On 20th October every year, Kenyans around the world commemorate the heroes of independence from colonial struggle. In a modern light, we also acknowledge the heroes of today and continue to pass the baton of light, hope and courage to the next generation. It is, therefore, suffice to say that paying homage to our history is important as living in the present and charting out a foreseeable future.

Mental health in Kenya, has a history too. It has the curves and delineation of struggles – those from past and future. Yet, in spite of all odds, there are some wins on the path to freedom. The first law regarding mental health was introduced during the colonial era under the British.

The English Mental Health Act 1959, recognized need for medical treatment of mental illness and emphasized provision of community services. While it may have been progressive for its time, it offered little protection of patients’ basic human rights. The right to confidentiality, autonomy, respect and many others breached. Eventually, it was replaced by Mental Health Act 1989, that attempted further decentralization of services. Allowed any hospital to be gazetted as a mental health hospital. Admission procedures were made easier and provision of voluntary treatment of people with mental illness made accessible. There was also an attempt to integrate mental health services. It failed to integrate the World Health Organization’s mix of counselling, psychotherapy, aftercare and rehabilitation services.

In 2013, the World Health Organization(WHO) unveiled its Global Mental Health Action Plan 2013-2020: its main aim to ensure effective leadership and governance of mental health services, and provide mental and social care services in community-based settings. WHO also aimed to implement strategies for promotion and prevention of mental health, and strengthen information systems and research in mental health.

Mental Health Bill 2014’s primary cause was to reduce inequalities in allocation of health resources and improve access to services, decentralization of services to local and county government to improve accessibility, establish a Mental Health Board, which would be charged with responsibility for regulating mental health services, including advising government, inspect facilities and investigate matters related to mental health services.

The Mathari Mental Hospital begun as an isolation center for chicken pox in the late 19th century and later changed to the Nairobi Lunatic Asylum in 1910 as the need for psychiatric care grew with the growing population of White settlers in Kenya and neighboring colonies. This century old colonial era facility represents the state of mental health care in Kenya from historical and contemporary viewpoints. The award winning CNN documentary on mental health in Kenya ‘Locked Up and Forgotten’ showed the neglect and abuse in Mathari Hospital. Following this documentary, the Kenya Human Right Commission (KHRC) audited the state of mental health in the country and found a flurry of disturbing factors.

Mental health conditions contribute significantly to the disease burden in Kenya and already vulnerable groups are more likely to have higher rates of mental disorders. Although there is no data on prevalence of mental disorders in Kenya, it has been estimated that up to 25% of out-patients and 40% of in-patients in health facilities will suffer from some form of mental health condition. The government of that time did not take sufficient steps to address the burden of mental health in Kenya. Most policies are outdated, and initiatives from the Ministry of Health failed to bear any visible fruit.

Furthermore, mental health services have been overly centralized, keeping to Level 6 health facilities such as Mathari and Kenyatta National Hospital. Only recently are we witnessing the sprouting of facilities like Chiromo Hospital and private clinics. However, on social awareness a lot of progress has been made; there are many community-led and based organizations and also research centers for mental health. Some of them are Mental 360, Shamiri Institute, Finding Me Community, Convocare KE among many others.

The mental health practitioner space is also seeing a boost – though the figure is still a long way from making mental health accessible for everyone. With such an eventful mind map of the past and present, we can see the gaps that need to be filled as we savor in those that have been filled. Mental health has a long walk to go in Kenya, and with constant accurate research and careful implementation, we may finally arrive at our foreseeable destination of freedom.

REFERENCES

**The photo on display is of a group of nurses at Mathari Psychiatric Hospital in 1957.**

Kenya’s Mental Health la ~ Ndetei et al, BJPsych Int.2017 Nov 1;14(4):96-97, doi: 10.1192/s2056474000002117

Silenced Minds: The Systemic Negkect of the Mental Health system in Kenya ~ Kenya National Commission on Human Rights, November 2011