Sunday, November 1, 2009

MENTAL HEALTH IN AFRICA: KENYA’S MATHARI HOSPITAL

This past week’s AHPIG meeting focused on mental health in Africa. While exiting the meeting, a fellow graduate student commented that the discussion was lively and raised pertinent issues on the subject. Two journal articles on public perceptions of mental illness in Kenya, and lay beliefs regarding causes of mental illness in Nigeria served as foci for discussion (Adewuya & Makanjuola 2008; Muga & Jenkins 2008). There was not a shortage of contribution from those present; comments were mainly regarding stigmatization of the mentally ill and the dearth of knowledge of mental health issues amongst the lay public in African countries. As the discourse evolved the similarities between our experiences came to light. Everyone present was familiar with an infamous institution for the mentally ill, in whichever African country they knew best, where inpatients are allegedly treated inhumanely. Some of those present shared commonly circulated tales of mistreatment at these institutions. By the end of the meeting it dawned on me that I did not know much about my own country’s infamous mental health institution - Mathari hospital. To satisfy my curiosity about Mathari hospital, I embarked on an internet research project to unearth some details about this institution’s history.

Mathari hospital was known as Mathari mental hospital (1924-1964); it was also formerly called the Nairobi Lunatic Asylum, a center opened in July of 1910 at the site of a small pox isolation center that was closed earlier that year (Kiima et al. 2004). During the colonial era in Kenya, Mathari housed in-patients from each of the 3 major race classes in the country, Africans, Europeans, and Asians. Care of in-patients and rationale for admission was race-based. The different races received different diets and residents of the European section tended to be alcoholics. Mathari hospital housed people who, for myriad reasons not specifically related to psychiatric illness, were deemed unfit to coexist with the general public based on outdated legislations such as the Indian Lunacy Asylums Act of 1858 (McCulloch 26). As cited by McCulloch “[t]hroughout the 1920s Mathari was simply a holding centre for acutely disturbed Africans and chronically ill Europeans” (21). In 1958 at least 10% of the residents of Mathari had committed serious criminal offences (28). Perhaps this explains why even today Mathari hospital is a maximum security institution. A recent article in the Daily Nation, a Kenyan newspaper, reported that some of the inpatients with a criminal history were destined to languish in Mathari hospital for fear that they would commit more crimes or because their families would not take them back (Okwemba 2009).

Like many mental institutions in Africa Mathari hospital has the reputation of being an inhumane place. Perhaps the inhumanity associated with Mathari was a result of the scant resources. Since the 50s the hospital was not adequately equipped with space and expertise for the needs of its residents. In 1958, with 700 total residents, there were 200 more patients than the hospital could accommodate. In 1960 the patient to staff ratio was about 1:11 and only 16% of the staff had formal qualifications. However, McCulloch posits that Mathari’s infamous reputation may be attributed to the fact that the only historical files of the institution available in National Archives chronicle the insanity of past European inpatients. This reputation stems from reports of “the fragility of settler families and the intensity of the stigma which, throughout the colonial era, was attached to mental illness” rather than case histories of the African in-patients who may have had a different experience (28).

The leadership at Mathari hospital has historically comprised of psychiatrists. In the colonial era these tended to be of European origin. One of the medical superintendents at Mathari hospital, James Cobb, who was eventually persuaded to retire on the grounds of ill health, proves to be an intriguing character in the institution’s history. As cited by McCulloch:
Cobb came from a good family and was a personal friend of the Prince of Wales. He was also alcoholic, homosexual and thoroughly eccentric. … Cobb kept a Great Dane named Obe in the hospital compound and also obtained two lion cubs. He was constantly drunk and was given to arriving at the hospital late at night with his drinking companions, entertaining them by showing off the more interesting inmates. … According to Colin Carothers who replaced Cobb as medical superintendent, Cobb was actually ‘having sex with one of the animals’ (23)
Colin Carother’s contributed to a rights based approach to admissions and care for inmates at Mathari. His efforts culminated in the revision of the Indian Lunacy Asylums Act, allowing for voluntary admission of those over 16 years while they retained the right to leave, amongst other stipulations (McCulloch 27). Interestingly Carother’s, who studied psychiatric issues in Africa, contended that the normal African “more closely resembles the European child” and that “normal African mentality resembles that of European psychopaths” (Carothers 1951).

Currently Mathari hospital is referred to as Mathari Psychiatric Hospital, a national referral and teaching psychiatric hospital. It has 600 beds and admits patients whose behavioural disturbances cannot be managed within the community or by their relatives who are too poor to seek treatment in private facilities (Ndetei et al. 2008). As discourse on mental health issues becomes less riddled by stigma I hope that the untold stories confined within the heavily guarded Mathari hospital will come to light.



REFERENCES

1) Adewuya, A. and Makanjuola, R. (2008) Lay beliefs regarding causes of mental illness in Nigeria: pattern and correlates. Soc Psychiatry Psychiatr Epidemiol, 43, 336-341.
2) Carothers, J. (1951) Frontal lobe function and the African. J Ment Sci, 97, 12-48.
Kiima, D., Njenga, F., Okonji, M. and Kigamwa, P. (2004) Kenya mental health country profile. Int Rev Psychiatry, 16, 48-53.
3) Muga, F. and Jenkins, R. (2008) Public perceptions, explanatory models and service utilisation regarding mental illness and mental health care in Kenya. Soc Psychiatry Psychiatr Epidemiol, 43, 469-476.
4) Ndetei, D., Pizzo, M., Ongecha, F., Khasakhala, L., Maru, H., Mutiso, V. et al. (2008) Obsessive-compulsive (oc) symptoms in psychiatric in-patients at Mathari hospital, Kenya. Afr J Psychiatry (Johannesbg), 11, 182-186.
5) Okwemba, A. (2009) Anguish of Mathari inmates rejected by society. Daily Nation, Nairobi: Nation Media Group.

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