Mental Health For All; Greater Investment, Greater Access – For the Kenyan People

On the 10th of October every year, we celebrate the World Mental Health Day. The theme for 2020 is Mental Health for all, Greater Investment, Greater Access. The goal of this year’s World Mental Health Day campaign is increased investment in mental health owing to the pandemic that has caused great distress to many due to loss of jobs, scrupulous job terms as individuals work from home and drastic changes that have affected our daily lives.

A friend of mine needed some counselling services as she was going through deep distress. She calls me and after our usual chitchat, she asks me if I can point her to a counsellor who will help her deal with whatever she is experiencing. I told her I have a few contacts that I can send her way. She had a budget we always have a budget for everything. Her budget was Ksh 10,000. Calmly I asked,

“how many sessions do you expect to have?”

“Ten, ten sessions” she responds confidently

If you do your math correctly, ten sessions mean ksh 1000 per session. What my dearest friend did not know is that counselling is expensive. I had to inform her how it works. A counselling session costs anywhere from ksh 1500 to ksh 3000 for an individual, ksh 3000 – ksh 5000 for couples and ksh 10, 000 to ksh 30, 000 for a group. Group rates depend on the size of the group. In counselling, a group is 5+ people. Luckily, she convinced her counsellor to drop the rates. However, does not happen every day. Do not always expect it. It was just the counsellor’s grace that allowed it to happen.

Counselling is expensive, I am saying this as a trained counsellor. This is because seeing a counselor does not differ from going to see a doctor. This is true because for the counsellor to ‘treat’ a client a test, in counselling terms referred to as a clinical assessment, must be undertaken. Forget the false myths that counsellors know your problem just by looking at you, that they read your mind. Counselling is a process.

Counselling is expensive. I dare say because it is privatized. All private institutions are expensive. Walk into a private hospital for a regular checkup–just be sure you have insurance cover. You want your child to learn in a private school just to ensure you have a job that can cater for that.

Unfortunately, most counselling institutions in Kenya are privately owned. Even though the institutions are run in line with the ethics as stipulated by counselling bodies in the country the prices are not going lower.

Our government through the ministry of health needs to put in measures that will ensure mental healthcare is accessible to all no matter where you live. Forget the Taskforce. The Taskforce is largely composed of individuals who own private institutions thus would not put in measures to throw themselves off the market. The National Hospital Insurance Fund (NHIF) has just recently started the accreditation of Rehabs in the country. I love the terms and conditions for accreditation in which they state the facility must be an outpatient institution. Therefore, you can walk in and receive counselling without having to be admitted for 3-month duration that rehabilitation centres take in clients.

However, the NHIF only covers up to 20, 000 per month whether the admission is inpatient or outpatient. That means for a duration of 3 months the cost covered is 60, 000. The Rehabs I have interacted with charge ksh 50,000 to ksh 75,000 a month, they charge additional charges on the first month for detoxification and other medication.  This brings the total cost to anywhere between ksh 150, 000 and ksh 300, 000.

The government therefore has a role to play in ensuring that every citizen in the republic of Kenya can afford access to mental healthcare. This can be done by establishing facilities that would offer counselling in all the counties. Some counties will need are big enough to have up to 3 facilities. These facilities should be the size of a level 5 hospital such that there is a unit for persons in a critical state and can be used as inpatient facility for persons with mental illness, a rehabilitation centre, an outpatient facility among other wards.

The government can ensure that NHIF caters fully for the treatment in the facilities. This is because those who are diagnosed with schizophrenia, bipolar, depression among other illness spend a lot of years taking their medication and such medication is expensive. Medication used to treat mental illness is equal to and sometimes double the cost of malaria quin. I know people who spend up to 70, 000 on medication annually.

It would be even better if the government provided a subsidy for all medication used to treat mental illness, be it in public or private institutions. We can regulate institutions to ensure that medication is not above certain costs.

Countries spend on average only 2% of their health budgets on mental health. Despite some increases in recent years, international development assistance for mental health has never exceeded 1% of all development assistance for health. Our government should therefore be keen on allocating at least 35% of health budgets to mental health care, which will enable the establishment and growth of different government institutions that will help every Kenyan access to mental healthcare.

In conclusion, it is, therefore, necessary for the government to take concrete action to ensure mental health care is a health priority for the country and is accessible to every individual rich and poor. This will be an essential piece towards attaining the UN sustainable development goal number 3 Good health and wellbeing.

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