DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20221516

Barriers to mental health services utilization among outpatient clinic attendees at Mathari National teaching and referral hospital, Nairobi City, Kenya

Chelelgo Kibichii Victor, Munyoki Muima Gilbert, Onyambu Meshack Ondora, Khisa Otieno Abel

Abstract


Background: World health organization defines mental health as a state where people realize and recognize their capacities, cope with life stressors, and contribute positively to the society. A gap exists between the need or demand for mental health services and their utilization due to a set of barriers that limit access. The prevalence of mental illnesses is approximately 10%. The study sought to investigate barriers to utilization of mental health services.

Methods: The study used mixed-method research approach that is cross-sectional descriptive and qualitative study design. The study was conducted at Mathari national teaching and referral hospital outpatient clinic. Structured questionnaires and key informant interviews were used to collect data. Study participants comprised 216 caregivers of mentally ill patients and 6 key informants.

Results: Costs of seeking mental health services is a barrier to accessing these services at the MNTRH outpatient clinic. More than half of the participants missed their clinics due to cost of medication, 56% (n=120), consultation costs 55% (n=118), and transport=54% (n=116). Caregivers sought other types of mental health services such as spiritual healing before taking their mentally ill relative for formal care. People with mental illness experienced social stigma 59.3% (n=128).

Conclusions: The cost of mental health service access and stigma are the outstanding barriers to access and utilization of mental health services.

 


Keywords


Barriers, Mental health, Utilization, Outpatient clinic, Kenya

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References


Depression and Other Common Mental Disorder: Global Health Estimates. Available at: http://apps.who.int/iris/bitstream/10665/254610/1/ WHO-MSD-MER-2017.2-eng.pdf?ua=1. Accessed on 20 November 2021,

Frost DM. Hostile and harmful: Structural stigma and minority stress explain increased anxiety among migrants living in the United Kingdom after the Brexit referendum. J Consult Clin Psychol. 2021;88(1):75-81.

Bruwer B, Sorsdahl K, Harrison J, Stein DJ, Williams D, Seedat S. Barriers to mental health care and predictors of treatment dropout in the south african stress and health study. Psychiatr Ser. 2017;62(7):774-81.

WHO IRIS: World Health Statistics: Monitoring Health for SDGs. Available at: http://apps. who.int/iris/bitstream/9789241565486-eng.pdf?ua=1. Accessed on 20 November 2021.

Mental Illness and the Family: Recognizing Warning Signs and How to Cope. Available at: https://www. mhanational.org/. Accessed on 20 November 2021.

Ali SH, Agyapong VIO. Barriers to mental health service utilisation in Sudan - perspectives of carers and psychiatrists. BMC Health Serv Res. 2016;16:31.

Rathod S, Pinninti N, Irfan M, Gorczynski P, Rathod P, Gega L, Naeem F. Mental Health Service Provision in Low- and Middle-Income Countries. Health Serv Insights. 2017;10:117.

Samouilhan T. Outside the cuckoo's nest: investigating the reasons behind African male engineering students' under-utilization of mental health services. Psychiatr Ser. 2015;60(1):774-81.

Kenya Mental Health Policy, 2015-2030: Towards Attaining the Highest Standard of Mental Health. Available at: https://repository.kippra.or.ke/. Accessed on 20 November 2021.

Musyimi CW, Mutiso V, Ndetei DM, Henderson DC, Bunders J. Mental Health Outcomes of Psychosocial Intervention Among Traditional Health Practitioner Depressed Patients in Kenya. Cult Med Psychiatry. 2017;41(3):453-65.

Mental Health and Wellbeing towards Happiness & National Prosperity. Available at: Ministry of Health. https://www.pdokenya.org/uploads/8/0/2/8/80287644/taskforce_on_mental_health_report__web_1_.pdf. Accessed on 20 November 2021.

Mental health Taskforce urges government to declare mental health a national emergency Nairobi. Available at: https://www.health.go.ke/mental-health-taskforce-urges-government-to-declare-mental-health-a-national-emergency-nairobi-tuesday-july-7-2020/. Accessed on 20 November 2021.

Okasha A. Mental health in Africa: the role of the WPA. World Psychiatry. 2002;1(1):32-35.

Kenya Mental Health Policy, 2015-2030: Towards Attaining the Highest Standard of Mental Health. Available at: https://www.frontiersin.org/. Accessed on 20 November 2021.

Muhorakeye O, Biracyaza E. Exploring barriers to mental health services utilization at kabutare district hospital of Rwanda: perspectives from patients. Front Psychol. 2021;12:638.

Cyril S, Smith BJ, Possamai-Inesedy A, Renzaho AM. Exploring the role of community engagement in improving the health of disadvantaged populations: a systematic review. Glob Health Action. 2015;8:29842.

Carbonell Á, Navarro-Pérez JJ, Mestre MV. Challenges and barriers in mental healthcare systems and their impact on the family: A systematic integrative review. Health Soc Care Community. 2020;28(5):1366-79.

Smith JA. Qualitative psychology: A practical guide to research methods. India: Sage; 2015.

Mental Health and Wellbeing towards Happiness & National Prosperity. Available at: https://www.pdo kenya.org/uploads/8/0/2/8/80287644/taskforce_on_mental_health_report__web___1_.pdf. Accessed on 20 November 2021.

Medication adherence improve patient outcomes and reduce costs. Available at: https://edhub.ama-assn.org/ steps-forward/module/2702595. Accessed on 20 November 2021.

Chow SC, Shao J, Wang H, Lokhnygina Y. Sample size calculations in clinical research. United States: Chapman and Hall/CRC; 2017.

Vasileiou K, Barnett J, Thorpe S, Young T. Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. BMC Med Res Methodol. 2018;18(1):148.

Nyblade L, Stockton MA, Giger K, Bond V, Ekstrand ML, Lean RM, et al. Stigma in health facilities: why it matters and how we can change it. BMC Med. 2019;17(1):25.

Minding the Gaps: cost barriers to accessing health care for people with mental illness. Available at: https://www.ranzcp.org/files/resources/reports/minding-the-gaps-cost-barriers-to-accessing-health.aspx. Accessed on 20 November 2021.

McCann TV, Mugavin J, Renzaho A, Lubman DI. Sub-Saharan African migrant youths' help-seeking barriers and facilitators for mental health and substance use problems: a qualitative study. BMC Psychiatry. 2016; 16:275.

Ali SH, Agyapong VIO. Barriers to mental health service utilisation in Sudan - perspectives of carers and psychiatrists. BMC Health Serv Res. 2016;16:31.

Priester MA, Browne T, Iachini A, Clone S, DeHart D, Seay KD. Treatment Access Barriers and Disparities Among Individuals with Co-Occurring Mental Health and Substance Use Disorders: An Integrative Literature Review. J Subst Abuse Treat. 2016;61:47-59.

Ariam H, Abburi A, Chukwuemeka NB, Jackson K. Mental health and the stigma. Available at: https://www.physio-pedia.com/Mental_Health_and theStigma. Accessed on 20 November 2021.

Medication adherence improve patient outcomes and reduce costs. Available at: https://edhub.ama-assn.org/steps-forward/module/2702595. Accessed on 20 November 2021.

Knaak S, Mantler E, Szeto A. Mental illness-related stigma in healthcare. Healthcare Manage Forum. 2017; 30(2):111-6.

Lannin DG, Vogel DL, Brenner RE, Abraham WT, Heath PJ. Primary caregiver cultural humility, racial identity, and mental health for multiracial people. J Counsel Psychol. 2015;66(3):269-79.

Rasmussen JD, Kakuhikire B, Baguma C, Ashaba S, Cooper-Vince CE, Perkins JM, et al. Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda. PLoS Med. 2019;16(9):e1002908.