Open letter to Aden Duale: Mental health is Kenya's silent emergency

I hope you have returned safely from Geneva, where you attended the 79th World Health Assembly (WHA79), and where mental health was elevated to a standalone agenda item signaling its recognition as a core pillar of global health rather than a peripheral concern.

I write to you at a timely moment, as May is Mental Health Awareness Month, which draws attention to the role mental health plays in human well-being, dignity, and national development.

If I were to begin this conversation differently, I would not start in Geneva or with global policy language. I would start with music. I would play you Siko Fiti by Matata, which reflects the quiet reality of many young Kenyans who continue functioning while struggling internally. I would then play Beshte Yangu by King Kaka, which shows how friendship and informal support networks often become the first response in the absence of accessible formal care.

This raises a simple question: What does it mean when a nation’s mental health reality is more visible in music than in its health system?

The scale of need is already significant. An estimated five to 10 million Kenyans are living with a mental health condition, representing up to one in five citizens. In primary healthcare settings, one in every four patients presents with a mental health concern, yet most cases are not diagnosed or treated.

Government estimates indicate about four suicide deaths per day. Each represents a preventable loss of life linked to untreated distress, stigma, and delayed access to care.Behind these figures are individuals and families navigating silence, where support often comes too late or not at all.

Despite this burden, mental health remains one of the most underfunded areas, receiving less than 0.01 per cent of the national health budget. At the same time, the treatment gap remains as high as 75 per cent, meaning most people who need care never receive it.

The shortage of human resources deepens the crisis. Kenya has fewer than 100 psychiatrists serving a population of over 50 million, leaving mental health care largely dependent on overstretched general health workers who are often undertrained and unsupported.

Access to treatment is also inconsistent. Many patients report that essential psychiatric medication is not reliably covered under the Social Health Authority (SHA). For individuals living with conditions such as ADHD, monthly medication costs can reach approximately Sh10,000, forcing families into rationing, interrupted treatment, or complete discontinuation of care.

In practice, mental health conditions are frequently missed or addressed late in primary healthcare settings, where services are already overburdened and priority is given to acute physical illnesses.

Kenya does not lack direction. The Presidential Taskforce on Mental Health, co-chaired by renowned psychiatrist Dr Frank Njenga, released a landmark report in 2020 and strongly urged the government to declare mental illness a national emergency. The Taskforce also set out a clear roadmap for reform. The challenge is not knowledge. The challenge is execution.

Honourable CS, three priorities require urgent attention. First, investment in mental health must reflect its true burden, as current funding remains disproportionately low. Second, mental health must be fully integrated into primary healthcare so that detection and treatment happen at the community level where most people first seek care. Third, Kenya must expand and decentralise the mental health workforce through task-sharing models that equip nurses, clinical officers, and community health workers to deliver basic mental health services.

Mental health must also be understood beyond the health sector. It is shaped by unemployment, poverty, inequality, substance use, academic pressure, and rapid social change. Any meaningful response must therefore involve education, labour, and social protection systems alongside health services.

Stigma remains a major barrier, discouraging help-seeking and delaying care. Awareness efforts such as Mental Health Awareness Month are, therefore, not symbolic but necessary for shifting public attitudes and encouraging early intervention.

Kenya already has the evidence, the policy framework, and the global alignment. The gap is in implementation.

Aki Bwana CS, do something.

The author writes on politics, policy, and current affairs