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Diversity in Solutions: One-size-fits-all is inadequate
  • April 8, 2024
  • Comments: 5308
  • Posted by: cbtkeadmin
By Lambert Oigara, Consultant Clinical Psychologist

The unintended consequence of deinstitutionalizing mental health facilities, commonly known as asylums, was a rise in homelessness. The misconception that chronic mental illnesses like Bipolar Disorder and Schizophrenia were curable led to a complex interplay between individuals with mental illness who self-medicated with alcohol and drugs, perpetuating a cycle of arrest, incarceration, and homelessness.

While the decision to close mental health hospitals in favor of community health centres was initially well-received and marketed, it ultimately faltered due to insufficient funding and political support. The groundbreaking legislation by J.F. Kennedy in 1963 brought hope to millions of people with mental illnesses; the ambitious goal of establishing 2000 mental health community centres across America was abandoned by 1980.

At the time, health experts opined all psychiatric hospitals were inhumane, unsafe and were to be closed and replaced by community mental health services. In 1984, a report by the American Psychiatric Association revealed that 50 percent of the homeless population had some form of mental illness.

This casted doubts on the viability of the asylum replacement strategy. Today, both urban and rural America grapple with a pervasive mental health crisis exacerbated by substance abuse. The lesson learned is clear: one-size-fits-all solutions are inadequate. This historic American project underscores the need for strategic implementation tailored to diverse needs.

In Kenya, mental health professionals have long advocated for comprehensive care in both hospital and community settings, supported by family, religious, and educational institutions. The closure of psychiatric hospitals could have dire consequences, leaving vulnerable individuals without crucial support during times of stress or relapse.

In that regard, questions arise: what if they relapsed and no one in the community was trained to take care of them? What happens in cases where symptoms recur due to poor compliance with treatment? What about those with symptoms of paranoia, which exposes them to imminent self-harm and wrongfully accused/mistaken identity? As discussions on community mental health progress, it’s essential to strengthen existing support systems within cultural contexts.

A Glimpse of Hope

Despite these huddles! The recent commitment by the Biden-Harris government to fund existing Certified Community Behavioral Health Clinics (CCBHCs) programs in the USA confirms the commitment to provide services even to those who cannot afford them.

Sixty years later, the Biden-Harris administration, on Thursday, September 21, 2023, Boosted President J. F. Kennedy’s 1963 community mental health law by awarding a $127. 7 million grant through the U.S. Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA), CCBHCs across the country will be expanded. A sign of support for the ongoing efforts to tackle the country’s mental health crisis and beat the opioid epidemic.

Similarly, in Kenya, the government and developing partners could support the existing public and private institutions dedicated to providing mental health services.

Replicating a similar metric will not only speed up the much-needed services for millions from all walks of life who are in dire need of mental health services. It will also ensure uniformity, quality, affordability, and standardized programs that complement the continuum of care at all levels.

NOTE: After an initial session of screening, assessment and diagnosis of a mild form of depression or social stressors in a client, they can be assisted with either a CBT approach, life skills coping mechanisms, coaching, psychotherapy, or referral to a support group in the community and other interventions.

If they are not responsive to therapy by the fourth session, a referral to a psychiatrist to consider medication or short-term admission should be recommended. Such team efforts have existed for years in institutions in Kenya.

Diversity in Solutions: One-size-fits-all is inadequate, Mental health in Kenya, mental health professionals, Psychologists in Nairobi
Author: cbtkeadmin

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