THE LONG WINDING ROAD: SUICIDE PREVENTION IN KENYA

Empty path by 12019 from pixabay

When I started my advocacy work in mental health some years ago, I didn’t quite anticipate the magnitude of distress calls and messages that come with the role. Naturally, I would direct these individuals in crisis to the professionals they needed, as best I could. Nonetheless, it felt like fumbling in the dark, even with the information I had; which was a lot more than most people do. I would then get on and hope they got the help they needed and the crisis had been averted. Over the years spanning the pandemic and after, the messages got a lot fewer. Perhaps there has been a global silence on many things as we try to reconfigure.

A few months ago, however, I was surprised to receive a distress message in the wee hours of the morning. As always, it was a friend reaching out on behalf of a friend of a friend…of a friend, to figure out what could be done or where to go. Someone somewhere, in a quiet neighborhood where cars are parked on the walkway, had spent the better part of their night watching their close friend languish. Whether overtly emotionally distressed, they speak openly about injuring themselves or just won’t stop drinking. At some point, intuition kicks in, often a lot later than it should have and you can see the signs. You need to ‘call for help’. Isn’t that what they always say to do?

That’s how I would imagine that message got to me at dawn. As I processed that message, I tried to give a couple of options on the next best steps to take. What was evident about all these possible solutions was that none seemed to be straightforward. There are many instances I could be called and I would have a straightforward answer. If a pregnant woman had sudden regular contractions, a child was choking, intractable left-sided chest pain, robbery, a gas leak, or an electrical short circuit; heck EACC could be at your front door and I would probably have a few direct solutions to offer. While I have the answers to all these, the grim fact remains that despite years of active advocacy in mental health, I do not have one straightforward answer for individuals going through crisis!

By Khonkorn

Concerted action has brought widespread awareness to mental health and with it, improved care and the protection of human rights. In the realm of healthcare, the mind, while part of the human body ecosystem, is still treated like a second cousin. We continue to think about mental health and physical health in exclusivity. Consequently, the solutions, health systems, and policies we create reflect this schism. Mental health services are far from being wholly integrated into primary healthcare even as we hold discussions on Universal Health Coverage. The WHO definition of UHC is that all people have access to the full range of the quality health services they need, when and where they need them, without financial hardship. The current reality is that when someone reaches out, I have to have certain caveats in mind. Where do they live? What is their socioeconomic status? If I direct them to their closest health facility, do services exist? Do they have the appropriate healthcare personnel? Are the existing personnel adequately trained in this area? Are there referral channels and are they foolproof?

In 2021, Kenya launched its suicide-prevention strategy. This outlined the approach, roadmap, targets, and deadlines that were going to guide the steps taken towards prevention between 2021 and 2026. There were four main basic objectives: establish suicide prevention programs with appropriate supportive laws and policies, avail quality, integrated and comprehensive healthcare, and increase public awareness of suicide and prevention. These seemed like a good enough place to start for what seems like a mammoth of a problem. As we draw to a close this year, however, most targets are yet to be met. In fact, 3 years on and halfway through the projected span of the strategy, there seems to be no tangible difference.

We have made some irrefutable gains in mental health in the last 5 years. In November 2019, a mental health task force was formed that reported its findings and recommendations in 2020. A mental health action plan and suicide prevention strategy were created in 2021. Consequently, the Mental Health Act, sponsored by Senator Sylvia Kasanga, was signed into law in 2022. Most recently, a guideline for mental wellness in the workplace was launched. We have made a lot of plans and a lot of structures for the plans, great. On the flip side, Section 226 of the penal code is yet to be repealed. The current (reduced) healthcare budget 2023/2024, does not reflect all the ambitious plans and commitments that the national government needs to allocate resources to. The 2023 postulated targets for suicide prevention remain documented as good intentions.

Wooden chair by Schmidt on pexels

As the year comes to a close, and as a reflection of the unmet 2021–2023 targets for suicide-prevention and intervention, many individuals (youth especially) across the country will experience life-threatening crises. You and countless others will receive (or make) distress calls at odd hours in the hopes of saving a life by ‘calling for help’. You will not be sure who to call, there isn’t an operational prevention helpline set up. You will be unsure of where to go, crisis interventions are yet to be integrated into primary healthcare, healthcare workers remain untrained in this crucial area, and management protocols are non-existent. In the event that you’re lucky to receive emergent basic support that is responsive to your needs, you will pay out of pocket to travel across counties. You finally get to a facility with mental health service providers through poor referral pathways, it is overburdened and underfunded because only 15 counties out of 47 have facilities. The only other alternative is private mental health services that are equally inaccessible. An expensive route, possibly far from the support of family and friends at home.

Next year, we will celebrate yet another Suicide-prevention Day, yet another World Mental Health Day; there will be events, awareness walks, talks…all of it. However, does the current plan by the government for Universal Health Coverage cover mental health and crisis management integration into primary healthcare? Does it support appropriate training of healthcare personnel to offer mental healthcare? Will financing and budgetary allocations match this commitment by the government? Until then, Kenyans will unfortunately not be receiving the full range and standard of quality of health owed to them. They will be receiving something the Gen Z infamously call, vibes.

Conversations on harm to self continue to be uncomfortable discussions. They are not the kind we have over Sunday lunch; not over the breakfast table either, because who wants to listen to that in the morning? This is not the kind of topic you bring up on a friendly WhatsApp group chat, won’t it make everyone uncomfortable? No, this is the kind of talk you have when it’s dark outside and you must, because nothing is promised when the sun comes up. That’s why we’re here. Hiding from the responsibility, still. It seems easier to hide this scourge and the people we have lost than it is to shift in our seats in discomfort and do the work that must be done.

By the time this article was published, only one county out of forty-seven had any publicly available information regarding setting up a suicide prevention strategy for their county.