Mental Health and Well-being

I am a single 27-year-old male with immense passion about mental health. The need for adequate attention to mental health not only locally in my country Kenya, but also globally led me to choose my career path as a medical psychologist and clinical researcher. I also represent Africa in the United for Global Mental Health Blue Print Group Advisory Board. 

I possess extensive experience as a psychiatric practitioner from community level to major referral hospitals in the country.  Currently, am a Project Manager on Mental Health and Wellbeing at BasicNeeds BasicRights Kenya. I work across Kenyan Universities to improve the provision of mental health support services with established practitioners, researchers, emerging philanthropists, innovators and advocates who are committed to the sustainable and inclusive development of Africa.
In research works, I have a published study on "The Relapse Rate of Bipolar Mood Disorder in Patients at Moi Teaching and Referral Hospital".

Rates of mental health problems are higher among students from lower socioeconomic backgrounds, and higher overall in poorer countries; research in Kenyan universities has identified high levels of depression and anxiety among students. This accounts for the large numbers of drop outs and suffering due to inaccessibility of psycho-social services in the university settings. Despite the higher education sector in Kenya growing immensely in one generation, the development of pastoral and support services has not taken place at the same pace. 

The project will develop core mental health support services in Kenyan universities and provide vulnerable students prevention and support services whilst attending the university. 

Many of these students have come from extremely poor communities, and the pressure for them to achieve is immense. By offering mental health support services we aim to educate, support and treat students who are vulnerable and at risk of developing mental illness. 

The 2016 Global Burden of Disease studies identified major depression and anxiety conditions, separately, as among the 10 leading causes of years lived with disability in Kenya, and severe mental health problems shorten life expectancy by decades. Lack of budgetary allocation and political will have been significant barriers to achieving adequate legislation and policy implementation, where education and health systems have been unable to make the needed reforms or at sufficient scale to meet the enormous demand for accessible mental health services.
Few individuals living with mental disorders around the globe have access to mental health care, yet most have access to a mobile phone. Digital technology holds promise for improving access to, and quality of, mental health care. Low-income and middle-income countries are disproportionately affected by the burden of mental disorders, largely because of fragmented and underdeveloped health-care systems, few available mental health specialists or treatment opportunities, and the devastating consequences of poverty, stigma, and social disenfranchisement on individuals’ mental well-being. The gap between individuals with mental disorders in need of treatment and those who receive it is substantial and up to 90% of individuals living with mental disorders in low-resource countries receive no mental health care.

The project aims to improve the provision of mental health support services in Kenyan universities through the following key activities;

1. Improving access to treatment including clinical and low intensity psycho-social therapies. The university staff (both teaching and non-teaching) are trained on early detection of mental challenges, supporting vulnerable students to build resilience and providing brief interventions.  

Training of peer group leaders in group counselling skills, and peer support skills.

Structure and strengthen the staff and student peer support groups.
Establishment of the safe spaces both physical and online. 

2. Health promotion including behavior change and communication skills.

Theatre and arts productions such as ‘forum theatre’, music and dance. Utilizing these for regular mental health awareness sessions and events.  Production of information packs. Increasing knowledge on Mental Health and Human Rights through face to face and online WHO Quality Rights in Mental Health modules. Knowledge, attitude, and behaviour surveys undertaken in each university to measure the impact of the anti-stigma work.

3. Offering peer support services.
4. Establishing anti-stigma services; online campaigns and awareness events.
5. Incorporation of technology leverage ; Establish a helpline managed by the student counselors. Also, deploy a chat-bot themed around artificial intelligence to provide mental health first aid.

The mental health and well-being project is targeted at the university population which entails the university staff(teaching and non-teaching), students and the surrounding community. So far it is being implemented at two public universities in Kenya. The planning and formulation of this model entailed collaborative meetings and participation between the university Wellness Centres, students and our organization.

The project beneficiaries are actively involved in the rolling out of the program through receiving relevant capacity buildings, active participation in advocacy of mental health rights and sensitization on mental health care among-st the university population and community in general. The project activities build on already existing structures and practices at the university to increase buy-in and sustainability. 

Through the project: mental health stigma is being tackled, mental health care among-st the university staff and students has improved as evidenced by increased number of visits to the counselors, students suicide rates have reduced, peer support groups have increased and safe spaces have been established at the universities.

The model has continuous data collection during implementation and Knowledge, Attitude and Practice Survey in order to monitor and evaluate the level of impact the project campaigns and initiatives have of the target population.

This project at the universities is a high impact project being that it targets a huge university population of more than 100,000 currently. 

It's emphasis on inclusivity and upholding the rights of persons with psycho-social disability together with other physical disabilities has empowered the lives of many forgotten youth in the society who are faced with too much negative stereotypes and misinformation. 

The model also raises awareness on forgotten mental health care needs and ways of upholding each individual's well-being. It tackles the high levels of stigma accorded to mental health in Kenya; a habit with more harm than good.

The Mental Health and Well-being project begun from increased cases of depression and suicide among-st university going students. It begun with the use of art to create awareness on mental health through a club at the university. The use of forum theatre was well received by the students who somewhat found a platform to actually discuss issues that are silently eating them internally with no cure at hand. It is from forum theatre approach that referrals to the Students counselors was made possible. Therefore, we learned from this how early detection of mental illnesses is a very key element in the program moving forward and training the students enacting the psychodrama on mental health first aid. This in turn led to an increase of students seeking the counseling services which resulted to burn out rates among-st the very few students counselors at the university. Therefore, there was need to train more university staff on offering brief interventions and facilitating support groups among-st themselves. 

Technology is an additional boost in increasing access to psycho-social services through a chat-bot, virtual peer support groups and the presence of tele-counselors who may provide the services without the traditional therapy rooms.

I am a product of the Kenyan public university system. During my study times at the university, I underwent and witnessed a lot of mental health suffering among-st my circles and also at a personal level. I have lost a couple of friends/college mates through death to substance use, gender based violence, suicide and homicide cases. 90% of these cases at the university stem from lack of the necessary intervention when the students needed the psycho-social support the most. There was no awareness or promotion of positive coping mechanisms to the daily stressors that come with being in pursuit of the university degrees.

The insufficient level of importance and resources accorded to the mental health landscape is of key concern to me. In order to safeguard the health of the future generation, it is very important that we approach it differently compared to how it has been done in the past whereby the neglect accorded to the field of mental health has been a normal culture. There is no health without mental health and thus improvements in line with access, sensitization and availability of psycho-social support is very integral for a fully functional and healthy society tomorrow.

I possess a noble level of experience in the field of mental health at policy, practice, advocacy and community level. My work is hugely driven with passion and the desire to change the negative narration on mental health globally. Personally am a young advocate for mental health and disability inclusivity which is very evident in the works am currently implementing in the universities and from my previous engagements in my field of practice. I am currently working in collaboration with  Ember to improve this project in the universities in terms of implementation efficiency, replication and scalability. At a global landscape, I am serving at the United for Global Mental Health Blue Print Group advisory board committee as the representative for the African region, where I voice concerns of the continent's mental health context with the relevant deliberations on solutions at a global landscape. 
My specific skills are;

1. Satisfactory competency in conducting research studies.
2. Very attentive to details, accurate and a keen observer.
3. Highly organized with good time management skills.
4. Good community mobilization and interpersonal skills.
5. Sufficient and effective competency in training of trainers.
6. Proven advocacy skills. 
7. Ability to work independently, meet deadlines and obtain results.
8. Good project management skills with excellent data presentation skills.  
9. Efficient and proven knowledge in monitoring and evaluation of projects.
10. Proficiency in computer applications and ability to use softwares such as MS Word, SPSS and Excel.
11. Excellent team working skills, good organizational and social skills.
12. Possess excellent communication skills both spoken and written.

Our program at the universities targets mostly public universities where there are large numbers of students who enroll under the support of the government bursaries and scholarships. We are currently working with two universities in which one is in the urban setting while the other is in the rural settlements which is 175km away from the capital. I travel weekly by road to monitor the activities and make sure implementation and project objectives are met and well coordinated between the two universities despite the distance challenge. 

Secondly there exists no psychiatrists or psychologists in the whole of the county where the second university is located. Thus in our program, we are working with the community stakeholders in the county through capacity building of primary caregivers and relevant medical professionals to provide the necessary mental health services to the community in their district hospital. 

We are also tackling burn out of the counselors through debriefing sessions. The fatigue is brought about by the increased treatment seeking behavior among-st the university population from the project campaigns.

With Covid-19 limiting gatherings, the physical activities have transformed  to the online platform whereby the support groups and therapy sessions are currently held through digital approaches. 

During the 2019 World Mental Health Day Commemoration on 10th October, which was themed "Suicide Prevention", I had initiated a huge collaboration between the mental health stakeholders in the capital city of Nairobi to mark the day and increase sensitization and awareness of mental health in the country. At the same time, I also coordinated another different event of the same nature in another different county in the rural settings. Both the events were very successful, got covered on national television and newspaper and got the nation talking few days later post the function. 

At the universities, the project that I lead has impacted the university populations in more positive ways than ever existed. The rates of suspension or expulsion of students at the university has greatly gone down since the inception of the project. My level of mental health advocacy has extended also at the national level where I have represented my organization at the public hearing of a mental health amendment bill that was due for discussions by the Kenyan parliament; and also a different sitting on Universal Health Coverage where I pushed for the attention and inclusion of mental health as a key area of focus.

It is a project that aims to improve the provision of mental health services at the universities by using the university population and the surrounding community. The capacity building involved in the program is targeted at the student counselors, teaching and non-teaching university staff and the various youth clubs bound at the universities. Scale up of the therapy rooms or assessment tools is also built on what the university already has at the ground. This increases it's buy in capacity and the sustainability of this model at the project implementation sites. 

The use of technology to leverage for behavior change is another unique component of the project. We intend to increase accessibility of psycho-social services through the use of smartphones and web. Better yet, the transformation of the human interaction in therapy conversations into an artificial intelligence chat-bot prototype is the first in our Eastern African region. This is intended at providing a low intensity interventions or mental health first aid when the end user really needs it at their convenience and thus tackle the challenge of inadequate mental health practitioners in the country in some way. This approach helps at early detection of mental illnesses among-st the youth, managing through brief counseling sessions and them eventually referring appropriately to psychologists and student counselors based on the severity of the presenting conditions.

The problem that the Mental Health and Well-being project is trying to solve is the worrying upsurge of high rates of substance use, early pregnancies, school drop out, anxiety, depression and suicide among-st other mental illnesses at Kenyan universities caused by different factors, such as difficult unfavorable economic situations; pressure to succeed emanating from family members so that one may salvage the entire community from poverty; peer pressure to fit in; and unhealthy coping skills to academic stressors.

The project audience includes; 

• University Students
• University staff
• Community around the universities and the youth in general
• Students’ families 

The entry point to reaching our audience is; 

• Induction days
• Artistic Theatre sessions (Psycho-drama)
• Freshers' events  
• Awareness walks (Anti-stigma campaigns)
• Students forums 

The steps required to bring about change entail; 

• Engagement of current stakeholders - Nous Cims Foundation; CBM; Ember;
• University Departments of Counseling; University youth clubs.
• Building links with the Ministry of Education, Youth Affairs and advocating for policy change.
• Building links with communities. 
• Looking for new funders for the replication phase of the model.

Our work shall be measured ; 

• By number of universities replicating the model.
• By growing number of students seeking therapy at both Kenyatta and Chuka universities.
• By the decrease in a number of suicide rates at universities. 
• By the decrease of stigma around mental health at universities. 
• By the decrease of prevalence of mental health problems in higher education.
• By the decrease of students expulsion from higher education due to mental health problems.

The wider benefits of our work include; 

1. Creating a society with a strong foundation in mental health. 
2. Increasing the accessibility of mental health services at universities in Kenya. 
3. Advocating for good mental health policies at the national level.
4. Taking the model outside Kenya and replicating it at other universities globally.

The long term change for the project is improved societal mental healthcare  and knowledge about mental health in Kenyan education system via the adoption of the Mental health and Well-being model. This means the mental health and well-being model being replicated at each university (public and private) in Kenya.Then elsewhere in Africa and globally.

The university population the project is working in is an average of 120,000 students or more. The number of direct beneficiaries from our first year of the project is at an average of 2,000 people. This includes students and staff who have received psycho-therapeutic interventions from the program. They were reached through the forum theatre sessions, the buddy group sessions, the peer support groups for students, peer support groups for university staff, training sessions for the university staff, training sessions for the peer leaders, training sessions for peer counselors, training sessions for the student counselors, training sessions for the psycho-dramatists, students referred for psychological support and counseling from anti-stigma campaigns and students referred from sensitization events.

  In one year, the numbers may increase by 50%-70% due to increase in intensity, reach, networks and approach efficiency of the sensitization and awareness. Also, the capacity building of more students and staff means more of the university population will benefit from the increased access to psycho-social support. 

1. Provision of mental health literacy and psycho-education 
Through the use of art to increase awareness on mental health and counter the prevalent misbeliefs and stigma, MH+WB shall deploy forum theatre and psychodrama sessions which will be carried out by the university students enrolled in mental health clubs, to sensitize the university population on prevalent mental health challenges common to students. 

2, Access to treatment and psycho social support

These will be a combination of traditional core mental health services as well as low intensity psychotherapy. The students that will be trained in the project on brief interventions will be tasked with offering mental health first aid to their fellow students in need and form support groups that will be both physical and digital in practice.

3. 

Youth Empowerment
All the project campaigns and activities will be youth informed. Mental Health themed events such as art festivals and Wellbeing concerts will be used to reach larger population of students and communicate the messages and content at a youth friendly language that promotes a high level of absorption. The student champions, mental health ambassadors, university role models and general university population will actively be involved in the advocacy for mental health in such events and other online campaigns thereafter. 

4.Anti-stigma services 

• Holding an anti-stigma publicity campaign around the time of student inductions for new students
• Use of role models, including and not limited to people with a lived experience of mental illness, carers and other others who have overcome other adversities 

Covid 19 pandemic; With the restrictions put out by the World Health Organization on the containment and management of the virus, it will be very hard to meet the project indicators dependent on gatherings and physical socialization. Mental health is highly dependent on social support systems and the practice of contentedness.Therefore, with these isolating and keeping distance measures, the rates of relapse among-st the project beneficiaries is likely to go up.

Technology inadequacies; A huge population from the public universities come from low socio-economic background. This means that their access to smart phones is also highly unlikely as they are not able to afford. 

Most of the students who are able to possess one, mostly reside in the rural settings in areas where there is poor network coverage thus they may not be able to access the psycho-social services offered in the project.  

Institutional infrastructures; Not all institutions of higher learning might have adequate spaces for psycho-social interventions by the university student counselors or the trained peer counselors. 

Cultural practices; Cultural beliefs and ways of lives may play a significant role in the acceptance of contrary opinions to what the society has been made to believe as the normal perception or understanding to some mental illnesses. This is one of the major contributors to the stigma and low treatment seeking behavior with regards to mental health care.

In adopting to the covid-19 restrictions, the project will transform its activities to the online platform. The digital approach to the psycho-social activities will help provide the required support to the students and society in general at a timely manner and at a wider reach during this Covid-19 period, compared to the traditional normal means. However, collaboratively with the structures already put in place physically, it will be more effective post Covid-19 to address the challenges that will be as a result of the pandemic. 

In addressing technological inadequacies, simple mobile health initiatives that are not limited to smart phones and the internet web such as tele counseling will provide solutions that are very integral in our push to mainstream mental health care in the higher learning institutions in areas such as clinical decision-making, treatments, assessment, self-care, healthcare management, research and much more.  This will more so also impact on the challenges with regards to institutional infrastructures.

To counter cultural practices that are a hindrance, the project has a strong component of and emphasis on community-based mental health services approach. This is attributed to greater accessibility of the needed psycho-therapeutic support and high levels of acceptability compared to traditional healthcare facilities practice and beliefs the society has grown accustomed to. The trained peers and university staff in the program are constant elements of the university community thus the imparting of skills and knowledge on them and subsequent empowerment, ensures the perspectives of longevity in terms of knowledge, practice and attitude.

Nous Scims Foundation are the project funders.

CBM; which is an international Christian development organisation, committed to improving the quality of life of people with disabilities in the world's poorest communities.  In the project, they offer technical advisory support, Resource mobilization for Scale-up Phase, incorporating lessons from other CBM supported programs, Monitoring & Evaluation, and sharing tools as appropriate. They also capacity build Basic Needs Basic Rights staff on Disability Inclusive Developments in project and policy planning and implementation.

Ember; which is a collaboration between the SHM Foundation and the Mental Health Innovation Network,  provides mentorship and funding to excellent mental health initiatives in low-resources settings. They are helping in the solidification of our project's model.

Basic Needs Basic Rights Kenya developed the Memoranda of Understanding (MOU) with:
1. Kenyatta University - Directorate of Wellness and Rehabilitation Services
2. Chuka University - Department of Student Affairs

Basic Needs Basic Rights Kenya later engaged other resource partners:
1. Amazing Minds Africa who lead in the arts for mental health component and development of buddy groups.
2. Centre for Assessment, Psychotherapy, and Research (CAPRE), who are our technical partner in building the capacity of the university staff on mental health screening, management and low intensity therapies.

3. Mtoto News International and Zindi; they coordinate a data science competition platform, bringing together a community of data scientists who compete to come up with the best possible solutions. In the project they specifically facilitate the hackathon competition and ensure the delivery of an eventual winning working solution.

Our project relies on getting funded through sustained donations and grants.

It has high levels of integration and buy-in of project approaches into the university. 

Our 2020 total estimated expenses is 200,647.39 USD. 

Cultural beliefs entails the core perceptions that the society has developed towards mental illnesses which in turn is leading to the high levels of stigma surrounding mental health. Consequently, this has led to poor treatment seeking behaviors on matters of wellness, a situation that has led to high levels of suffering and loss of lives to suicide and other deviant behavioral coping mechanisms.

Elevate Prize may assist in our quest to change this narration through the provision of accessible, acceptable, affordable and scalable psycho-social interventions. This is attainable through community-based mental health services and interventions.The evidence to the effectiveness of mental health interventions delivered by non-specialists in community platforms in low- and middle-income countries is increasing in the landscape of mental health. 

This approach offers greater clinical effectiveness through factors such as ongoing contact amongst the target beneficiaries and the benefits from the trust of local internal service providers amongst the university population, probable family involvement, and the huge economic benefits involved being that psycho-social services remain very costly for the normal citizen.

Through this active and inclusive participation of the community, the MH+WB model increases availability and integration of mental health services into the university population and surrounding communities at large. This in turn leads to the promotion of psychosocial services accessibility, acceptability, affordability, and their scalability, consequently leading to the improved stimulation of adherence to treatment and increase in the likelihood of positive clinical outcomes.