Going beyond the Nairobi attack: the psycho-social response

LSE’s Victoria de Menil says that no time should be wasted in putting in place a comprehensive response for new and existing mental health and social needs following the shopping mall attack

Hospital escapees highlight need for community mental health in Kenya

LSE’s LSE’s Victoria de Menil argues that hospitals are not a viable alternative for community mental health care in Kenya and other low and middle-income countries. argues that hospitals are not a viable alternative for community mental health care in Kenya and other low and middle-income countries

Private Keep Out: A Case Study of Private Mental Healthcare in Kenya

As discussed in a recent LSE Africa seminar, LSE’s Victoria De Menil discusses the rise of private mental healthcare in Kenya. The LSE Africa seminar series takes place every Wednesday in term-time from 4 to 5.30pm in CLM1.02, Clement House, The Aldwych

Have your say on the treatment gap in global mental health

An historic first took place in Portcullis House on 10 June. The UK All Party Parliamentary Groups (APPGs) on global health and mental health convened a joint hearing to discuss global mental health. The event, chaired by Lord Nigel Crisp together with James Morris MP, was the first of two oral evidence sessions to address the question of whether the UK government should be “doing more or doing differently” to address the treatment gap in global mental health. Three additional Parliamentarians, Meg Hillier MP, Vicount Eccles and Peter Bottomley MP, were also in attendance

Nelson Mandela left his mark on the Commonwealth

In the opening post of our series looking at Kenya’s 50th anniversary of independence, LSE’s Victoria de Menil revisits the politics of Jomo Kenyatta’s supposedly de-political master’s thesis, later published as Facing Mount Kenya, particularly in relation to land and female circumcision. She asks who the intended audience was, and what legacy the book has left behind

Under-cover in Kenya: the contribution of non-state actors to mental health coverage

Half of health care in sub-Saharan Africa is privately provided, however, for mental health, the literature is all but absent on these services. Kenya provides a useful case-study, as it has a wellorganized non-state sector and data are readily available. My thesis asks what contribution do non-state actors make to coverage for mental disorders in Kenya? Non-state mental health care is conceived along two axes: for-profit vs. not-for-profit and formal vs. informal. Four empirical chapters use mixed-methods to examine: 1) not-forprofit NGO care; 2) for-profit inpatient care; 3) for-profit outpatient care; and 4) traditional and faith healing. Data were collected on 774 service users and 120 service providers from four primary sources, and two secondary sources, as well as from a wide range of key-informant interviews. The first two chapters set the research question within the context of existing knowledge in the fields of health economics and health services research. The third chapter provides an overview of methods, focusing on cost-effectiveness analysis, case study method, and crosscultural psychiatric epidemiology. The first empirical chapter presents an NGO intervention called the model for Mental Health and Development, evaluated qualitatively and quantitatively, using cost-effectiveness analysis. The second empirical chapter offers a case study of a growing private psychiatric hospital, using regression analysis on the effects of insurance on charge and service use. The third chapter is a short descriptive analysis of a questionnaire completed by psychiatric nurses about their participation in mental health care, and structured interviews with specialist outpatient providers. The final empirical chapter contains qualitative and quantitative data on traditional and faith healing, analysed for similarities and differences. The conclusion ties together findings thematically according to capacity, access and cost, estimating the degree of mental health care coverage offered by non-state actors in Kenya, and offering lessons for policy and research

Is more better? The effects of private health insurance on mental health care in a Kenyan mental hospital

In 2004, Kenya’s parliament passed a promising bill to create a National Social Health Insurance Fund to pay for outpatient and hospital care for all Kenyans, but the bill was not signed into law out of concerns over financing. Today, Kenya’s only social insurance is the National Hospital Insurance Fund (NHIF), which is under investigation by the Ethics and Anti-Corruption Commission. Private health insurance (PHI) remains one alternative to out-of-pocket payments for financing healthcare, including mental healthcare, among those who can afford it. In Kenya, PHI is used by 2% of the population and accounts for 4% of health expenditure. Critics of PHI argue that it leads to spiralling use and costs of services, while proponents suggest that it increases early access to services and improves financial protection

Cost-effectiveness of the mental health and development model for schizophrenia-spectrum and bipolar disorders in rural Kenya

Background. The treatment gap for serious mental disorders across low-income countries is estimated to be 89%. The model for Mental Health and Development (MHD) offers community-based care for people with mental disorders in eleven low- and middle-income countries. Methods. In Kenya, using a pre-post design, 117 consecutively enrolled participants with schizophrenia-spectrum and bipolar disorders were followed-up at 10 and 20 months. Comparison outcomes were drawn from the literature. Costs were analysed from societal and health system perspectives. Results. From the societal perspective, MHD cost Int$594 per person in the first year and Int$ 876 over two years. The cost per healthy day gained was Int$7.96 in the first year and Int$ 1.03 over two years – less than the agricultural minimum wage. The cost per DALY averted over two years was Int$13.1 and Int$ 727 from the societal and health system perspectives, respectively – on par with antiretrovirals for HIV. Conclusions. MHD achieved increasing returns over time. The model appears cost-effective and equitable, especially over two-years. Its affordability relies on multi-sectoral participation nationally and internationally