Addressing social stigma and enhancing health systems capacities for improved bipolar disorder care in Kenya

March 30, 2023


Frederick Murunga Wekesah

Associate Research Scientist


Bipolar disorder (BD), also known as manic depression, is characterized by unusual episodes of extreme mood swings of emotional highs (symptomized by mania characterized by high energy, restlessness, sleeplessness and loss of touch with reality) and emotional lows (characterized by depressive symptoms of low energy, low motivation and loss of interest in day to day activities). These mood episodes can last several days, weeks or even months. The depressive phase of BD is often very severe, and presents with the risk of suicide.

Overall, BD patients report high levels of morbidity, disability, and are more likely to die young.

The exact cause for BD is not known, but experts have figured that it may be as a result of a combination of factors: genetics, environmental, changes in the brain structure and diet. What makes it difficult to manage BD is that the condition is difficult to diagnose and can often get overlooked or confused with other mental illnesses. This situation consequently delays when individuals can get appropriate care/treatment and may worsen the outcomes.

As we mark World Bipolar Day on 30 March, we join mental health workers, patients, families across the globe in reflecting on BD and other mental health challenges we face today, with a particular focus on what can be done to address the issues in Kenya.

What is the scale of the problem?

In 2022, the World Health Organization estimated that in 2019, one in every eight people across the world (equating to 970 million) lived with a mental disorder. Little research has been carried out on the burden of BD in low and middle income countries (LMICs). Data by the Institute of Health Metrics and Evaluation (IHME) reports that in the same year, 40 million people experienced BD. In a large study involving 11 countries, findings report an overall lifetime prevalence of bipolar spectrum disorders (BSD) to be 2.4%. The BSD continuum ranges from full blown illness (referred to as BD I) to milder illness to temperament traits that do not meet full criteria for BD (referred to cyclothymic disorders). However, the actual scale of the problem is difficult to estimate partly due to misdiagnosis, stigma and insufficient access and use of mental health services (hence under-diagnosis).

Myths and misconceptions regarding BD

No two BD patients are the same because different individuals experience BD differently. Like it is with depressive and anxiety disorders, BD is plagued by a number of myths and misconceptions such as substance use being the cause of BD. The fact is that substance use/abuse may actually exacerbate the condition. Thus, although substance use is not a cause for BD, it may make the condition more difficult to diagnose and manage.

Impacts of BD on productivity, and social relations

Bipolar disorder patients experience difficulties across many facets of their lives, from sustaining relationships with family and friends to performing optimally in their education and work. Overall, they suffer a poorer quality of life. These struggles start at an early age because the onset of BD generally starts in childhood/adolescence and continues into adulthood.

Among the employed, the illness limits their performance due to impairment and decreased productivity at work resulting from disability and morbidity. The social ramifications are also heavy; most people with BD (as with other mental illnesses) experience stigma, discrimination and violations of their human rights. Because the condition is fairly misunderstood, BD patients are likely to get into conflict with those who encounter them for the first time especially when they are going through the manic phase.

The employers of patients with BD suffer losses and a financial burden too. Economic analyses have shown that ‘BD costs more than depression per affected employee, with a large proportion of the total cost of BD being attributable to indirect costs from lost productivity, arising from absenteeism and presenteeism.

 Healthcare systems’ capacities to manage patients with BD

As it is with other mental illnesses, BD patients get little or sub-optimal access and utilization of  effective care, centrally because health systems in many developing countries are significantly under-resourced to effectively respond to their needs. Even where there is a semblance of care for BD patients, more often than not the quality is poor or the service is not responsive to their needs.

Care and support for BD patients

Effective treatment options for patients with BD exist. The WHO recommends psychoeducation, reduction of stress and strengthening of social functioning, and medication as the major interventions.

With the decentralized governance in Kenya, and health services provision being led by the counties, there is an opportunity to bring effective mental health care closer to the people.

In the final analysis, BD patients require unconditional social support to sustain personal, family, and social relationships. Specifically, people with BD need support at school to effectively attend classes and improve their academic performance, at work to improve their productivity and get along with colleagues, and in the community to effectively participate in social activities.

At the policy and health system levels, there is an opportunity for LMICs to adopt the WHO’s Mental Health Gap Action Programme (mhGAP) which employs evidence-based technical guidance, tools and training packages to expand services in resource-constrained settings through a prioritized set of conditions (including BD), directing capacity building towards non-specialized health-care providers (task-shifting) in an integrated approach that promotes mental health at all levels of care.

Let’s address #BipolarTogether.