Written evidence submitted by BasicNeeds
EXECUTIVE SUMMARY
In response to the invitation to report on urbanisation
and poverty to the International Development Committee a report
is given of the project funded by the Department for International
Development's Civil Society Challenge Fund in the urban informal
settlement of Kangemi 2005-08. This project demonstrates DFID's
contribution to meeting the MDG7 target of improving the
lives of slum dwellers by providing access to health services,
specifically mental health services.
BasicNeeds a UK registered charity (1079599)
that developed a proven community mental health and development
model. As a result of the funding awarded by DFID CSCF a total
of 4,005 people of which 2,276 people with mental illness
or epilepsy and 1,729 carers benefited from the project with
a further 11,380 indirect family members in Kangemi's informal
settlements.
Training of community volunteers and primary
health carers enabled mental health services to be integrated
into the existing primary health care services making certain
the services continue in the future. The inclusion of community
mental health service provision in the Government of Kenya's National
Mental Health policy will support medication supply and access
to treatment within Kangemi informal settlements. The task now
is to monitor implementation of the policy in the future.
INTRODUCTION
1.1. According to the World Health Organisation
"Mental health now accounts for about 12.3% of the global
burden of diseases. It is projected that this will rise to 15%
by the year 2020, by which time depression will disable more people
than complications arising from AIDS, heart disease, traffic accidents
and wars combined. World Health Organisation (WHO) investigators
studied cross-national comparisons of the prevalence of mental
disorders and found a consistent pattern of higher prevalence
in urban areas rather than rural.
1.2. BasicNeeds, founded by Chris Underhill,
MBE, is a UK registered charity (1079599) which has been implementing
programmes since 2000 to enable people with mental illness
or epilepsy to live and work successfully in their communities.
BasicNeeds developed and implements a proven model of mental health
and development in the following countries: Uganda, Kenya, Tanzania,
Ghana, India, Sri Lanka, Laos and Colombia.
1.3. The BasicNeeds model is broken down
into five modules:
1.4. Capacity building: BasicNeeds
supports people with mental illness or epilepsy and their carers
to actively participate in consultation workshops and self-help
groups; institutional strengthening of community based partner
organisations on a range of aspects required for the sustainability
of the programme.
1.5. Community Mental Health: BasicNeeds
mobilises public sector health professionals to provide easily
accessible mental health services in the community.
1.6. Sustainable Livelihoods: BasicNeeds
supports individuals with mental disorders and their families
to get involved in productive activities such as returning to
their original work, being trained in new job skills or starting
a small business.
1.7. Research: BasicNeeds engages
in two forms of research i) Action Research in which people with
mental illness or epilepsy analyse their own experiences, which
are used for advocacy activities and ii) Policy Research which
creates an evidence-base about mental health.
1.8. Management and Administration:
BasicNeeds administers its programme with the active participation
of partner organisations, covering planning, implementation, monitoring
and evaluation.
1.9. BasicNeeds has implemented the model
in the rural and urban setting and it is our experience in the
latter which provides us with the factual information to contribute
to the International Development Committee's inquiry on Urbanisation
and Poverty.
1.10. The Department for International Development's
Civil Society Challenge Fund (CSCF) has supported BasicNeeds since
2003. Two projects awarded grants by CSCF focused on addressing
issues faced by people with mental illness or epilepsy in the
urban setting in Uganda and Kenya.
1.11. Drawing on our experience of providing
mental health services in Kangemi informal settlements, Nairobi
we will demonstrate how DFID CSCF is supporting the reduction
in urban poverty and facilitating the provision of mental health
services.
FACTUAL INFORMATION
2. Kenya: Mental Health Situation
2.1. All healthcare services, including
mental health care in Kenya are coordinated by the Ministry of
Health (MOH) and are offered at national, provincial and district
levels. The healthcare has a referral system where patients from
the lowest level at the community visit the dispensaries and health
centres. People with mental illness or epilepsy requiring secondary
health care services or cannot be managed at the community health
centres are referred to the district and provincial levels where
specialised care and facilities exist. Referral to specialised
hospitals is another option if necessary.
2.2. As indicated although a referral system
exists in policy it faces numerous obstacles including: lack of
adequate medication, equipment and shortage of medical personnel.
The high poverty level in the country results in huge demands
for all health care services including mental health services.
2.3. The current National Health Sector
Strategic Plan (2005-10) envisages collaboration and partnership
through the Sector Wide Approach (SWAP). This will entail collaboration
of many partners ranging from the Ministry of Health, Government
of Kenya and other local and international organisations to donors,
non governmental organisations and most importantly people with
mental illness or epilepsy their carers and families and the general
community in which they live.
2.4. The draft national mental health policy
also recognizes the need for collaboration between public as well
as private sector. This would involve training, research and service
delivery in mental health. In Kenya, non governmental organisations
(NGOs) and faith based organisations (FBOs) have been the crucial
players in the provision of mental health services, particularly
because the Government of Kenya (GOK) budget allocations for mental
health have traditionally been inadequate.
2.5. BasicNeeds as a member of the review
team charged with finalising the National Mental Health policy
is ensuring lessons learnt in implementing the pilot urban programme
funded by DFID CSCF are incorporated into the final policy.
2.6. The final National Mental Health policy
outlines the practical ways of ensuring mentally ill people access
treatment in their local community and recognises sustainable
livelihoods is an integral element to sustained recovery especially
in the slum environment.
2.7. Though some efforts have been made
in providing a conducive, user friendly environment for mentally
ill people, the mental health situation in Kenya has been negatively
influenced by a number of factors ranging from the high poverty
levels, large influx of refugees, reliance on archaic systems,
lack of facilities, poor stakeholder coordination, funding issues
and the stigma associated with mental illness. On funding for
instance, the proportion of the entire public health budget to
Gross Domestic Product (GDP) is 7.8%, from which only 0.01% is
set aside for mental health (WHO Atlas 2005). In Kenya, mental
health constitutes not only a real public health concern but is
also a socioeconomic and development problem.
3. Slum Conditions and the link to Mental
Health
3.1. Kenya's slums are growing at an unprecedented
rate as more and more people migrate from the rural area to cities
and towns in search of employment. Kenya's urban population is
at present 40% of the total population.
3.2. The multiculturalism of slums contributes
to heighten social tensions and coupled together with different
cultural opinions and beliefs these issues all play a part in
exacerbating mental health problems.
4. BasicNeeds Experience
4.1. In 2005 the CSCF awarded BasicNeeds
a grant to adapt and implement the mental health and development
model in Kangemi's informal settlements in Nairobi. The majority
of people in Kangemi are migrants from rural Kenya who have arrived
in search of employment and business opportunities. A total of
4,005 people benefited from the project among them 2,276 people
with mental illness and epilepsy and 1,729 carers.
4.2. As indicated above all health services
are coordinated by the Ministry of Health and offered at national,
provincial and local levels. BasicNeeds facilitated the mainstreaming
of mental health into the existing primary care services in Kangemi's
informal settlements through training primary health workers.
As a direct result of this training a German operated urban refugee
programme has initiated the integration of mental health in their
clinics. A further four health centres within and around the city
of Nairobi have expanded the quantity and quality of services
to people with mental illness or epilepsy. This has ensured the
sustainability of the services beyond the three year funded project.
4.3. Due to the Government of Kenya's ignorance
of the magnitude of the mental health problems in Kenya there
is poor planning of medication procurement. From 2007 onwards
the recording and reporting of mental illness has been integrated
into the district tally sheets. This is an important development
which will directly improve planning of medication procurement
based on demand.
4.4. Selection and training of appropriate
local partners ensured people with mental illness or epilepsy
continue to access family support services, alcohol rehabilitation
and specialist care for children with epilepsy.
4.5. People with mental illness or epilepsy
and their carers were involved from the beginning of the project
and consulted about their needs and how they could be addressed.
For many this was the first time they had been consulted and encouraged
to voice their opinion. BasicNeeds approach to participatory research
further empowered individuals to participate and understand issues
about security, local environment, stigma discrimination and community
acceptance.
4.6. Training and education changed attitudes
at the health facilities and in the community at large providing
a better environment for recovery and social reintegration.
4.7. Alcohol abuse is a problem in Kangemi
informal settlements however the improvement rate for individuals
who joined the detoxification and treatment programme was found
to be above average. As a result 21 individuals joined group
therapy activities and formed and registered their own social
economic group.
4.8. The provision of mental health services
at the local health facility contributed immediately to the reduction
of poverty by significantly reducing family outgoings. Previously
access to treatment meant incurring expenditure and valuable time
to travel to referral hospitals. If travelling to the hospital
was not possible the only alternative was to consult expensive
and often ineffective faith and traditional healers.
4.9. In order to allow alternative sources
of support to be available in the Kangemi Informal Settlements
a sensitisation programme was implemented to education traditional
healers about mental health. A marked increase in the number of
referrals to the outreach clinics from traditional healers was
witnessed in the last year.
4.10. Drawing on proven development tools
people with mental illness or epilepsy and their carers formed
self-help groups. Eight groups, each with 35 members, were
registered and successfully work together on several income generating
projects. One group successfully received a grant from the Department
of Social Services to expand their catering project. Although
it is recognised that not all economic needs are met important
linkages with government Extension Services are established. A
work culture rather than a hand out culture now prevails and will
in the long term reduce the poverty of the group members.
4.11. Returning to formal employment is
a challenge but through various activities targeted to raise awareness
among employers seven people with mental illness secured jobs.
4.12. The formation of self help groups
is not just about reducing poverty its about lobbying and advocating
for the rights of people with mental illness and epilepsy. BasicNeeds
has supported the registration of the Users and Survivors of Psychiatry—Kenya
(USP-Ke)which is affiliated to the Pan African Users and Survivors
of Psychiatry Network with who BasicNeeds as a a strategic partnership.
USP-Ke plays an important role in linking self help groups to
local and national forums and providing resources to enable advocacy
activities to take place to influence policy makers and raise
awareness of mental health issues.
4.13. Stabilised mentally ill people in
Kangemi's informal settlements have become ambassadors of community
mental health using their own experience to highlight the advantages
of attending the clinic and encouraging others to attend and in
some cases accompanying new patients on their first visit.
4.14. All the information given above has
occurred because DFID CSCF awarded BasicNeeds a grant to pilot
a community mental health programme in Kangemi's informal settlement.
5. Conclusion
5.1 In order to continue making progress
towards achieving MDG7, the issues of provision of mental health
care services as well as sustainable livelihoods for people with
mental illness or epilepsy should feature in future plans of the
Department for International Development.
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