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| Wrong evaluations hurting mentally ill patients |
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| Written by Judy Waguma | |
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Health workers in Kenyan public hospitals and even private ones are passing patients with mental illness as malaria case or sufferers of other illnesses. Psychiatrists who deal with these patients say the rate at which misdiagnosing is happening is not good for the country. And such patients are reaching mental experts or institutions when the damage has already been done. “Cases of misdiagnosis are indeed happening because we have not trained health workers who come into contact with these patients, on how to tell they are a mental case,” says Dr Nelly Kitazi, the Hospital’s Acting Medical Superintendent.A few weeks ago, while opening a mental health workshop at Pan Afric Hotel, the Director of Mental Health, Dr Kiima lamented that the cases of misdiagnosis were on the rise. A recent study in Nairobi showed that 45 percent of people attending a health centre in Nairobi had some form of psychiatric morbidity. All were misdiagnosed. According to Prof David Ndetei, a psychiatrist, thousands of patients continue to be misdiagnosed because those with psychological disorders present with physical symptoms. They are also at a loss due to the beliefs regarding mental health. “It’s the way we refer to the mentally ill patients, we sometimes believe that’s its witchcraft or even demonic spirits, and it is in this regard that one is referred to a psychiatrist,” he says. Ndetei says at least one in every patient visiting a health centre has a mental or neurological disorder. Only 0.01 per cent of the Ministry's annual budget is spent on mental health, which is less than seven percent of the national budget. Worsening the situation is the 67 psychiatrists the country has, who are expected to respond to the needs of over 30 million Kenyans. Majority of whom are based in urban areas. A national mental health policy expected to remedy the situation has been dragging for years, with those at the ministry citing lack of funds for the sluggishness. The policy is meant to set national treatment standards and staff requirements because currently there are none. Ndetei says that there are several levels of misdiagnosis, the first being at personal level. This is the most common level, where the patients self examines himself or herself according to the physical symptoms that present themselves. “Individuals say how they feel, and diagnose diseases that could have presented itself in various forms, commonly, malaria, and typhoid,” he adds. The next is the lay level, where the patient seeks the opinion of the relatives, friends and other people. “Here, the most common conclusion would be that the person is bewitched, because he or she starts behaving in an abnormal manner,” says Prof Ndetei. Families of such patients revert to traditional healing methods, before approaching the conventional mental health care system. Then there is the professional level, where professionals who are not medically trained misdiagnose patients. This is most common among the spiritual leaders, a group worrying doctors. “Most of the time we forget that even with the slightest form of depression or stresses, one, more than often present with various neurological or mental problems,” says Prof, Ndetei. Diseases like schizophrenia, for instance, present itself in a manner that is easy to deduce that the patient is haunted by ghosts. Margaret Makenyengo, a consultant psychiatrist, at the Kenyatta National Hospital admits that the biggest problem is recognizing the complication of mental illness. One such condition is diagnosing Cyclothymic- a mental health disorder in which a patient suffers from mental health episodes ranging from extreme feeling of euphoria, to periods of depression disorder. The patient suffers frequent mood swings, sometimes every two months. In most cases, this disorder is under diagnosed and not promptly treated. Patients experiencing the disorder will only seek treatment when their mental health condition begins to create a negative impact on professional, personal and social relationships. When this happens, it may lead to many years of failed relationships and struggles within familial, social relationships and job performance. “Often, by the time the mental health patient is fully diagnosed, these relationships and activities of daily living are severely impaired,” says Dr Makenyengo. She thinks participation of a family member in assessing the patient is critical as people may not know they are mentally ill. “Patients may not always acknowledge parts of their illness, especially the manic parts,” she says. "Often, they are not withholding or denying, but it just doesn't register."
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