Pamoja Initiative

The Pamoja Initiative has been bridging the gap between the need for mental health treatment by targeting the poor and marginalized in the community who are left out by mainstream mental health service providers.  This is currently achieved through a stepped care approach where both specialists and advocates with lived mental health experience work together to improve access to services at the grassroots. The peers offer peer support and peer counseling in a unique way – blending lived experience and training and they are supported by specialists for referral, supervision and training.

Through these efforts, over 10,000 Kenyans have received free/affordable therapy, diagnosis and treatment, and social support for those in recovery. This gives them an opportunity to be productive members of the community. If this initiative is able to improve its capacity to offer such services, it will ultimately reduce the mental health treatment gap in the country.

More than 13% of the global burden of disease for mental disorders is due to neuropsychiatric disorders, and over 70% of this burden lies in Low-and Middle-Income Countries (LMICs). Suicide is one of the leading causes of death globally for all ages. Despite this burden, mental illness has not achieved commensurate visibility, policy attention or funding, particularly in LMICs.

In Kenya, only 0.01% of the annual health budget goes to mental health. This is compounded by the fact that there are only 62 government psychiatrists serving 47 million Kenyans. In addition, the total number of health workers per 100,000 population is 0.19 (WHO 2017).

The Pamoja initiative has taken up this momentous challenge to ensure that the underserved populations  have a chance to receive professional help when ill and that the stigma in the community is reduced to enable those with mental illness access work and don’t get discriminated. It has been bridging the gap between the need for mental health treatment by targeting the poor and marginalized in the community who are left out by mainstream mental health service providers.  

Pamoja Initiative 

Mental illness can be a very lonely place to be, especially when no help seems to be forthcoming. Pamoja means ‘we are one’ in Kiswahili. It is about reaching out and bringing help to the many who suffer.

Pamoja Initiative is a community  innovation through which we bridge the gap in mental health treatment and care at the grassroots. It provides a platform for psychologists and people with lived mental health experiences to volunteer their time to help our community overcome the biggest barrier to treatment– access (cost and distance). This will equip communities with the capacity to respond to emerging pandemics and health security threats particularly the low-and middle-income countries like Kenya.

 It has 3 pillars;

• Task-shifting - using a stepped care approach where peers are trained as task-shifted lay counsellors in their community.
• Telepsychiatry - using a video link to connect task-shifted peers and their clients at the community with specialists (psychiatrists and psychologists) locally and abroad.
• Cultural adaptation –the model is culturally sensitive and has adapted interventions refined through feedback from local stakeholders and  Persons with Disability (PWD).

The Pamoja Initiative targets the poor and marginalized in our community who are left out by mainstream actors. Our beneficiaries are largely drawn from people living in low income settings, vulnerable adolescents, PLWHIV, prisoners, drug users, sex workers, GBV survivors, survivors of disasters such as the #SolaiDam disaster that claimed 47 lives.

The initiative provides a platform for psychologists and people with lived mental health experiences in the community to volunteer their time to help other members of the community overcome the biggest barrier to treatment– access (cost and distance).

It intends to expand its capacity to meet the rising demand of mental health services in Kenya focusing more on the socially disadvantaged who were worst affected by COVID-19. Through this initiative,underserved Kenyans will be able to receive affordable, accessible mental health services and psychosocial support at their doorstep from the mobile telepsychiatry unit – Wellbeing Lounge .

 Additionally, it hopes to expand the reach (from the current 856) and range of psychosocial interventions for health workers deployed at COVID-19 isolation units across Kenya. They continue to face exceptional mental stress due to stigma by their communities for being potential carriers of the virus and carry the psychological burden of processing COVID-19 fatalities in their hospitals. 

Distress is inevitable in communities experiencing pandemics and their aftermath. In LMICs,the mental health aspect is ignored during emergency response. 

The Pamoja Initiative, through the stepped care approach provides evidence based proof that peer training of people with lived experience and telepsychiatry services help fill in the mental health treatment gap in the community. 

This is in line with the challenge's need to equip communities with the capacity to respond to emerging pandemics and health security threats. It helps combat stress, depression and other mental impacts of disease outbreaks that have detrimental impacts in the long run such as PTSD.

Over the last three years, the Pamoja Initiative has gone through a process of iteration, learning, evaluation and implementation. It has been proved to work and was featured in the UNAIDS Ten Global Community Innovation booklet of 2020.

The Pamoja Initiative's biggest strength and unique selling point is its approach which integrates two very critical skills set in its programming – expertise by lived experience and expertise by training. It is an initiative run by the Psychiatric Disability Organization of Kenya which is a user-led mental health organization founded by people with lived experience and psychotherapists. This means that is uniquely placed in understanding the needs and support necessary in its service provision. 

This innovation is as a hybrid model that brings on board the versatility of mental health unit on wheels, and the efficiency and affordability of digital telepsychiatry services. The technology enables the initiative to connect its local non-specialist mental health lay workers at the grassroots with specialists (psychologists and psychiatrists) located far away via video conference technology enabling underserved communities to access high quality services at their doorstep.

The innovation has won accolades internationally including being featured in the UNAIDS Ten Global Community Innovation booklet of 2020. 

 The Initiative has trained over 420 community mental health workers and peer advocates, and has worked with 36 therapists. We have liaised with specialists to provide treatment to 400 patients with severe mental illnesses and provide therapy and social support to over 10,000 clients. We have also provided psychological services to 856 COVID-19 health workers. 

It intends to expand its capacity to meet the rising demand of mental health services in Kenya focusing more on the socially disadvantaged who were worst affected by COVID-19. The solution will be providing 2,000 underserved Kenyans with high quality mental health and psychosocial support services majority of them at their doorstep from the mobile telepsychiatry unit. This figure will grow by 50% every year and hit a total of 20,000 in five years. 

The indicators we use to measure our progress toward the impact are:

1.The increase in the number of people with lived experience trained as peer counselors to provide lay counseling in the community.

2.The increase in the number of trained community health workers who carry out advocacy on mental health in the community

3.The number of referrals through the stepped care approach and the number of people referred through the telepsychiatry mobile unit.

4.Self reports by community members showing demonstrated improvement on their psychosocial wellbeing.

Full time staff-10

Part time staff:32

Community mental health workers:30

Peer advocates:15

The Pamoja initiative integrates two key skills in its programming; expertise by lived experience and expertise by training. The organization behind it, PDO Kenya, was founded in 2016 by people living positively with mental health conditions in Nakuru, Kenya. Majority of the highly skilled psychotherapists, mental health champions, staff and volunteers that make up the team of the Pamoja Initiative are people with mental health lived experience. This is a clear indication that our team is representative of the population we serve. It also places our team in a unique position in terms of input, ideas, agendas and implementation of its services in relation to the community it serves.

The initiative is in a better place to understand the needs and support necessary in its service provision. It offers services that are Affordable (subsidized prices for drugs, therapy and consultation), Accessible (mobile mental health clinic unit hence able to make services available to rural areas), Accommodative, Available (offers face to face interactions and tele psychiatry) and Acceptable (Peer friendly hence able to reach a high number of young individuals).

Pamoja Initiative embraces the power of lived experience and psychosocial disability in all structures and programs which makes it stand out. Ideally, it demonstrates a great breakthrough in challenging pervasive mental health stigma. It is user-led going against the widely held misconception about abilities of people with psychosocial disabilities and mental health lived experience. Majority of its members; staff and volunteers are people with mental health lived experience. 

It also employs a non-discriminatory policy by employing individuals who are diverse with reference to race, ethnicity, religion, gender and disability(psychosocial). This policy also extends to its service provision. 

The initiative also demonstrates intersectionality by providing free/affordable therapy, diagnosis and treatment, and social support for the poor and marginalized in the community who are left out by mainstream mental health service provider

10.8% of Kenyans suffer mental illness at any time with WHO estimating that the treatment gap is as high as 85% in low and middle-income countries (LMICs) like Kenya. For the poor and the marginalized communities in Kenya, mental health services are virtually inaccessible. It results in a loss in  productivity and unprecedented human suffering to those affected, their families and their community hence worsening their already disadvantaged socio-economic situation.

 By applying to Solve, the Pamoja Initiative intends to address the financial barrier that is limiting its ability to expand its capacity to meet the rising demand of mental health services in Kenya especially among the socially disadvantaged who were worst affected by COVID-19. 

 Additionally, if this barrier is overcome, the initiative will be able to support a range of psychosocial support services for health workers deployed at COVID-19 isolation units across Kenya who continue to face exceptional mental stress due to stigma by their communities for being potential carriers of the virus.

To expand our capacity to provide quality mental health services, we would require more funding and capacity building in terms of human capital such as through board trainings.

MIT faculty, mental health initiatives and Solve members.