Learning from Holistic thinking in Mental Health Programmes in Kenya
This case study describes three levels of intervention on mental health in Kenya that reflect a paradigm shift towards more holistic community centred thinking on mental health and associated intersectoral collaboration. The three levels are a (i) multi-faceted and intersectoral process for national policy development and implementation on mental health, (ii) a co-ordinated district programme on mental health and (iii)locally driven social action on mental health. Using a desk review of (limited) available literature, the case study describes the context for, inception, processes used, outcomes and impact of and lessons learned from each level. Each level was informed by collaborative situation appraisal to inform planning. The appraisal at local level was implemented using a participatory reflection and action approach to support communication and shared understanding across diverse actors, including those directly affected.
A national policy process using various forums for dialogue and operational tools supported the integration of mental health into health management systems and guided intersectoral action and liaison with police, prisons and schools, and public education. The district and local level processes linked with economic actors and resources to link health responses and caring with economic and production services to strengthen the social inclusion, incomes and wellbeing of people with mental ill health and that of their households. These economic sectors may need more profile in national level policies. The role of community based workers, social networks of people with mental illhealth and their carers, of communication across actors and of embedding and building capacities in existing institutions is described as contributing to a sustainable intersectoral patient centred approach to mental health. Key informant interviews, surveys and costing studies are proposed to obtain information on the interface between levels, including in terms of resource flows.