In the aftermath of the COVID-19 pandemic, many women in Kenya’s informal settlements have struggled with depression, anxiety and other mental health challenges. To address this quiet crisis, AKU’s Institute for Human Development (IHD) launched a multi-phase project to enable non-specialists to provide support to individuals suffering from poor mental health. Such community-based initiatives are urgently needed in Kenya, where there is just one psychiatrist for every 540,000 people.
“This work is about more than just research,” said IHD Director Amina Abubakar, the project’s principal investigator. “It’s about restoring dignity, wellbeing and hope to women whose struggles are often invisible to the systems meant to support them.” The project’s co-investigators are Postdoctoral Fellow Dr Patrick Mwangala, Researcher Gideon Mbithi, Project Coordinator Judith Tumaini Dzombo, Data Manager Rachel Odhiambo and Senior Manager Margaret Kabue. In addition to community organizations, they worked with the health departments of Kwale, Mombasa and Nairobi City counties.
The researchers began by interviewing local leaders, government officials, health care professionals and staff from community organizations. They also surveyed more than 1,500 individuals from informal settlements in Nairobi’s Westlands neighborhood, Changamwe subcounty in Mombasa County and Matuga subcounty in Kwale County. The findings of the survey were sobering. Some 28 percent of women reported symptoms of depression, as did 22 percent of men. More than one-fifth of both women and men reported symptoms of post-traumatic stress disorder. Some 12 percent of women and 8 percent of men reported anxiety symptoms. Among the main predictors of such problems were economic hardship, debt, hunger, health problems and spousal abuse. Participants also reported mental health care was poor or nonexistent in their community.
Beyond the numbers, the voices captured during interviews painted a painful picture. Women spoke of hunger, of being unable to pay rent, of abuse, grief and the weight of caregiving with little to no support.
Rather than devising solutions in isolation, the team chose a different path: co-design. They held workshops with two dozen stakeholders to tailor two evidence-based interventions. The first, a mental health literacy programme, aimed to raise awareness, challenge stigma and promote early help-seeking through a series of nine modules delivered over three to five days. The second, known as Problem Management Plus (PM+), is a World Health Organization-developed, low-intensity psychological intervention that can be delivered by trained non-specialists in just five sessions. PM+ aims to alleviate symptoms of common mental health problems and self-identified practical problems such as interpersonal conflict. Over the five sessions, participants are taught four main strategies: managing stress, managing problems, behavioral activation and strengthening social support.
“What’s powerful about PM+ is that it doesn’t require a psychiatrist,” said Dr Mwangala. “It can be delivered by someone from the community—someone who understands the language, the context, the daily realities.”
Eight community-based civil society organizations were selected and trained to deliver the interventions. Preliminary findings, based on results for 638 participants, show the mental-health literacy programme has the potential to improve mental-health literacy, reduce negative attitudes regarding mental health, minimize symptoms of depression and anxiety and improve general wellbeing. Among the 315 individuals who received the PM+ intervention, preliminary findings show there was a significant reduction in symptoms of depression, anxiety and post-traumatic stress disorder three months after participation. In addition to benefitting community members, the project enhanced the capacity of the participating civil society organizations to deliver mental health programmes.
To help inform national and regional planning, the project team has developed two policy briefs that provide practical recommendations for strengthening community-based mental health services and integrating them into Kenya’s health system.
Another notable aspect of the project is the fact that several of the civil society organizations that participated have taken the initiative to continue their work beyond the project’s completion. For example, the Tuwajali Wajane Kwale Initiative, an organization addressing the needs of widowed women, was able to obtain independent funding to sustain its efforts.
The IHD study addresses Sustainable Development Goal 3, good health and well-being, including target 3.4 regarding mental health.