By Hope Katana

In my six years of being a mental health clinician in Kilifi County, I feel that the past two years have been my most fulfilling years as a Psychiatric Nurse. For this, I am thankful for the Inclusive Communities project.

For a long time, there had been a general lack of awareness amongst the community about mental health, poor prognosis amongst clients due to lack of follow up, higher number of defaulters due to lack of finances to buy medication, and some essential drugs were not stocked at the pharmacy.

However, thanks to the commitment by the county’s leadership team to streamline mental health service provision, and the timely introduction of the Inclusive Communities project in Kilifi County, in collaboration with Basic Needs Basic Rights Kenya and CBM Global, we have seen tremendous change.  

Immediate positive outcomes from the inclusive communities’ project

With the inclusive Communities project came a lot of mental health outreach activities in the community. The immediate result was increase in number of clients seeking mental health services, positive attitude towards mental health services, better prognosis in clients with mental health conditions and supportive family members who now got to understand that mental health conditions were illnesses just like any other, and not the result of long held misconceptions such as curses, witchcraft, or sorcery. 

As a solution to the stockouts of psychotropic medication, the inclusive communities project has also supported the county by supplementing medication, and this has ensured that we have the necessary drugs at all times to meet the ever-increasing demand for services. 

Taking services to the doorsteps of those most in need

One other thing I find amazing about the Inclusive Communities project is how it speaks to the needs of the community. One of the biggest challenges we have that hamper access to services is the poor socioeconomic state of a significant portion of the community. This means that they don’t have adequate resources to cover the requisite monthly visits to the health facility to enable us to monitor their progress. This program therefore mitigates this by having a component of home-based care. 

Our team is therefore able to make house calls where we prioritize defaulters i.e. clients who were on treatment but due to unknown reasons decided to stop taking medication or visiting the clinic, patients with poor outcomes despite being on treatment, and individuals with suspected mental illness who have been neglected in the community. The common mental health conditions we encounter in Kaloleni Sub County include schizophrenia, depression and substance use disorder.

It is noteworthy that we don’t just treat mental illnesses during these home visits, we also address other ailments that these clients may be having. In the event an ailment needs specialized attention, we are also able to make referrals. 

Memorable stories of recovery

One of my clients, Brian (not his real name), a form 2 student with a diagnosis of schizophrenia had been discontinued from his schooling for about a year due to his illness. In spite of being on treatment, he kept having relapses in between meds and at some point, his parents were chased from the community following accusations of bewitching their son. Brian’s parents had lost hope in treatment and at one point they stopped medicating their child. Currently, however, following our intervention, Brian has shown great improvement and has been able to resume his schooling.

Another client, Diana (not her real name) a young lady in her late twenties, was first brought to the clinic after long standing symptoms of mental illness. When she was brought to us, she was delusional, holding a strong belief that she had to get her nursery school certificate in order for her to join a teaching career. She was put on medication though had a few relapses along the way. However, with close follow up and monitoring, Diana, who we diagnosed as having schizophrenia, has greatly improved and currently works as a shop attendant.

Our hope for the future

We fully appreciate what the Inclusive Communities project has done in Kaloleni sub county, but I would be remiss if I didn’t mention that we need more. We have just scratched the surface as far as access to service is concerned. Kaloleni is a vast sub county, and there’s still a large population that we haven’t reached.

We are currently lobbying our leadership to integrate mental health care into routine primary health care, and as we continue to do this, we need to continue having community outreach activities to create awareness, address stigma and improve health seeking behavior. This means that other health care workers across all our facilities as well as the community health promoters attached to these facilities need to undergo mental health training.   

We are hopeful that the Inclusive Communities project will continue to support the scale up of this initiative.