Title : Accessibility, availability, and acceptability of mental health services in rural Kenya: A literature review
In 1953, Africans were presented as “the happy savage” with an ‘idle’ frontal lobe protected from psychic conflict that arise from the untamed environment, which made them less susceptible to mental illness. This historical neglect and false depiction of Africans and the need for mental health services have had a ripple effect into the 21st century, such that most of the health care resources and health care providers in many African countries, including Kenya, have focused their efforts in reducing the burden of communicable diseases. Consequently, a non-communicable disease such as mental illness, has taken on a different and new urgency. Evidence suggests that despite the increasingly high prevalence of mental health disorders among Kenyans residing in the rural areas, there remains an extraordinary gap between help seeking behaviors, treatment and availability of mental health services. This literature review seeks to examine the interrelationship of, accessibility, availability and acceptability of mental health services in rural Kenya and its impact in reducing the burden of mental illness. A literature review search of published articles in CINAHL, MEDLINE and PsychInfo database from 2000-2022, was conducted. Additional references were obtained from bibliographies of these articles. Data was analyzed and categorized into broad topics. The healthcare system posed a significant barrier to accessibility of mental health services through the long waiting time, lack of psychiatric medication, and perceived poor healthcare attitudes towards patients. The preference for a traditional healer and the use of complementary medication influenced the lack of urgency to seek professional help. An intense stigmatization of affected individuals and the view of mental illness as an evil spirit or generational curses inhibited the acceptability of mentalhealth challenges and utilization of mental health services. Understanding these factors may provide concrete evidence of the gap created several decades ago in terms of allocation of resources, inform implementation strategy for destigmatizing mental health challenges and develop intervention programs that promote mental health awareness.
Audience Take Away Notes:
- This literature review has shed light to the importance of taking a step back to a history of a nation, to reflect and critically examine the myths of the past, and explore past ideas and truths that were either accepted or rejected. The history of the Kenyan people depicted them as less susceptible to mental illness, a false narrative that influenced the allocation of health resources. Understanding history can be an essential instrument that informs our approach to critical issues, appreciating the choices and circumstances that brought us to the present situation.
- There is a wide recognition that mental health is an essential component to one’s overall health and wellbeing. Given the potency of globalization and the reality of global interconnectedness – the urgency of global mental health is paramount – thus the need to evaluate the current mentalhealth challenges of people in rural Kenya. Within the literature reviewed, several authors haveoffered suggestions towards an educative collaboration between the traditional healers and healthcare providers to postulate initiatives that will increase mental health awareness. Other researchers propose a need to have an intervention program that will assist in increasing mental health awareness and enhance care to individuals with mental challenges thus bridging the treatment gap. Future studies should purpose to include interventions that include the traditional leaders and the healthcare professionals as key persons of the study. In addition, longitudinal studies are needed to assess the continued accessibility, availability and acceptability of mental health services. The results of these studies may influence and inform policy changes and increase mental healthcare resource allocation.