By Sidayi Sidney

Often overlooked on Africa’s health and development policy agenda, mental health disorders affect 1 in 7 people worldwide. Despite the social and economic consequences of this unchecked conditions, there is a jaw dropping scarcity of mental health experts and neurologists in the continent.

In Kenya, the number of mental disorder cases has experienced a tremendous upward surge with official data indicating that approximately 25% of outpatients seeking basic healthcare exhibit signs of mental illness at any given time.

Mental health awareness has been a big issue worldwide especially when the covid19 pandemic kicked in. In February last year, the English Premier League ran a two-weeks campaign called Heads Up to show the federation’s commitment to build an encouraging conversation around mental health, because mental health is as crucial as physical health.

In Kenya organizations such as ANGA IMAX movie theater has joined hands with Chiromo hospital group to run youth meetings every Saturday, where they provide counseling on mental health disorders. In these meetings, youths get to share their mental health experiences and be guided on how to go about it by the experts.

According to the Kenya Mental Health Policy (2015-2030), 1 in every 4 Kenyans has suffered from mental illness in their lifetime, yet the country allocates only about 0.05% of its health budget on mental health. Common mental health issues that many Kenyans suffer from include substance abuse, depression, anxiety and stress.

Furthermore, 75% of Kenyans are not able to access mental health care, partly because the country is lacking in mental health specialists.

According to Health ministry records by the Office of the Auditor-General (OAG), there are about 100 psychiatrists in Kenya, most of who are based within Nairobi. For people with mental health issues residing outside Nairobi, only one psychiatrist is available to serve 1 million people.

Additionally, due to stigma, abuse and discrimination, there is substantially little use of the available health services for mental health disorders in the country. The African society often ridicules people who struggle with a mental illness or seek help for emotional disorders such as depression and anxiety.

“I live with a father who belittles me all the time. He is a narcissist who makes me feel depressed by lowering my self-confidence especially around people. When relatives and friends come to visit, he’ll call me stupid and tell me I’ll never amount to anything. One time I couldn’t take it anymore so I told an uncle who then told me to grow up, be a man and stop whining,” Joseph Makau, 21, a depression victim says.

For people like Makau, advancements in telecommunications technology have transformed modern life in the way clinical psychologists are availing mental health services. The penetration of telemental health in Kenya makes mental health services available to victims who would rather not be seen at the psychiatrist’s office for fear of being labeled crazy.

Through virtual medical clinics such as SASAdoctor, certified mental health counselors are interacting with clients through a wide range of technological tools including apps, videoconferencing, text messaging, e-mail, chat rooms, blogs, and websites. In this way, the services reach people in rural or remote areas where specialists may be lacking.

Combining telemedicine with mobile doctor services, SASAdoctor enables patients to seek medical consultation via live video conferencing. It also gives patients access to their personal medical records and allows them to request for diagnostic investigations using an app available for download on smartphones.

Once you download the app, you are required to fill in your details including personal identification information and even a selfie. Then the user is obligated to state if they have a pre-existing condition before requesting for a service.

The concept of Telehealth is not new in Kenya. In 2015, Kenya introduced the first phase of a national telemedicine action plan that aimed to improve access to better healthcare for poor and marginalized people living in rural areas.

In partnership with Merck Group, Germany, the initiative sought to enable the interaction of rural patients and healthcare providers at Kenya’s leading referral hospital, Kenyatta National Hospital (KNH), through video conferencing.

Informal forms of telemental health have also been in existence on social media platforms for a long time now. Sites such as Twitter offer moderated and noncritical mental health chatrooms, commonly referred to as spaces. Anxiety and depression patients can express their struggles, tell success stories and share coping strategies. Telehealth has however, taken shape during the global COVID-19 pandemic.

The idea of telemental health is still foreign to most health care providers and physicians in Kenya, given the especially slow integration of modern technology in the healthcare sector. Nonetheless, the continued advances in technology and healthcare innovation have greatly increased its functionality.

Additionally, the pandemic demands for a tech savvy way of getting services remotely thus pushing for its adoption due to its convenience and cost saving features. Being a time of great reflection and learning, everyone is trying to figure out how to do things online from home during this COVID time, specifically the lockdown period.

Harrison Mumia, 25years, a student at Kenya Institute of Mass Communication (KIMC) a uses the SASAdoctor mobile app. He is glad that through telemental health care, he can still access health care while reducing the risk of contracting coronavirus.

“The SASAdoctor app eliminates the costs of travel, increases scheduling flexibility, maintains the privacy of patients and engages patients just as much as physical meetings with doctors do. It also keeps Kenyans safe by ensuring that social distancing measures are upheld during the pandemic,” Mumia retorted.

Harrison Mumia, Sasadoctor beneficiary

For Joyce Adoyo, 29 years, a beneficiary of the app, the experience has been anything but subpar. “I really enjoyed my experience with SASAdoctor. The doctor I got was very friendly caring and kind and really followed up on my case until I got better. I would definitely recommend this app for anyone who needs convenient treatment,” Adoyo says.

The pandemic has led to a rise in the number of patients accessing the app, clocking an all-time high record of over 800 patients in the month of March alone.

According to Dr. Francis Osiemo, Founder SASA doctor, the telemental services are affordable with counselling costing shs. 895 (about USD 9), with those who have subscribed to the app getting free access and able to get services from several specialists.

“A patient is required to pay before starting a consultation. General practitioner fees is shs. 450 (about USD 5), pediatrician shs. 1300 (USD 13) and shs. 895 (about USD 9) for counselling psychologist. Payments are made via M-pesa/mobile money, credit card, insurance, SASAwallet and subscription,” he said.

“For our prepaid program, patients are able to get counsellors and other health care providers at a very small fee. It’s usually shs. 1,500 (USD 15) per family per year, and it is unlimited.”

“We also hold webinars where we try to pass health information. That is where a variety of health practitioners including counsellors come to give advice. From a talk, people are able to realize they may be having a problem after which they can then schedule an appointment,” Dr. Osiemo adds.

Although the app has made doctor-patient consultation fast and efficient, some app users have made complains that the registration process is too long while for others slow internet connection buffers video conferences with doctors thus making conversation unclear.

Fatima Hemani, a SASAdoctor app user, complained that the app is impossible to log in, even more difficult to operate thus not user friendly.

In response, Dr. Osiemo reiterated that a person cannot use the up before filling in the registration details properly. He also said that good internet connection is very key when using the app.

The cost of implementing new technology often goes far beyond the price tags of the hardware required for the service. To avoid having teleconferencing equipment laying dormant in hospitals, provider training and consumer adoption are costs that cannot be ignored.

“It’s not easy. You have to have a plan before you do it. It has cost us millions of shillings to reach where we are. If you’re not willing to part with such an amount then it becomes difficult. That is the only way you can be able to make something that can revolutionize health care. It’s not just something you can close your eyes and decide to do,” reveals Dr. Osiemo.

SASAdoctor which has more than 260,000 registered users says it’s potential supersedes well over a million. While it is extremely vital to provide a space to your end users for sharing their opinion regarding the app and its functionality, bad comments and reviews are unavoidable. Majority of potential users download an app only after reading its reviews.

Doctor Osiemo giving a demonstration of Sasadoctor App workability

“We actually contact these people and some of the time we find out that whatever they complain about is petty and they don’t want to change their reviews. This discourages others from using the app. If you are asked to register by putting in your ID number and you refuse, is it our problem?” Dr. Osiemo said.

He mentioned that they have been experiencing some technological challenges with some tools. “We integrated the symptom checker but we have not put it live because it is not giving us good information especially because of our African setting. Whatever information most of the artificial intelligence (AI) has is not African based. It is European or Asian. We have been analyzing it and it will not fit our African settings,” Dr. Osiemo said.

To counter this, SASAdoctors in conjunction with Amazon web services are working on developing a proper AI that will better serve the African Population. For now, however, the symptom checker remains just a concept.

Another challenge presented by telemental health is the difficulty of observing and interpreting a patient’s mannerism. Part of effective doctor-patient communication involves understanding what each party is trying to get across. This becomes especially crucial in the therapy room, where a counselor’s ability to pick up on inconsistencies between spoken and body language might disclose exactly what a client is saying.

“Some people try and hide the mannerism. Some people that I’ve seen are experts in hiding, and these are people who suffer mental health issues for a long time. So some of them have had to be brought in. You know somebody has a problem but they will pretend, yet they are fidgeting,” Dr. Osiemo said.

“You will tell a patient to put their phone down and then sit back, and they will blatantly refuse. Maybe someone is holding something or maybe they are tapping their feet while talking to you, trying to bring in an element of monotony to hide something. You must be able to see that. So unless people trust the system and honestly don’t try to beat the system then it would be better.”

Skepticism is a major hindrance to the growth of telemental health use in Kenya. Boniface Ongachi who was diagnosed with Bipolar disorder in September last year, says his major concern regarding telemental health would be receiving a misdiagnosis.

“I can only imagine how easy it would have been for a doctor sitting behind a screen to tell me I have major depressive disorder and have me on prescription medication for the wrong illness, only for me to find out later that I’m bipolar,” says Ongachi.