1. By Dr M Makanyengo

2. ‘ the state of complete ‘Physical Mental and Social Well Being’ and not merely the Absence of disease and infirmity’

3.  A state of well –being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community

4. The Mental illness now account for 13 % of the global burden of disease, Up from 11 % in 1990. Expected to rise to 15 % by 2030. It is estimated that 450 million people worldwide have a mental disorder and that at any given time 10 % of adults are experiencing a current mental disorder ; And that 25 % will develop one at some point during their lifetime.

5.  Vision ◦ A Center of Excellence in the provision of innovative and specialized mental health care in Kenya  Mission ◦ To provide specialized quality health services, facilitate mental health care training, research and participate in the National

6. CadreArea of specialisationNumber PsychiatristsChild and adolescent services Adult services Youth 231231 PsychologistsAll round2 Nurse counsellorsgeneral9 HIV Pact Coe counselors Psychological support/ adherence counselling 5 Medical officerNone for GBV and alcohol rehab0 Social worker/sAll round1 SecretaryAll round1 AdministratorPartial availability1 Support staffgeneral2 Medical recordsClerk1

7. Site of Service provided in KNHNumber seen Adult Psychiatry Clinic 231241 Department of Mental Health1976 Youth Center (MH/RH)3191 Inpatient mental conditions174 Total 2013 (Jan to Dec)6582 Special Staff services Human Resource Department (Oct 2013 to Mar1014 (sessions given) 140 from 57 clients

17.  Started Jun2013  1 full time psychologist engaged and overwhelmed  Services provided ◦ Individual Counselling Services ◦ Organizational counselling Services

19.  Ongoing since 2006  Over 8000 survivors seen since the start  Awaiting renovation from MOH GDP  Policy not yet approved although forwarded to the Board  Strategic plan available for over 1 year  Ongoing research inplace between UON and KNH staff

20.  Proposal/policy paper forwarded to KNH Board for implementation  Still; awaiting feedback

21.  Urgently needed for KNH to manage inpatient mentally ill with underlying medical conditions  High risk of suicide in KNH due to wards in tower block which are not secured or safe.  Meanwhile very violent staff are being taken to Nairobi West Hospital (though not yet formalized)

22.  Center of excellence for national Training and mentoring in collaboration with UON  Research, consultancy and participation in national guidelines and policy formulation  Income generating potential ◦ Drug and Alcohol rehab services ◦ GBV services/MOH/GDP ◦ Research grants

23. Staffing uptake of new younger psychiatrists to take over Urgent need for psychologists (Currently severely understaffed. Staff establishment for Psychologists and mental Health services in general Policy approval for rehab and GBV Policy approval for mental health unit – General and Private Wing

24. No safe or secure wards for inpatients. Patients commit suicide despite mental health services – KNH staff with mental disorders (Spending 4 million per year in Avenue hospital) – High demand from inpatients who are civil servants and do not want to go to Mathare Hospital – High demand from the general public who cannot afford private hospitals and prefer KNH and are ready to pay

25. WHO guidelines, world standards – Mental health is part and parcel of holistic care Cap 248 laws of kenya – Establishment of mental units in all hospital at least 2 beds or more Bill rights addresses the needs to establish the highest attainable standard of health care Establishment of rehab centres at each county within 3 months recent decree by His Excellency the President

26.  THANK YOU