Today is world suicide prevention day and in many parts of the world we share resources and numbers to hotlines for people to get help when in a crisis. This is such a critical strategy as stigma and resistance to help-seeking is a critical barrier for reducing suicide deaths. Making the information and services readily available for persons in need is a key prevention priority. It simply just means we need to inform people so that they know what to do, who to call and where to get help. In the US, as an example, we can call the 988 number which is the Suicide and Crisis Lifeline. We have a range of short and longer term treatment strategies to support a person in crisis. In fact we even have population level prevention strategies to reduce suicide deaths.
Photo: A poster on a wall of a youth center to urge help-seeking in Uganda.
These strategies are based on decades of research primarily in the U.S. and in Europe and across disciplines. Some of these research studies are public health oriented and focus on the predictors and correlates of suicidal behaviors and death. In essence, some of this is very pragmatic public health research that seek to increase our knowledge and pinpoint those at highest risk, how to allocate resources, and also to guide treatment and prevention strategies. But, in many other parts of the world, such research remains scarce. In fact there often is no hotline or number to call when in crisis and there are also a tremendous shortage of mental health services.
One of my friends and colleagues in Nairobi, Dr. David Ndetei (Professor at University of Nairobi) who is likely the most highly regarded and prolific psychiatrist and researcher across Africa (last I counted he had about 400 publications) says, that if we are to wait until there are enough psychiatrists and psychologist to address the unmet mental health needs across Africa, we may need to wait for hundreds of years. (Dr. Ndetei is also the Director for the Africa Mental Health research and Training Foundation).
The point is well made. In low resource settings, it is unrealistic to assume that mental health can be a key priority when there are so many other urgent and compelling needs. Mental health issues are less known and something most people don't talk about. The stigma is real. So, it is very hard to know how many people are impacted, what the needs are and how to allocate those resources available. And, as such, many government prioritize other concerns that have stronger advocates and where the needs can be more clearly articulated.
Kenya has really become a model for mental health in terms of developing plans and policy. They have a mental health policy in place (Kenya Mental Health Policy 2015-2030: Towards attaining the highest standard for mental health). This summer, the Kenyan President also signed the Mental Health Act 2022 into law after it was unanimously passed by the Kenyan Senate. This is transformative progress and something to be celebrated.
While I was in Kenya a few months ago, I had an opportunity to meet with Hon. Senator Sylvia Kasanga who sponsored the Mental Health Amendment Bill in the Senate and who also was a champion for its enactment. For any transformative change, there is a need for a champion to lead and push the way, and she is a passionate, committed champion who has worked tirelessly to achieve this goal. It really was an honor for our Kennesaw State team (Drs. Kandice Porter and Chris Emerson and also our community partner Charles Chandia) to meet with her.
In Photo: Charles Chandia, Dr. Kandice Porter, Dr. Chris Emerson, Hon. Senator Sylvia Kasanga. Dr. Monica Swahn & Dr. David Ndetei.
The purpose of our visit to Kenya was to determine how we could best strengthen the mental health services in Makueni County, one of the most diverse and poor counties in Kenya. As a psychiatric epidemiologist, I have conducted suicide prevention research for over 20 years both in the U.S. but also in the global health context. So it was with that background we teamed up with Dr. Ndetei and Dr. Mutiso who have conducted extensive research on a range of mental health concerns across sectors in Makueni county for decades.
During our visit we had a chance to meet with the Governor, visit hospitals and clinics to determine how we can scale up services and evaluate if they work. As a first step, we're thinking of a pretty large, multi-component research project, so meeting with a range of stakeholders and facilities were key.
We were so impressed with the engagement with the Ministry of Health and the lead Psychiatrist in Makueni county. They have really been proactive and were so insightful and thoughtful with the resources they have and they also embrace a partnership approach.
We were also impressed with the training that community health workers had received in the past by Dr. Ndetei and his team, using the WHO tool, the mhGAP. The mhGAP is developed to scale up mental health services specifically in low-resource settings.
Transforming mental health care through research, interventions and new services require partnerships. And, that is what our trip was all about, we met stakeholders across sectors and we talked to those delivering care. We visited communities, hospitals and clinics to see how we can assist. As we say in Uganda, you have to network with your feet.
In Photo: Drs. Monica Swahn, Victoria Mutiso, Chris Emerson & Kandice Porter
So, on this World Suicide Prevention Day we reflect on our partnerships and the importance of the work ahead. we can all do something. But, in our Wellstar College of Health and Human Services, addressing health disparities and unmet mental health needs are key priorities. And, in my Integhral research lab, we have published many papers on various aspects of suicide which have informed prevention and intervention strategies primarily in Uganda. We are also conducting a large NIH funded study to understand the social drivers of mental illness (#TOPOWAproject). So, if you are interested in this type of research, always feel free to reach out, we are always looking for collaborators.
Because that is what it takes for all of us to to make a difference, we need to partner and we need to care. We all know someone who needs help. We all can do something.