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2 Kenya
Pages 11-32

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From page 11...
... . Syengo Mutisya noted that in addition to common disorders such as depression and schizophrenia, Kenyans are at risk of other MNS disorders because of difficult conditions in the country: psychosis due to HIV infection, neurodevelopmental disorders and epilepsy due to poor mother–child health, posttraumatic stress disorder due to terrorism and political tensions, and anxiety due to high poverty rates.
From page 12...
... Kenya does not have a comprehensive national mental health law; the Kenya Mental Health Bill of 2014 has been introduced and is awaiting discussion in Parliament. However, David Kiima, director of Mental Health at the Ministry of Medical Services, noted that there are several relevant draft national policies, including the Kenya Health Policy 2014−2030, the Kenya Mental Health Policy 2014, and the Health Sector Strategic and Investment Plan, all of which include strategies to address mental health care.
From page 13...
... . Stigma toward people with mental illness exists on every level, from the community to health care workers; this stigma may deter health professionals from choosing to work in mental health, further diminishing the workforce (Marangu et al., 2014)
From page 14...
... ," and suggested that all health workers -- not just specialists -- should be involved in mental health care to reduce stigma. On a related note, many workshop participants recommended that in order to increase the number of people able to care for patients with MNS disorders, the mental health workforce must be expanded to include not just specialists but workers across the spectrum: from traditional and faith healers, to community health workers, to clinical nurses and primary providers.
From page 15...
... POTENTIAL DEMONSTRATION PROJECTS Experts in each of the four challenge areas -- lack of diagnosis and treatment, poor access to medicines, stigma, and inadequate mental health information systems -- presented information about how these issues hamper the care of MNS disorders. Workshop participants discussed the challenges and identified opportunities for improvement.
From page 16...
... Three priority conditions were chosen for the proposed project -- depression, ep ilepsy, and alcohol abuse -- because they result in a high burden of disease in Kenya; they are not being addressed through other major initiatives; there are existing evidence-based algorithms for diagnosis, treatment, and care (i.e., a Mental Health Gap Action Program) ; and there is an opportunity to develop community-based interventions using lay or non-specialist health care workers.
From page 17...
... can be prohibitive for patients. In addition to the public- and private-sector health care workers, people with MNS disorders also seek care from traditional healers.
From page 18...
... Expanding the mental health workforce Training primary care and community health workers in mental health: Throughout the workshop, many participants identified the shortage of mental health specialists in Kenya as a major barrier to diagnosis and treatment. Expanding the mental health workforce beyond traditional specialists (e.g., psychiatrists)
From page 19...
... Improving the use of guidelines and diagnostic tools Adapting existing diagnosis and treatment guidelines from other countries: Several participants observed that Kenya has a pressing need for consistent, evidence-based guidelines for the diagnosis and treatment of MNS disorders. Using the treatment guidelines for epilepsy as an example, Kioy discussed how to adapt existing guidelines from other countries for use in Kenya.
From page 20...
... The Drug and Alcohol Training Assessment in Kenya program provides free online training to health care workers about identifying and treating substance use disorders. AMHF has also developed a mobile app version of the mhGAP Intervention Guide depression module in order to train, supervise, support, and monitor non–mental health workers in the screening and management of depression.
From page 21...
... He said the absence of a national program to oversee treatment guidelines and to standardize treatment leads to an array of different treatment policies throughout the country, and there is a significant "lack of adherence to treatment guidelines and policies." Due to this lack of consistent treatment, individual counties have different procurement needs, so KEMSA loses the advantage of economy of scale. Munyu reported that health care workers, especially in local facilities, are not informed about the availability of new drugs or they resist adopting new drugs.
From page 22...
... She also observed that a robust health information system is essential for effective planning, managing, and monitoring of the drug supply chain. Many participants identified numerous goals and strategies for improving access to essential medicines.
From page 23...
... Improving the affordability of drugs Expanding the National Health Insurance Fund (NHIF) to provide coverage for outpatient care: Several participants noted that NHIF now only covers inpatient care, and they suggested trying to expand the program to include drug benefits for outpatient care.
From page 24...
... Stigma Stigma surrounding MNS disorders is a pervasive problem in Kenya; as Syengo Mutisya said, "Most Kenyans hesitate to seek psychiatric care because of the stigma." She said that "people are scared" to seek services from mental health facilities out of fear of being labeled and facing stigmatization in the community and the workplace. Graham Thornicroft, consultant psychiatrist and professor of community psychiatry at Kings College, London, mentioned that because of a type of stigma called internalized or self-stigma, people anticipate discrimination and thus avoid seeking help for MNS conditions because of expected embarrassment or reputational damage.
From page 25...
... A few participants identified two mechanisms for conveying these messages and reducing stigma among the groups: education and social contact with people with MNS disorders. Research shows that one successful way to reduce stigma is to have direct personal contact with people with the stigmatized condition, Thornicroft said.
From page 26...
... Such programs, they added, might help to reduce the stigma by changing future generations' perception associated with people diagnosed with an MNS disorder. Reducing stigma among health care workers Integrating mental health services into primary care: Many participants noted throughout the workshop that in order to reduce stigma for MNS disorders, services must be integrated into primary care to avoid the appearance of a separate system.
From page 27...
... Several participants said the health care curriculum should include adequate information about MNS disorders, including current information about the etiology and pathophysiology of disorders, because increased knowledge about the disorders might lessen stigma. Improving stigma reduction training: Several participants also proposed incorporating stigma reduction training into health care education, using the methods outlined by Thornicroft: using MNS-affected "champions" presenting a stylized script, an emphasis on recovery, and supplemental materials.
From page 28...
... The CHEW summary, which collects data on 66 indicators about the efforts and services offered at the household level, has only one MNSrelated indicator: "total number of known cases of mental illness referred." DHIS2 collects district-level information on eight mental health areas: • Mental disorders • Psychosis • Psychiatry attendance • Psychiatric ward • Epilepsy • Drug-induced psychosis • CHEW referred with mental illness • Delayed development milestones Wagacha suggested that a robust health information system would ideally contain four major components: EMRs, community-level information, district-level information, and patient tracking. He noted that the first three exist already in the Kenyan health information system, though they could be improved.
From page 29...
... Several participants identified two overarching ideas: first, that any effort to improve health information systems for mental health must be integrated into existing systems, and second, that the communities being asked to contribute to a data collection system must see and reap the benefits of such a system (see Box 2-2 for a comprehensive checklist for strengthening an MNIS)
From page 30...
... Collecting more MNS data Adding more MNS indicators to the community health worker data tool: Of the 66 indicators on which community health workers collect data, several participants said only one refers to mental health -- "total number
From page 31...
... .2 He encouraged mental health advocates to become involved in the ministry committees that make these decisions. Using data from existing sources: Several participants observed that health workers are not the only people in a community who have data about the mental health of community members.
From page 32...
... Aligning the health information system with diagnosis and treatment guidelines: Many participants stressed that any new health information system should align mental health indicators with existing training, diagnosis, and treatment guidelines.


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