German-Kenyan collaboration to encourage brain awareness in Kisumu
“Afya ya akili” means “mental health” in Swahili. The approach to mental health in Kenya is very different from the understanding in Europe and Northern America. German non-profit organisation (NGO) On The Move e.V. and Kenyan youth organisation TINADA have implemented projects to fight the stigmatisation of mental illnesses in Kisumu County, Kenya. I am Marie-Louis, a final-year joint-PhD student at King’s College London and TU Dresden in Germany. Driven by my interest in mental health in Africa, I decided to get involved in a brain awareness project with On The Move e.V. and TINADA in Kenya. In this article, I would like to share my volunteering experience. In addition, I had the chance to interview two representatives of both organisations and have included key citations in my article.
Mental health challenges in Kenya
Undoubtedly, mental health is a topic that requires broader attention globally and particularly in Africa. Statistically, African countries invest less than 1% of their health care budgets into mental health, which is significantly below the recommended minimum of 5% for low-income countries and more than ten times less than Europe and Northern America. There are approximately 1.4 mental health workers per 100,000 people in Africa, which is sixfold below the European and Northern American average.
In Kenya and other countries in Eastern Africa, perceptions of mental health are shaped by a mix of traditional beliefs, stigma, and limited access to mental health services. Local communities typically view mental health issues through a cultural lens, attributing them to spiritual or supernatural causes such as curses, witchcraft, or demonic possession. This leads to individuals with mental illnesses being stigmatised and sometimes ostracised. The shortage of resources and persisting traditional beliefs affect rural areas of Kenya, in particular.
“In Kenya, living with a psychiatric disorder like psychosis or schizophrenia is often perceived as a form of 'madness'. In consequence, people living with mental health conditions face social isolation from their families and communities. They often don’t have access to specialised psychiatric care,” says Dr. Rick Wolthusen, MD, MPP, staff psychiatrist and physician-scientist at the McLean Hospital, a Harvard Medical School affiliated teaching hospital, and co-founder and co-director of On The Move e.V. He has contributed to the documentary “Obuongo Edhano – Embracing Mental Health in Western Kenya” (2018), which is publicly accessible and provides a deeper insight into the mental health landscape in Kenya.
Opportunities: how is mental health being promoted in Kenya?
After outlining the mental health challenges in Kenya, it is crucial to highlight the significant opportunities within Kenyan communities to promote mental well-being too. “Challenges can be viewed as opportunities—it's all a matter of perspective”, as Dr. Wolthusen puts it.
“There are different approaches to overcome the mental health treatment gap. Psychoeducation and destigmatization are key. One way to reduce mental health stigma is to increase people’s understanding of the brain and what it does when it is healthy. We call it brain awareness. After offering brain awareness sessions, community members start to deduct what happens when the brain is sick and how altered brain structures and functions can contribute to psychiatric disorders. The brain can get sick, just as any other organ,” continues Dr. Wolthusen.
Furthermore, there have been recent governmental efforts to tackle the shortage of infrastructures and trained professionals in psychiatry in Kenya. Since primary health care constitutes an essential part of the medical system in Kenya, local and international public health campaigns are currently initiating community mental health projects, for instance by training community workers and offering counselling at schools and colleges. “Local community members in Kenya come up with innovative ideas and promising solutions to their mental health challenges. Industrialised nations tend to overlook what they can learn for their own communities from countries like Kenya. Unfortunately, many community stakeholders in Kenya continue to operate in isolation and lack supportive networks”, comments Dr. Wolthusen. His NGO, On The Move e.V., teaches skills such as advocacy and research, supports opportunities for mutual capacity building, and aims to provide an empowering and sustainable environment for improving mental health in Kenya and other African countries but also in Germany and the United States.
Personal volunteering experience
Coming from the field of psychiatric brain imaging research, I have been interested in brain awareness from a global public health perspective for years. In September and October 2022, I finally had the opportunity to join a mental health project with On The Move e.V. and TINADA under Dr. Wolthusen’s supervision in the city of Kisumu and surrounding rural communities, which turned out to be an exceptionally enriching experience.
As a team of German and Kenyan volunteers from medical and psychological backgrounds, we attended official meetings and demonstrations to raise awareness about mental health, aiming to break down stigma. Additionally, we visited schools, engaging with students on mental health projects focused on prevention and early intervention. One of the most impactful experiences was visiting a prison and the psychiatric ward of a local hospital, where we spent time with Kenyan people struggling with their mental health, offering support and connection through conversation and activities. We also developed a handbook for community health workers, covering normal and altered brain functions, mental health myths, signs and symptoms of psychiatric disorders, and preventive measures. Moreover, our team created screening tools for identifying mental health risks such as suicidality and managing specialist referrals. Their practical application was tested through interactive role plays with mental health workers in multi-disciplinary meetings.
Born and raised in Germany, I was impressed by the outreach and “power” that primary health care has in Kenyan communities. I genuinely hope that mental health initiatives in Kenya will soon yield positive results on an even larger scale. The open-mindedness and motivation, with which the young Kenyan people I met approached mental health topics, was simply contagious. “After you left Kisumu in 2022, we have started several new projects at TINADA. For example, our current work focuses on support for teen single mothers, gender-based violence prevention, and mental health promotion for young people with disabilities, non-communicable chronic diseases, and sexually transmitted diseases like AIDS. In addition, we have developed peer-to-peer cognitive-behavioural therapy approaches to improve mental health in students with special needs”, states Whitney Ndemo, psychologist at TINADA.
Interested in further information and/or getting active?
If this article has attracted your interest in mental health in Kenya, please feel welcome to consult the websites of both NGOs On The Move e.V. and TINADA for current projects, further resources, and contact details. Concluding in Swahili with "Ninapenda afya ya akili" aka “I love mental health”, I am certain I will re-visit Kisumu in the future and get involved in another mental health project.