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 - 2008. 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 (2005-2010) 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.