Thursday, May 10, 2012

The 3rd Mental Health Stakeholder’s Legislation Review meeting – Part 1 (Gov’t Point of view)



Good afternoon beautiful souls, get your legal and human rights caps on as you read this post.

On Tuesday 8th May 2011 so us at Ol leria on Jumuia Place along Lenana Rd. The room was set with yellow table clothes and orange seat and I am so sure the never ending discussions were sparked by those colors. This gathering was a collective meeting of all the stakeholders in mental health from users, carers, medical staff, lecturers, Gov’t rep, NGOs that deal with a face of mental health. Just mention a few of those in attendance and stood out; Article 19, Schizophrenia Foundation of Kenya, Users and Survivors of Psychiatry, Psycharists; Dr. Njuguna who was representing the Director of mental health, the PS and the Minister and the ‘famous’ Dr. Owiti, Samwel Tororei - Acting KNHCR Chair, Nairobi Hosp MH Chair, Mathari Hosp, Aga Khan Hosp University rep, Maendeleo ya Wanawake, Nyeri and Laikipia Rep, Rep of Public Health and Sanitation among many others.


We began this review process in July, 2011 and our aim is to have proper legislation in matters Mental Health a sector guided by outdated Act, Cap 248. We sort to review and amend the Act, but saw many areas need to be review and the work to be done would be equivalent  patching an old wine skin with new, we all know how that story ends. Armed with the Act and borrowing from the South African, Australian, Ghanaian and Tanzanian mental health bills and other international policies like the UNCRPD on Disability that Kenya is a signatory to, we began the process. We meet in twos, a reference group and stakeholders. The stakeholders meet every five months and the reference group which is a smaller group,meets after the stakeholders meeting to input what was discussed and pass the reviewed legislation to the stakeholders to digest and send their input.

Dr. Njuguna, Psychiarist under the Division of Mental Health
i)                    Inefficiency of the current Act, Cap 248
Although the gov’t rep, Dr. Njuguna kept holding firm and referring to the Act, he confirmed that there were gaps especially in the property, substance abuse and rights angles. In my previous posts, I had talked aboutproperty administration citing the Kirima case. A new angle to this debate emerged on Tuesday; what if the ill person get really better and they need to go back to work or need to in charge of their property yet the family or appointed custodian turns greedy or due to stigma the employer does not allow them back to work, what happens? I have never thought about the return to work part. I got fired for falling on a client and that marked the end of employment for me. Offices give me the creeps, they actually close my mind. For five months, ie Nov – Jan, then Mar – April, I tried reporting to two different office spaces and it just didn’t really work. The first one was fun because it was in a mall but the second, I always felt cold, I was always fidgeting and googling on how to make my work environment warmer until I got sick and was back to bed office spaces aka my bedroom and things are good save for many other temptations homepreneurs can attest to but waking up at 4 and working to midday then relaxing with the occasional email peep is proving to work just fine. Back to the legislation, what happens to those who cannot work from home since that is not their nature? Those who will not make good farmers or good beadwork or craft makers since that is what we assume all self-help groups should focus on?
The other citation was on rights. From the CNN feature to Huruma case cited the last time to many other unreported cases that we witness or hear of in our communities are some of the reasons the Bill leans heavily on Human Rights, mental health issues are definitely human rights issues. The legislation we are currently working on is a human rights hand book. I am very excited about the report done by the KNCHR under the leadership of Florence Jaoko, launched last year and the continued involvement of the commission as this meeting was graced by Samwel Tororei the Acting Chair. A point that was heavily discussed under rights is the confinement and restraint of persons with mental illness. What are the best places to confine or restraint a PMI, who turns violent because there are such cases. Most medics use jabs, I have to admit the first two years of my illness, jabs and hospitalization were my way of life. But nowadays I fall, come back to and life goes on. The restraint and confinement need to go hand in hand with rehabilitation, the more society and medics treat PMIs with an animalistic touch, the more violent they become. I used to have four people hold me down just to be jabbed, now no one holds me. I tell people just make sure I do not hit my head.

ii)                  Devolution of counties
He also confirmed that Mathari is a National Institution meant to train, research and for major referral cases meaning all other issues need to be dealt with at the primary level ie the nearby dispensary, clinic especially with the devolution as cited in the constitution. This will mean the Ministry of Health will be responsible of Policy, Guidelines and Human Resource and the counties provide the services.
For years on end, there has been an ongoing debate of whether Mathari should be rebranded to remove the stigma attached to it or should the whole mental health sector be rebranded or people’s perception on mental health rebranded? I go with the latter; people need to rebrand their perceptions. For some time I was for the idea to have Mathari rebranded to the proposed New Muthaiga/Upper Muthaiga hospital but if society still perceives mental illnesses as they still do, we call it Obama’s best hospital but that is all it will be a name. It is unfortunate that the gov’t uses the same speech on World Mental Health Day in Oct that the name will be changed to elevate status but I think more should be done with regards to awareness creation. That people should know their local hospitals should have a mental health unit where according to Article 43, they are meant to receive the highest attainable health standard.
Dr. Njuguna brought an amazing debate on the table, should there be a mental health hospital or should there be mental health services offered in every hospital? My take, Mathari is a general hospital that offers all other services but it’s specialty is mental health, the same way Mbagathi Hospital is TB and I think Moi Referral in Eldoret and Kenyatta Hospital have specialties. Once PMI receive ‘special’ care or units, they increase the stigma, let them go to the same reception with other patients, it is not like the illness is contagious and this integration is part of the rebranding.

iii)                Health Bill
Dr. Njuguna informed us of the Health Bill that is in the making and has Part 12 dedicated to mental health. I will go through it with my tooth comb and share my views later. A few points he raised that I liked;
-          Health Insurance – I think save for AAR, none of the other insurance scheme take care of mental illnesses. Personally I am anti-health insurance given the last time I was admitted despite the form I filled clearly stating that I have my illnesses and it was checked and I was accepted into the premium paying club, the insurance company refused to pay saying I have a pre-something illness(someone in insurance help). But why did they allow me in the scheme in the first place? Well and the ongoing NHIF fiasco is another blow not forgetting some online blow I got from Peter Nduati of Resolution Health. I await to read the Health Bill before I comment further.
-          Funding & Infrastructure – Who doesn’t talk about funding? Well we receive around 1% of the health budget. This affects the number of public sector practitioners, affect the cost of medication, affect the advocacy level; that’s why the local Dr. Phil (private practice) charges you Ksh 5,000 to sit on his couch for one hour as he doodles on his note pad. The percentage on the Health Bill is 5 %, I am so waiting for the budget this June.
-          Commission involvement – This was my happy hour. They have it in the Health Bill that every commission formed in this country should have a mental health ‘expert’ which I totally agree. Let us look at PEV, we have the ICC out to prosecute and do all these things to the Ocampo 6 or 4 but what about the people living in tents, who have been there for the last four years and have a gov’t that is not helping much, have we ever sat down and thought of the psychological torture they go through? Until it happens that is when people will say, we should have done something. As much as there is psychical justice and resettlement, there should be mental justice and resettlement. Who is looking into that? I am a rape survivor and from the mental torture I had, I can tell you for free, the mental resettlement is what makes me who I am. It was a personal discussion coupled by ignorance at the time that made me take the case forth, what if all that mother in a tent in Naivasha needs is someone who cares enough to check on her, make sure her mentals are well and well enough for her to pull herself out of the hole she did not ask to be in the first place as the physical justice and resettlement happens? One of my best local mental health activists, Rahab of the Joint Epilepsy always says Nothing for us, without us. How can we represent IDPs when we go back to our big cars and bigger houses to eat even bigger meals? They need to be there, but how can they be there when they are not in the best mind frame?
Still on the health bill Rahab pointed out that epilepsy though not a mental illness, receives the same stigma and pros & cons as any other mental illness so Bill should read MNS – Mental Neurological and Substance Abuse Disorders. This was another happy hour for me given my recent post on theinterrelation between mental illnesses, substance abuse and HIV/AIDS

I think I have preached enough for one post…read the next one for part 2 come up shortly where Acting Chair, KNCHR, Samwel Tororei speaks statistics and ILA which is the legal component of this process…remember to catch me this Saturday from 9a on Ghetto Radio, 89.5 FM discussing the legislation, you can stream live http://tunein.com/radio/Ghetto-Radio-895-s77900/. Bipolar support group meeting from 10am, this Saturday at IMAC, 5th Floor Tumaini House behind Kencom. I will be there immediately after my radio talk.

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