understanding attitudes related to mental health in kenya · 2019. 12. 3. · background. • since...

1

Understanding attitudes related to mental health in Kenya

Qualitative Report of Findings

Sep. 2019.

Prepared for: Time To Change Global (TTCG)By: Tabitha Wanja & Joseph Ogeto

Table of Contents

Background

Sample

Summary

Main Findings

• Perceptions of Mental Health

• Associations of Mental Health

• Word association

• RIB analysis

Conclusions

2

Sample design

The sample for the Qualitative study was drawn from the general population i.e.

· People aware of mental health issues

· People with lived experience of mental health

·

The sample further looked at demographic profiles of consumers i.e.

· Age

· Gender

· Social class

3

Coverage

The study was conducted in the capital city of Kenya:

• Nairobi city only---------- 4 FGDs

4

Background

• Since the year 2007, Time to Change Global (TTCG) has been working in England with an aim of ending the stigma and discrimination faced by people with mental health problems.

• In 2018 a new global program was confirmed to work with commonwealth member countries to support people with lived experience, communities, local organizations and nations address mental health stigma and discrimination.

• The global program in conjunction with local Non-Governmental Organizations and people with lived experience in Kenya among other countries will run and evaluate five pilot campaigns and deliver wider global learning and networking on stigma with the production of an international anti-stigma ‘toolkit’.

• Findings of this study will inform social marketing- communications aimed at the larger population to challenge stigma associated with those who suffer from mental health problems.

5

Objective

• To assess the understanding and opinion of mental health issues and the associated stigma.

6

Sample design

• Females aged between 18-25 year olds from the general population

• Mixed group: People with proximity to someone with lived experience of mental health problems (aged 20 years to 65)

• Males: aged between 20-40 year olds from the general population

• Females: aged between 26-50 year olds from the general population

7

SUMMARY OF FINDINGS

Summary of findings

Understanding of project Terminologies

• Mental health is still misunderstood among the sample participants.

• Only a few participants could correctly describe it accurately.

• “…as a state of mind.”

• Majority relate it with mental disorders that they believe are inherent in everyone.

• Mental illness was defined as;

• Sadness, anxiety, lack of confidence, eating disorders, sad thoughts, giving up in life and

manifesting in diseases such as hypertension and diabetes.

9

Summary of findings

Response to reported and intended behavior change (RIB) statements

• Majority of the participants claim they can live with affected persons.

• Only if those people were close relatives receiving medication for their conditions.

• However, a significant number of male respondents would cease relations with their

partners if they developed mental health problems.

• Male participants would be willing to work with people with mental health problems.

• Majority felt they could live with neighbours with a mental health problem.

• They felt the responsibility of caregiving was on someone else.

10

Summary of findings

Drivers of fear, empathy and disengagement

• The main source of fear of people with mental health problems was violent tendencies,

are unpredictability.

• Empathy arose more among those with lived experience with people with mental health

problems.

• Disengagement to people with mental health problems is mostly informed by

helplessness.

• Most participants expressed a lack of knowledge on mental health issues.

11

Summary of findings

Campaign Awareness

• There was no recall of awareness campaigns about mental health.

• The most recalled health campaigns are;

• Polio, malaria and reproductive health issues.

12

MAIN FINDINGS

WORD ASSOCIATIONS & PERCEPTIONS

UNDERSTANDING MENTAL HEALTH

Associations to ‘Mental health’

15

Mental health

Mental health problems

Mental health illness

Depression

Bipolar disorder

•A health condition exhibited by stress, depression•A state of mind

•Escalated mental health condition•Lowered mental capacity•Sudden mood changes

•Madness or an aggravated mental condition requiring medical intervention

• Feeling of hopelessness• Change of normal moods• Feeling of emptiness• Being overly stressed• Lack of confidence/self esteem• Anxiety

• Caused by lack of money• Could be a normal person with high/low self esteem• Caused by substance abuse

Schizophrenia • Being overly aggressive• Disorganized spec

Madness or Insanity

Generally misunderstood

Most people associate mental health to insanity

for lack of information

Response to Reported and Intended Behavior Change (RIB) statements

16

The following RIB statements were tested:

1. Many people aren’t willing to live with someone with a mental health problem

2. Many people don’t want to work with someone with a mental health problem…

3. Many people don’t want to live nearby to someone with mental health problems….

4. Many people don’t want to continue a relationship with someone who develops a mental health problem…..

17

Agree

RadioWord of mouthSign languageDrumsSignals (codes e.g. colour)Newspapers

They are blood relativesHave manageable conditionWilling to take medicationNo violent tendenciesAble to be ‘tamed’ indoorsNot a danger to others

Generally, there is conditional agreement to this statement and participants can only live with such persons where they have no choice.

Agreed only if…

• Majority of the participants agreed with this statement due to fear and lack of knowledge.

Assessment of RIB statements

Many people aren’t willing to live with someone with

a mental health problem

Disagree

Non blood relatives pose a ‘danger’ to others

A few persons feel isolation of affected people is immoral and can only make condition worse.

“... For me it was hell on earth and yet you cannot abandon this person. You feel the urge to abandon them but you just continue, I would say it was by the grace of God that I persevered till the very end and he passed on three to four months ago.”-Female participant, FGD 4.

18

Agree


It was an acute problemThey posed a danger to others

The statement is felt to be inaccurate since majority have no problem working with such people unless they become a danger unto others

Agreed only if…

• Most participants disagreed with this statement since they felt working with affected persons could not affect them adversely.

Assessment of RIB statementsMany people don’t want to work with someone with a

mental health problem…

Disagree

In cases of misconceptions and wrong perceptions people can shun the affected persons

Felt they can work with such people unless they exhibit violent tendencies to others

19

Agree


They become violentAffect them directly on a daily basis

Living near affected persons is not seen as constituting a danger to people unless they exhibit violent tendencies- otherwise majority felt they can live nearby to them.

Agreed only if…

• Most participants disagreed with this statement because they felt being neighbours does not affect them in their homes.

Assessment of RIB statementsMany people don’t want to live nearby to someone with

mental health problems

Disagree

If the affected persons are violent and a nuisance to the neighbours

Majority feel they have options of changing homes if it becomes unbearableThe direct responsibility is on others not them- so they can tolerate living close by the affected person

20

Agree


A long time spouseUnless they are blood relations

Most younger participants claim ending the relationship would be the first option while older participants showed more empathy towards the affected persons.

Agreed only if…

• Most participants agreed with this statement because they felt being in a relationship was dependent on the duration and type of relationship.

Assessment of RIB statementsMany people don’t want to continue a relationship with

someone who develops a mental health problem…..

Disagree

Conditional with type of relationship- if a young relationship, they would quitIf a marriage relationship, with no children, they would leave

Much older participants show more empathy in such instancesLeaving affected people would amount to moral betrayal

PERCEPTIONS OF MENTAL HEALTH

22

• Assessment of Mental Health:

- Participants were asked to group statements into

‘myth’, ‘fact’ and ‘there’s some truth in it’ based on

their feelings and perception.

Perceptions of mental health

23

Statement Fact Some

Truth

Myth Comments

1. We all have mental health × × - The statement is mostly interpreted as ‘mental health problems’ as opposed to just ‘mental health’.

2. The public are rarely at risk from

people with mental health problems × × - It’s seen as a fact that the public is not

exposed to any harm from people with MHPs.

3. Talking about mental health is

important × × - There is consensus that opening up about

MHPs is a step in the healing process.

4. Mental health problems are isolating × - Felt as a fact in the Kenyan situation.

5. We shouldn’t be scared of people

with mental health problems × × - Seen as partially true because in most

cases, people fear persons with MHPs.

6. Mental health problems are very

common × - This is seen as a fact despite the fact that

the public is not aware of these MHPs.

7. People with mental health problems

are not stupid × - There is consensus that indeed persons

with MHPs are not stupid, only suffering from a condition.

8. People with mental health problems

are more likely to harm themselves

than others

× - Seen as true since such people have no mastery of their own mental faculties and pose a danger to themselves before anyone else..

Perceptions of mental health

24

Statement Fact Some

Truth

Myth Comments

9. People with mental health

problems can and do recover - There is a belief that this is a Myth since

‘crazy’ people rarely recover. In a few cases, depending on the degree of the MH condition, they do recover.

10. People with mental health problems have brought it on themselves by not taking care of themselves

- This is unanimously seen as a myth and untrue across all FGDs


problems can’t manage their

lives – if they do manage then

they’re not unwell

× - Most seen as a myth since MHPs are not self-inflicted and some of these persons can manage their own lives.


problems should stop moping

about and get out to work like

the rest of us

- Seen as an untruth because such people do not understand themselves.

13. A lot of people with mental

health problems are just lazy × - Mostly seen as true in the Kenyan context

as MHPs are believed to be a form of ‘craziness’

14. Depression is an excuse for

everything × × - This is seen as partially true as the public

does not understand MHPs


problems should snap out of it × × - Unanimously agreed as a myth as it’s

impossible for anyone to get out of a MHP situation.

16. If you suffer from a mental

illness you are weak × - Largely seen as having some truth since

one’s personality can determine whether one gets a MHP or not. e.g. divorce, death

17. If I talk to someone who has a

mental illness I might make it

worse

- - - Seen as partially true as people believe engaging a sick person might trigger more problems.

25

Talking about Mental health is seen as part of the healing process

“Yes, my opinion is …it depends on who the person is to you. I can’t leave them, even if I don’t have money, I’ll try my best to organize on how they will get help. If it’s to take them to the hospital, take them for counseling or anywhere where they can be helped. Its true many people don’t want to continue relating with them but it always depends on who they are to you”

Most statements selected as factual was due to the agreement that empathy as opposed to isolation would be a better healing process for affected persons.

Perceptions of Mental health

26

Both Mental and practical barriers towards MH combine to militate against overcoming negative social perceptions towards MH in Kenya.

PERCEPTION

SOCIAL SAFETY NETS BELIEFS ON MH

MENTAL HEALTH BELIEFS

POSITIVEMental Health

“Most of us don’t know about mental health. Mental health is equal to madness for most of us…”

Mental barriers to MH

•Belief that it is madness

•It’s a result of being bewitched

•Lack of accurate information on what constitutes

MH

“…Every time we see a mad person, that is what “mental” means to most of us…no one understands MH except when seen as being mad.”

Practical barriers to MH

•Lack of awareness

•No information in the public domain

•Social stigma associated with MH conditions

Analysis summary of Mental health

27

Facts Truths Myths Remarks

Males ― Grapevine information and peer

speak about MH informs reality

to youthful males

― No expert validation of beliefs

No clear information

in public domain

Result of

misinformation &

rumours

Most beliefs informed by lack of

information.

No clear information on what constitutes

fact versus Truth hence giving way to

myths and rumours.

Females ― No expert information

dissemination on MHNo clear information

in public domain

Result of

misinformation &

rumours

Social support groups and

misrepresentation of facts on MH

contribute to negative beliefs

Females ― Despite being close to medical

facilities & regularly visiting the

facilities, no clear information on

MH is received.


in public domain

Result of

misinformation &

rumours

Older females tend to rationalize choice

of statements due to misinformation

Mixed gender

(with lived

experiences)

― All information on MH has been

through the lived experiences

― Have been able to identify facts

about MH


in public domain

Result of

misinformation &

rumours

Mostly driven by empathy towards

affected persons lived with- this group

exhits more underatsnding than others.

The cultural beliefs inform most of the perceptions about the mental health statements exposed to the participants- There exists an urgent need to validate or invalidate beliefs

Analysis summary of Mental health

28

What informs MH beliefs & perceptions?

Rumours & wrong, negative perceptions about MH can

be countered through medical facts

MH is a redeemable condition but people need information on what is MH-“WE DON’T KNOW WHAT IS

MH.”

Empathy, compassion & understanding affected

persons can lead to better understanding of MH.

MH is madness, incurable, insanity

MH can be dealt with if identified at early stages but

how?

Males-younger

Males- OlderFemales

Mixed group- with lived experience

GAP?

Facts vs. Myths

29

CULTURAL BELIEFS

TRUTHS

RELIGIOUS/SPIRITUAL BELIEFS

OTHERS

MEDICAL FACTS ON MH

Need to relook at all militating elements against MH and communicate with facts to counter the negative beliefs affecting MH in Kenya.

Currently, MH perceived negatively in Kenyan society with no supports systems away from the close family.

How do we move perceptions to a more accommodative realm and have acceptance of MH as a condition?

WHAT AROUSES FEAR ABOUT MENTAL HEALTH?

What arouses fear about MH?

31

Erratic behaviour

Violence

Negative cultural beliefs

Myths ‘spiritual’ beliefs

•People fear harm from affected persons•Not being able to predict their behaviour elicits fear

•Fear of getting harmed makes people fear MH victims•Inability to contain affected persons elicits fear

•Strong socio-cultural beliefs about MH makes people fear affected people

• Fear of being bewitched• Spiritual attacks due to ‘sin’• Association with evil spirits

…these people cannot be predictable, they can do something drastic at any time…if you don’t know them, its very scary.-Female, 35 years (FGD 2)

What makes one uncomfortable about MH?

32

•Lack of clear information about MH•Rumours about causes of MH

•Fear of association with MH•Association with affected people•Social exclusion of victims and families

•Lack of expert advice and support•Continued reinforcement of wrong beliefs

• Negative image of victims• Usually unkempt nature makes one

uncomfortable to associate with them• Erratic behaviour of victim

Misconceptions

Social stigma

Negative cultural beliefs

Image of victims

…in my family, we have a MH case, it takes so much time and effort to take care of them…when its your turn to care for him, it’s a bit uncomfortable but again it’s a parent so you have to do it.-Female, 25 years (FGD 2)

33

Awareness of MH campaigns

The majority of the participants do not recall any communication campaign about Mental health.

Most respondents have not seen or heard of any MH communication in the media or in health facilities.

There is equally a lack of targeted communication from experts on mental health- access to these experts is felt to be challenging and expensive.

Among participants with lived experiences of MH, they claim every information they have on MH has been through personal initiatives through;

– Visiting MH facilities and experts

– Research through the internet

– Sharing information through support groups of people with similar experiences

34

Awareness of MH campaigns

35

The Insights…

Conclusions

• Mental Health still a misunderstood phenomenon among Kenyans and in the Kenyan society.

• Separating facts from myths could gradually move people to understand what MH is about, accept and know how to deal with the conditions.

• Generally the society shows accommodative nature of affected people- Knowing more and better about MH could trigger better addressing of MH among people.

• Exploring ways of addressing MH conditions- at the work place, in the community could assist in demystifying MH conditions.

• General education about the condition and its manifestation can in the long run address the social stigma associated with MH.

36

Recommendations

• Targeted communication on facts about metal health.

• Consumer education on Mental health is a prerequisite to addressing social stigma about MH.

• Publicly addressing and talking about MH could demystify the condition.

• Consider offering updated information on help centres (that work) and access to experts on MH.

37

understanding attitudes related to mental health in kenya · 2019. 12. 3. · background. • since...

Documents