A New Post Election Dawn: What does the future hold for mental health in Kenya?
Kenyans went to the polls on 9 August 2022. The result marked the end of the second and final term of the Jubilee Alliance party government under President Uhuru Kenyatta and Deputy President William Ruto, who is now President-elect.
My organisation, the Coalition Action for Preventative Mental Health Kenya (CAPMHK), among others have spent the past few years pressing the outgoing regime to address our country’s mental health issues. We’re pleased to report the government took bold steps in this direction, starting with President Kenyatta’s Madaraka Day speech of June 2019.
In his remarks, he acknowledged: “Depression has today become a common phenomenon and it affects persons from all walks of life and ages.”
The government followed up these words with some significant actions. The Ministry of Health launched a taskforce to report on the state of mental health in Kenya. It concluded the government needed to increase the country’s mental health budget from 0.01% of the total health budget to the globally recommended 2%.
Next, the Mental Health Amendment Bill gained presidential assent in 2020 after a four-year passage through parliament. The Bill proposes a holistic approach to mental health, which aims to improve the prevention and treatment of mental illness, reduce its impact and safeguard the rights of people with mental health conditions. It proposes that the government provide the resources needed to make such an approach possible.
At the same time, the first ever Presidential Advisor on Mental Health was created, with the renowned psychiatrist Dr Frank Njenga appointed to the post.
There were other notable and positive developments during the outgoing government’s tenure too.
- The Ministry of Health launched a report in June 2022 making the case for investing in mental health, which highlighted the huge potential return on investment in mental health care – in terms of productivity and social gains.
- Mathari Mental Health hospital became semi-autonomous, allowing it to receive direct funding from the exchequer for the first time.
- Last but not least, in July 2022, the Ministry of Health launched a suicide prevention strategy which comes hard on the heels of calls for the decriminalisation of suicide – a matter which has reached the Kenyan high court, with CAPMHK as an ‘amicus curie’, providing information and guidance on the case.
It is right to celebrate these great achievements – especially in such a short space of time and at the height of the Covid-19 pandemic.
But that does not mean some glaring shortcomings have gone unnoticed – and it’s time that these were addressed.
Firstly, as the Ministry of Health’s taskforce reported, the national and county-level budgets for mental health care are still very small and largely go towards medicine and salaries. The government is yet to decentralise services from hospitals towards community-based approaches, as recommended by the Ministry of Health taskforce’s mental health investment case.
Suffice to say, it was baffling to see the President launch the construction of a mental health facility in Kajiado County at the height of OHCHR’s call for deinstitutionalisation. It was even more inexplicable given that he knows full well that Kenya is a state party to the Convention on the Rights of Persons with Disabilities, Article 14 of which states: “States Parties should immediately stop new placements in institutions, by adopting a moratorium on new admissions and on the building of new institutions, wards, and refrain from repair or maintenance.”
Then we have the enactment of the Narcotics, Drugs and Psychotropic Substances (Control) Act 2020. This, we believe, has been a retrograde step in the efforts to rehabilitate and socially reintegrate people who use drugs – and it is interesting to note that it is a step the President initially rejected. The Act has made the proposed punishments for drug possession more punitive and ambiguous.
We will call on the incoming legislature to amend the Act so it focuses on treatment not punishment, and on alternative ways of curbing the supply and demand of illegal drugs, which do so much damage to people’s mental health.
PUSHING FOR CHANGE
CAPMHK advocates for increased investment in the prevention of mental health conditions and the promotion of good mental health. We are very much aware that, during its election campaign and manifesto launch, the incoming government made no specific pledges on investing in mental health.
Our first task after we were established in 2020 was to petition the National Treasurer to increase the budget allocation for mental health, and we’re determined to take the new government to task on this. The petition also called for the:
- creation of a mental health fund that civic organisations can access
- training of more than 50,000 community health workers and volunteers in basic psychosocial skills
- mandatory establishment of counselling and psychosocial units at primary and secondary schools
- integration of mental health into primary health care
- development of a trauma-informed justice and legal system as a means of social transformation
- deliberate and multisectoral adoption of mental wellness policies in all government ministries – from housing, sports and agriculture to the Ministry of the Interior
- harmonisation of the National Hospital Insurance Fund (NHIF) universal care package to comprehensively cover mental health at all levels and minimise out-of-pocket expense.
CAPMHK also runs an online initiative urging our members and the public to engage politicians and make them commit to improving young people’s mental health.
All this and more will be needed to transform mental health in Kenya.
WE HAVE A GREAT FOUNDATION… BUT THE QUEST IS STILL ON
In conclusion, the outgoing government laid a great foundation. We are ready for takeoff.
We are now in a position to move towards eliminating the stigma that surrounds mental illness, and to provide high-quality support to people with mental health conditions.
The incoming government has championed an inclusive narrative, especially for the country’s most marginalised and vulnerable people. The Mental Health Act 2020 heralds the creation of a National Mental Health Board – we hope it provides the leadership the issue so urgently needs. The entire mental health family is keen to see what the board has planned and the direction it will take during its three-year tenure.
Progress is being made, but the quest is still on and we shall not relent.
CAPMHK volunteers and staff (l-r) Frankline Mudibo, Guest, Nungari Waithaka , Nelly Gichobi, Daisy Khaindi, Claire Amollo, Jozy Rope, Mathew Mutiso, Rhoda Kithure, Soon Wendy, Guest, Tony Kisaka)
Executive Director and Founder, Coalition Action for Preventive Mental Health Kenya