Stigma towards mental illness and the mentally ill in a rural community in Kenya
Introduction: Stigma is a mark of disgrace or discredit that sets a person aside from others. It is a term of prejudice based on negative stereotyping. It is based on the perception of a difference which is ultimately linked to negative traits. The stigma of severe mental illness exacerbates the patients' burden caused by the illness. It plays a negative role at every stage of the illness from presentation and diagnosis to treatment and outcome. It makes many people reluctant to seek help and less likely to cooperate with treatment and slows recovery. Because of this, The Mental Health act (1989) established The Kenya Board of Mental Health to among other objectives, address mental health related stigma. Objective: To obtain information on the current level of knowledge, attitude and practices regarding mental health in the general population in Kenya. This study aims at generating information in this field with special focus on stigma in the general population to fill the current knowledge gap, compare results with similar studies and make appropriate recommendations. Setting: The study was conducted at Kamburu sublocation in Central Province, Kenya. Sampling: The sublocation was divided into eight clusters and four of them were randomly selected. Consecutive sampling was done till the minimum sample size per cluster was attained. Methodology: The study design was crossectional descriptive in nature targeting 384 male and female household heads who consented to participate in the study. Data was collected using a researcher designed social demographic questionnaire and the Office for National Statistics (ONS) questionnaire on perceptions about mental illness. Data handling: Data was edited, coded and entered into a computer. It was analyzed using the Statistical Package for Social sciences version 12 programme and the results were presented in form of descriptive statistics and tables. Results: Three hundred and eighty four respondents were interviewed. Their ages raged from18 years to 74 years. The mean age was 40 years, median age of 37 years, and the mode and standard deviation were 35 and 14 respectively. One hundred and nighty four (50.5%) were males while 49.5% were females. The male to female ratio was 1:l.Majority of the respondents were Catholics (50%). Protestants were 48% while the rest were either Muslims (0.5%)or had no religious inclination( 1%).Majority of the respondents were married(95%) while the rest were either widowed(2%) separated(I%), divorced(I%)or were cohabiting(0.3%).Most respondents had attained secondary school level of education(42%) while the rest had primary school level(29%),tertiary level(9%) and 19% of them had no formal education .Almost half of the respondents knew some one in their neighborhood who had mental illness(43%).They described the character of these people by the nature of speech(34%), abnormal behavior(34%), violence(23%) and grooming (9%).Very few of the respondents (13%) had lived with a mentally ill person. Majority had never had mental health related information (65%) and the few who had (35%) got it from radio (47%), health worker (36%), newspapers (15%) and from school (2%).Most respondents thought that mental illness is caused by psychoactive substances (44% ).Majority of those interviewed thought medical treatment is necessary for the mentally ill while 48% thought prayers could treat mental illness. Negative attitudes towards mentally ill people were highly prevalent since 60% thought that these people are dangerous, unpredictable (56%) and hard to talk to (58%). Respondents in the over sixty years age group were more likely to seek help in religious facilties or from traditional healers. The same trend was observed in the respondents' attitude that the mentally ill are processed by demons. There was no statistically significant difference between the various age groups on their attitude that the mentally ill are dangerous while those with post primary education were less likely to believe so. Those who had lived with a mentally ill person held more positive opinions about mental illness and were also more likely to have had information on mental health issues. Those who had had such information were less likely to hold negative opinion on mental illness. Conclusion: Mental health related stigma is prevalent in the population that was studied. Most people in this community have never had information on mental health related issues. The health seeking behavior in this population is influenced positively by age, level of education, and whether one had been enlightened on mental health issues. Recommendations: It is necessary to increase public education on mental health to reduce stigma towards mental illness and to influence mental health seeking behavior in the community positively. Health workers should be more proactive in educating their patients and also use other fora to impart this information to the public.