A growing crisis: Addressing policy gaps in mental healthcare

As mental health issues continue to rise globally, an increasing number of people are struggling to access the care they need due to a range of policy barriers.

Some of the policy barriers observed by psychiatrists, psychologists, caregivers and patients include:

The stigma and misunderstanding of mental health 

According to a psychiatrist Dr Nelly Kamwele, disability, including that of mental health has faced a lot of unwanted stigmatisation.

She noted that some countries, including Canada, allow for Medical Assistance In Dying (MAID), especially for people with different kinds of disorders and disabilities.

MAID is a process that allows someone who is found eligible to be able to receive assistance from a medical practitioner in ending their life. 

Kamwele noted that there are cultures that abhor mental illnesses, making it difficult for people suffering from the disorders to seek medical health.

This also comes with misunderstanding as many people do not know the types of mental health illnesses.

Policies often fail to fully address mental health as a priority, with insufficient funding for mental health services in comparison to physical health care.

Insurance and coverage limitations

A major policy barrier continues to be the inconsistency in insurance coverage for mental health services.

Many insurance policies tend to limit coverage for mental health care, placing further strain on patients who cannot afford private treatment.

Kamwele said with the new Social Health Authority, the amount of money allocated for rehabilitation has gone down.

This, she said, will cause patients to either dig deep in their pockets or snub rehabilitation, which could cause a reoccurrence of episodes.

“In rehabilitation, what used to be in National Health Insurance Fund (NHIF), they were covering around Sh75,000, now they cover around Sh67,500,” she said.

She added that there is no direct admission with SHA, whereas before there was.

She added that for the previous cover, people would walk into a psychiatric institution and would be seen by a mental health provider and would be able to be admitted.

In Taifa Care, however, one has to go to the primary healthcare level and then get referred, which according to Dr Kamwele, deters access and delays to services.

She, however, said with SHA/Taifa Care, there is provision of aftercare for people dealing with mental healthcare after rehabilitation.

Furthermore, a shortage of mental health professionals means that even insured individuals may face long wait times for appointments, contributing to a cycle of untreated or inadequately treated mental illness.

Shortage of mental health professionals

Policymakers have failed to adequately address the shortage of mental health professionals, which is exacerbated in rural and underserved communities.

A shortage of psychiatrists, psychologists, social workers, and counselors means that people in these areas often face long waiting lists or no access at all.

“We are not employing enough mental health personnel. We are instead doing role-shifting by giving people who are not fully qualified to intervene in roles that are ideally for mental health professionals,” Kamwele said.

Role shifting is a notion of changing roles within a social group, organization, or family. It can refer to a shift in roles between members of a group, or to a shift in the roles of an individual within a group.

Dr Kamwele added that mental health is broad, and this should be put into consideration while employing mental health professionals.

Lack of awareness

A psychologist from Mathari Hospital, who requested anonymity, stated that awareness about mental health has not been given adequate priority.

“Preventive measures are neither streamlined nor effectively implemented. While we do have mental health institutions, available medications, and human resources, these efforts remain insufficient without robust awareness and preventive strategies," the psychologist said.

“Why don't we prevent the problem from happening first? So, the prevention aspect of mental health for me is a barrier.”

On her part, Dr Kamwele added that there is a need to understand that mental health illnesses have a neurobiological cause.

“The more we get more knowledge, we are finding that there is a more neurobiological cause,” she said.

Dr Kamwele added that there is a need for research, as the country is moving towards a place where it has found a lot of neurological bases of the illnesses.

“We need to research genes that make people get mental illnesses,” she added that so far, the research done has helped in treatment.

She added that besides the neurological causes, there are also trans-cultural aspects of mental illness.

“There is a lot of research to be done on both aspects,” she said.

Lack of coordinated care

Another significant barrier in mental health care is the fragmentation of services.

Often, mental health care is disconnected from general healthcare systems, leaving patients to navigate complex, uncoordinated services.

This disjointed approach results in inefficiencies and gaps in care, leading to poor outcomes for patients.

Policymakers have struggled to implement integrated care models that could better address the whole health of an individual, including mental, physical, and social aspects.