Kenya: left behind

Charity. In Africa, especially in rural Kenya, people assume that symptoms of mental health conditions are spiritual issues, such as being possessed by a demon or bewitched. You can find people who have been taken to traditional healers or religious leaders for 10 to 30 years, which only exacerbated their mental health condition. There are no early intervention programs for people suffering from mental illnesses. The consequence of this misconception is that many people, who are not necessarily violent, may eventually lash out as a symptom of their progressed conditions.

Social factors must also be considered. Kenya has been a low-income country for a long time. From what I have seen, prisons tend to incarcerate a lot of people from poorer areas. And when it comes to mental health issues, most of the time, people are also from low-income brackets.

Police also discriminate against people with mental illness. They arrest them on trumped-up charges. Police just pick any law that can justify detaining the person, often using petty offences as excuses. Once in front of the judge, these people often do not know their rights.

Criminal justice requires a continuum of care: from police to court, from prison to probation and back to the person’s community. The problem is that every one of these stakeholders lack a proper understanding of mental illness, so they give up on these people. Sometimes, they even believe they are better off in prison. In Kenya, there is no mental health system able to implement a national comprehensive support policy. There are a few officers who have studied psychology but since they are deployed as disciplinary officers, they do not have a conducive environment or structured system to apply their knowledge. If mental health conditions were identified early on, while still at the police station, then we would not even need to be talking about mentally ill people in prison.

Charity. Prisons usually have a special block for people with mental illness, typically block E or D. Only people with the most severe conditions are kept in these blocks. They do not take part in the prison community. They are put aside in order to be kept docile, managed, so that they stop disturbing people. This is clearly social discrimination. These people are completely left out instead of being integrated. They do not leave the block and they do not get to see the sun.

Prison staff do not consider enrolling them in primary and secondary school education programs. They are included in neither social nor spiritual events. Prison staff tends to overlook individuals with less severe mental health issues, making them practically invisible and failing to acknowledge their condition. Some people suffering from more severe illnesses are admitted to the prison’s health clinic. Access to psychiatric facilities is very slow due the lack of financial and human resources. Kenya only has 125 psychiatrists for the whole country, most of them working in the private sector. They see prisoners mainly when a psychiatric evaluation is required to determine their ability to stand trial.

Prisoners with mental conditions can also be sent to the maximum-security ward of Mathari Hospital, which is our National psychiatric facility. This 100-year-old facility has a terrible sanitation system. Some seclusion rooms do not have a toilet but a small bucket.

Mathari hospital also houses people waiting for psychiatric evaluation, usually in the case of murder, as well as mentally ill people who have been found ‘guilty but insane’. These people often stay a very long time in Mathari hospital. Once convicted, they must follow a three-stage treatment. The reintegration process starts if there is a favourable report by the doctor and an occupational therapist. However, most of these people have committed crimes so culturally unacceptable that they are often rejected by their family and are not able go back to their communities. Sometimes they receive death threats from their own communities. They do not have anyone who can commit to taking care of them and ensuring they adhere to treatment, which is a condition for release. As a result, they can stay in Mathari Hospital for 30 years, while the recommended time for these processes is a maximum of three years.

Nevertheless, there have been remarkable breakthroughs recently. Some people who were declared unfit to stand trial yet still imprisoned are now being released. Also, the procedure called ‘presidential pleasure’ – indefinite detention for those found ‘guilty but insane’ – was declared unconstitutional by the court in February 2022. Many of those people, however, are now stuck in the system due to delays in the justice system which is causing them a lot of psychological distress.

Charity. I think that the very first thing is funding. For the longest time, mental health has gotten only 0.01% of the health budget. We need a budget for health but also for reintegration. Kenya has a very high rate of recidivism, from 40 to 50%. This rate is even higher when it comes to people with mental health conditions.

To a greater extent, we must not forget prisoners who suffer from intellectual or neurodiverse disabilities. They are not considered mental illnesses per se, but they face the same legal difficulties as people with mental health conditions. A better understanding of what a mental health condition is and what it implies is essential from the beginning of the criminal proceedings to the reintegration of the offender.

We need trained prison officers who can understand what a mental health condition is and what it implies. We have seen the consequences of ignoring these issues. We need all people who are ill to be cared for, regardless of whether their illness is severe or not. If left untreated, the conditions will turn severe. In this situation, we all lose out.