions about their environment.

Mental health issues were identified as a priority in collaboration with co researchers both at Sub-County and community levels after an ARISE dissemination meeting. A root cause analyses using the fishbone technique for the sub county team and “5 Why’s” technique for the community culminated in the development of a change plan to address mental health issues in Korogocho, an informal settlement.

Quality improvement

Quality Improvement Teams (QIT) were formed at the Sub-County and community levels as an initiative to improve accountability from key stakeholders. Forty Community Health Volunteers (CHVs) from four units were trained on mental health; including the identification of people with mental ill-health and referrals for further care. In addition to this, there was sensitization for the health care providers at the link facility.

Challenges

Community dialogue meeting

There were gaps identified in referrals despite sensitizing the CHVs and the health care workers. One of the key challenges that came up was how to identify mental ill health at the community level. Mental illness has always been associated with the behaviour of ‘mad people’. Some of these characteristics include: being unkempt and dirty, collecting garbage, sleeping on the streets, talking to oneself among others. Many new referral cases did not seek help due to a fear of stigma and discrimination.

Another challenge that presented itself was a lack of a designated person to receive referrals for mental health issues. Most of the CHVs were not referring people due to a lack of sufficient skills to identify and refer clients. Some of the issues that people presented as mental health issues didn’t seem reason enough to refer them for treatment.

Within the community, there was a lack of realization about the severity of mental health issues which meant many people who were referred did not to seek medical attention. There’s also a lack of proper communication with the link facility and the designated person for mental health issues at the facility. Due to the low number of CHVs, they are usually unable to cover all the households in the community; which makes many go through life without realization of their mental health issues.  

Targeted interventions

A brainstorming session

Brainstorming sessions were useful for the community members to come up with activities that could be used to create awareness about mental health issues including; community outreach, action days at the community (involves people walking with posters within the community, perform role plays and road shows), mental health talks by CHVs in households, Chief barazas etc. The Community Health Assistant was also tasked by the Sub County to come up with awareness raising activities that were feasible and cost effective.

There was also awareness raising through Koch FM, a local radio station. Community members asked to be alerted in advance, in order to tune in during the show.

Outcomes

Quality improvement meetings helped people identify that most people were not familiar with mental health issues and how they manifested. However, despite mental health being a major issue few steps taken to tackle it and there was still a lot to be done and awareness raising was noted as a key step in implementation.

World Mental Health Day is an important day in the process, as it presents an opportunity to raise mental health awareness and to mobilize efforts in support. This is important in the realization of what more needs to be done to make mental health care a reality for people worldwide. This will be helpful at the community level, as it allows people to come up with effective approaches of identifying and referring people to mental health services.

Everyone has a role to play in increasing awareness about which preventive mental-health interventions work and World Mental Health Day is an opportunity to do that collectively. It is possible to have a world in which mental health is valued, promoted, and protected; where everyone has an equal opportunity to enjoy mental health and has an opportunity to exercise their human rights. It is possible to create a world where everyone can access the mental-health care they need.