Africa:New Report calls for Shift in Mental Health Training

By George Okore

NAIROBI---A new study has recommended that Kenya and other developing countries in Africa must explore alternative non-specialist training to achieve realistic mental health service delivery in the foreseeable future. 

The study by Africa Mental Health Foundation (AMHF) also found that distribution of psychiatrists in Africa is concentrated in their capital cities and other urban centres. The study recommends innovative approach to the problem by proposing that health care workers, faith and traditional healers be trained to provide effective mental health services, given limited availability and distribution of specialized mental health personnel in African countries.

For the general population living in the sub-Saharan region, psychiatric services are not accessible. Those suffering from mental health issues will often live their lives without a diagnosis or treatment. AMHF Project Principal Investigator Victoria Mutiso vouches for more accessible mental health services through innovative task-shifting

Professor David Ndetei, a psychiatrist and professor at University of Nairobi, has trained most of Kenyan psychiatrists. His efforts have helped to give Kenya the second highest psychiatrist to population ratio in the region after South Africa. Yet Prof Ndetei realized that mental health services were not accessible to most Kenyans, particularly the most vulnerable.

In 2004, Prof Ndetei founded AMHF to address this gap in services. Since then, AMHF has been active in mentoring mental health researchers in order to develop their capacity to carry out high quality research on issues of relevance to the region. With support of the Foundation, a number of students mentored by Prof Ndetei have completed doctoral programmes and research fellowships and conducted their studies in mental health. Dr. Victoria Mutiso is one example. Dr. Mutiso is now a co-principal investigator on a Global Health Research Initiative (GHRI) grant.

Since training sufficient psychiatrists was not feasible in the short term, the AMHF team began investigating innovative ways to make mental health services more accessible to the average Kenyan. In the absence of professionally trained mental health practitioners, Kenyans have sought out other options to alleviate psychological or physical symptoms of mental illness. Whether faith healers, traditional healers, community based health workers or health facility personnel, AMHF saw these actors as potential points of access to reach people suffering from mental illness, since they are already known and accepted by the community.

With the support of this GHRI grant, AMHF staff are investigating whether training these resource persons is an effective way to expand mental health services coverage to vulnerable populations across the country. The team is training members of these groups to perform basic psychiatric tasks, such as identifying symptoms, diagnosing conditions, and most importantly, referring patients to mental health services.

The team is carrying out research in rural and informal urban settlements to determine whether this is an appropriate strategy for mental health service delivery. If successful, this research could have an important impact on the health and quality of life of those suffering from mental illness in Kenya.

With some psychiatric tasks task shifted to community based health workers, faith healers, traditional healers, nurses and clinical officers (who are present throughout the country), the service coverage has the potential to increase significantly. The research will be of value not only to Kenya, but also to other low-income countries seeking to increase access to mental health services.

Dr Willis Akhwale- Kenyan Head of Diseases Prevention and Management Department welcomes the new proposal saying it complements the governments’ efforts at encouraging Public Private Partnerships (PPP) in healthcare delivery and management.