When I was diagnosed with bipolar disorder in Nairobi, Kenya, in 2008, at the age of 24, all I wanted to know was whether I would be all right. It was the first time I had ever heard about the condition, and many people around me simply believed that I had been cursed.
Even though my parents sought medical help, the psychiatrist who diagnosed me did not give any information about the illness, the side effects of the medication prescribed for me, or the manic and depressive bouts that I could expect.
My story is not unique. The World Health Organization estimates that 1 out of every 4 people in the world will experience a mental health condition in their lifetime — including depression and anxiety, bipolar disorder, schizophrenia and substance-induced psychosis.
In a developing country like Kenya, these patients and their families — including me at one point — must compete for space at the overcrowded, understaffed and underfunded Mathari Mental Hospital in Nairobi, the main referral hospital for the general public. A national audit in 2011 found that Kenya has just 79 psychiatrists — only 50 working in the public sector — to serve a population of over 40 million.
But things could be looking up. In April, the World Bank and the WHO met in Washington, D.C., to look at ways to move mental health onto the international development agenda, bolstered by new research that shows an investment of $147 billion in treating mental health issues could result in total economic returns of $400 billion as health and productivity are restored.
There’s no doubt that $147 billion is a lot of money. While there’s talk of building more hospitals, there are some relatively simple, low-cost ways to begin addressing the issue. Awareness campaigns that inform and start conversations about mental health and mental illnesses are crucial.
After I found out I had bipolar disorder, I lived with self-doubt and guilt. At times I considered suicide. This prompted me to start a blog, My Mind, My Funk, where I write openly about dealing with severe depression and provide resources for people in Africa going through similar mental health troubles. I’ve also written about another condition I face: epilepsy. Even though epilepsy is a nervous system disorder, some people in Kenya consider it a mental health condition with the reasoning that, like depression, it happens “in the head.”
Lack of proper mental health information and support is one of the primary obstacles patients face. Cultural beliefs that often attribute mental health conditions to witchcraft also make it hard for people to get proper and timely diagnosis, and in some cases they are shunned and ridiculed.
In Kenya, many families dealing with brothers or sisters who have severe mental illness resort to chaining them up at home, abandoning them in rudimentary mental health institutions, or for urban families, sending them to live with grandparents in the countryside if they can’t find anyone else to care for them.
As you can imagine, the appetite for information about mental illness in Kenya is overwhelming. So last year I established Kenya’s first dedicated text message hotline to deal with mental health inquiries and inquiries about epilepsy as well. People text in their issues: “I’m feeling very depressed.” “My girlfriend is driving me up the wall.” “Someone just had a seizure — what do I do?” Trained volunteer counselors respond via text.
In its first year of operation in 2015, the line got 25,000 messages from Kenyans across the country.
Currently, we’re restructuring the hotline so it can better serve people. We want to find a way to answer general questions — like what are the symptoms of depression or epilepsy — to free the line up for specific questions that require more personal answers from our counselors.
It is certainly good news that mental health is finally becoming part of the development conversation. But the discussion must include voices like mine — voices of people living with mental health conditions in the developing world — so we can help global institutions design the best mental health care systems for even the most remote African villages, where people may not have the words to describe mental health issues.
And more important than fancy new hospitals are community mental health projects that can shift public perceptions of the illness at schools, villages and the workplace. A better understanding would mean that people with mental illness might feel less isolated — and that their families might not automatically turn to institutionalization.
Not everyone who develops a mental health condition needs to see a psychiatrist or take medication, but everyone with a mental health condition — no matter where they live — needs an accepting environment.
Sitawa Wafula is a Kenyan mental health advocate, executive director of the mental health hub My Mind, My Funk, and a 2016 Aspen New Voices fellow.