Enhancing Integration of Community Mental Health Services in Kenya (EICMHS-K)

Across Kenya, there’s a terrible secret, hidden from the world. People who barely exist, they live in darkened rooms; if you call it living…they’re Locked Up and Forgotten. With nowhere left to turn and in inhumane ways in which Kenya’s mentally ill are treated and the degrading conditions in which they are housed. A country where stigma and discrimination against the mentally ill or disabled is deeply entrenched, these families result to chaining their ill and hiding them away from the eyes of a society that would rather pretend they don’t exist. In Kenya, there is huge inequity in the distribution of skilled human resources for mental health. Shortages of psychiatrists, psychiatric nurses, psychologists, and social workers are among the main barriers to providing treatment and care in the country. Additionally, there are inequities in the distribution of these already low numbers of mental health workers, whereby the available professionals are concentrated in Nairobi and teaching hospitals while rural areas are left with very few professionals. Our proposed project seeks to facilitate integration of community mental health services into the existing primary health care by strengthening community health strategy model in the provision of mental health services in unserved rural and low-resource urban areas in Nakuru County, Kenya by equipping 15 Community Health Volunteers (CHVs), 10 schoolteachers, 5 mental health family care support groups, 7 traditional and 3 religious leaders and with knowledge regarding mental health aiming at tackling stigmatizing attitudes and harmful practices.
At the onset, the project will undertake operational research seeking to determine the psychosocial problems of mental illness on the families, the number of health care professionals serving psychiatry departments in Nakuru County and the challenges the health care professionals undergo in supporting mental health patients. The study will seek to find out coping strategies utilized by the family members caring for a person with mental illness, investigate community attitudes and views concerning caring for a person with mental illness, coping strategies by caregivers and find out the experiences of caregivers while dealing with the mentally ill. Information will be obtained from County health Management Teams (CHMT), health care professionals on challenges at psychiatry departments and individual families living with mentally ill persons regarding the problems and coping strategies utilized. A qualitative study will be conducted, involving focus group discussions and in-depth interviews in Nakuru County. This study report will inform policy and programme changes for the groups working on mental health in target areas. Information generated will also be beneficial to the community since they will have knowledge on how to relate with the mentally ill and their families.
SIXKNM will work with a consultant psychiatrist expert in development of standardized training packages, for training CHVs, schoolteachers, traditional and religious leaders who will provide support to families and communities living with mental health patients and assist them maintain mental health patients in their homes. Trained CHVs will visit 3000 families in unserved rural and urban areas of Nakuru County living with mental ill patients, detect relapse and refer patients to the next level of health care system. The CHVs will be complemented with specialist psychiatric backstopping consultations during their monthly community health dialogue days. Mental health family care support groups, traditional and religious leaders will be sensitized aiming at advancing advocacy for mental health and mainstreaming mental health in their activities. Journalists will be sensitized aiming at increasing reporting on mental health. The project will therefore be increasing communities’ knowledge on mental health, reduce stigma and discrimination and increase uptake of mental health services in Kenya.

That with the use of CHVs supported by psychiatry care will enable care management, supervision, support, and referral, proposed interventions can work in synergy with the health system, especially where health system does not have capacity (or is unable) to reach populations. Our research study will build evidence base on integration and scaling up of care for mental disorders in routine health care platform and advance advocacy for mental health from an evidence-based platform. Our use of traditional leaders, schoolteachers, families caring for mental ill patients, family care support groups and the media will amplify voices for mental health and reduce associated stigma and discrimination. Formation and facilitation of support groups for families caring for mental health patients will ensure continued all round support of this project objective. The project activities will lead to community-level shifts in attitudes and social norms which will create a more supportive environment that enables individual to support mental health and mental health patients reducing associated stigma. Community involvement initiatives will create a sense of ownership necessary to sustain behavior change beyond the life of this project.

Proposed project overall objective contributes to community mental health services integration into the existing primary health care by strengthening community health strategy model in the provision of mental health services in unserved rural and low-resource urban areas in Nakuru County, Kenya. The project will therefore increase communities’ knowledge on mental health, reduce stigma and discrimination and increase uptake of mental health services which benefits majority of the 10000 potential, mentally ill or disabled currently living in darkened room, locked up, forgotten, and struggling to access mental health services in Nakuru County, Kenya.

Specific project results include: -
i. 15 Community Health Volunteers (CHVs), 10 schoolteachers, 5 mental health family care support groups, 7 traditional and 3 religious leaders equipped with knowledge regarding mental health aiming at tackling stigmatizing attitudes and harmful practices.
ii. One baseline research study established to determine the psychosocial problems of mental illness on the families, facilities present, challenges & experiences on mental health issues, community attitudes & views, coping strategies by caregivers, etc.
iii. Standardized mental health training packages developed for training CHVs, schoolteachers, traditional and religious leaders who will provide support to families and communities living with mental health patients and assist them maintain mental health patients in their homes.
iv. 3000 families in unserved rural and urban areas of Nakuru County living with mental ill patients visited to detect relapse and refer patients to the next level of health care system.
v. Twelve psychiatric backstopping consultations with mental health specialist conducted.
vi. Reduced treatment gap for mental health means amongst the population leading to healthy, productive lives; a significant step towards overcoming social inequalities in Nakuru County.
vii. Local community, traditional leaders, family care groups, community health service providers in unserved rural and urban areas of Nakuru County, Kenya mobilized and engaged in mental health advocacy.

The project goal is to improve the quality of life of mental health patients in unserved rural and urban areas of Nakuru County, Kenya. The project objectives are to reduce stigma and discrimination on mental health patients and families, to increase demand for mental health services and to increase knowledge on mental health. We will realise our project objectives by undertaking a research study, conducting entry meetings, training CHVs and facilitating them to go for household visits, sensitize family care support groups, media and traditional leaders aiming at advancing advocacy for mental health and mainstreaming mental health activities and conduct stakeholders’ meetings and media shows. SIXKNM will therefore seek to track increase in the number of mental health patients supported in the health facilities, number of support groups formed for families caring for a mental health patient, media reports on mental health and policy and programme reviews to measure outcomes of this project. We will also seek to track increase in knowledge and information informed by number of reports in the media and people seeking services. At output level, the project will track the number of families caring for a mental health patient visited, number of CHMT members reached, number of County leadership officials reached, number of CHVs trained, number of journalists, traditional and religious leaders sensitised, number of stakeholders reached, action plan developed for continued engagement, number of referral cases reported, number of mental health patients adhering to treatment, number, types of policies reviewed or developed will be used to track progress.