Integrated mental health services

TINADA Youth Organisation Economic Empowerment strategy picture

Mental Health Prevention, Management and Response

Mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

Mental health is a growing area of concern in sub-Saharan Africa, as it is at the global level. Evidence suggests that the burden of mental illness in Kenya is high and increasing. No serious attention is given to prevention and promotion of mental health while it is also estimated that 76% of people in the country with serious mental health conditions do not have access to the treatment they need, especially given that there are insufficient numbers of professionals trained to provide such care. COVID 19 has more adverse effects on young people as they continue to experience stigma, loss of social & economic power while Mental Health talk in this region is shrouded with secrecy, myths & misconceptions.

It is also estimated that about half of these mental illnesses begin around age 14, though most cases go undetected and untreated. Major symptoms are depression, anxiety, conduct disorders, and attention-deficit/hyperactivity disorder (ADHD). Left unaddressed, the problems continue into adulthood, affecting one’s relationships, work, and overall quality of life. Through devolution, county governments have the responsibility to deliver health care, including mental health.

TINADA is the first local organization around Kenya to model the integration of community based mental health services with Sexual Reproductive Health and Rights (RHR), Gender-Based Violence (GBV), Disaster Risk Reduction and disability inclusion.

TINADA aims to promote equitable access to integrated mental health services to the community with particular attention to children, youth, young women, refugees and young people with disability. More specifically, this will be achieved through the facilitation of integrated health interventions focused on services that are based on holistic needs of the beneficiaries, including combating stigma and discrimination among the affected individuals and families. The organization will work towards increasing access to quality integrated mental health care, education opportunities, leadership involvement and overall respect for human rights.

TINADA focus to reach more 120,000 most vulnerable young people, youth with disabilities, single mothers, adolescent mothers and young mothers who experience gathering mental health (MH) crisis linked to: abuse, violence, loss, grief, puberty, relationship, early parenthood, unsafe abortion, poverty, gender, stigma, conflicts & drugs abuse.

This program invests in evidence-based interventions to promote community-based peer-hood among youth with lived experience or at risk of psychological issues for prevention & response plan which is significantly for long term positive impact.

We will continue establishing, and running an effective & sustainable number of Mental Health clubs in schools and support groups in communities to enhance prevention and response with a complete peer referral & linkage to youth friendly spaces & facilities services & also enhance therapy, rehabilitation, reintegration & coordination efforts.

TINADA employ feminist psychological approach & empowerment through livelihood, leadership & technical & soft skills. We will use a web of meaningfully coordinated community networks that use community own resource persons & resource centers as rehabilitation & community-based care units useful in promoting ownership, scalability & sustainability. TINADA shall also invest in learning & feedback events for sharing of working models, document & disseminate ongoing work.

Under our Mental Health Psychosocial Support Services (MHPSS): TINADA offer holistic services by not only offering counseling services but also through effective referral to necessary services that a client may need. With eddective referrals, access to services is enhanced and a client is supported holistically.

Key Expected Outcomes
  1. Enhanced holistic and equitable access to integrated mental health services among children, Youth, and young women at risk of or with mental health conditions and psychosocial disabilities
  2. Children Youth, and young women demonstrate improved knowledge/information on integrated mental health conditions and psychosocial disabilities
  3. Improved integrated mental health systems at county and national levels that effectively support implementation of mental health interventions
  4. 4.Established and functioning Community Based Center for Mental Health “Home of Brains” offering effective Mental Health and Psychosocial Support services within the community (Prevention, Therapy, Rehabilitation services and Research products)

In the year 2023 – 2028, TINADA is looking forward to effectively continue investing in integrated mental health focusing on below interventions

Mental Health disaster Preparedness and Response

Goal: Increase awareness and knowledge about mental health and prevent the onset of mental health conditions among the general population.
Specific objectives Expected Outcomes
1. Increase mental health knowledge for prevention, promotion, and protection against all forms of discrimination and stigma for persons with mental health conditions and psycho-social disabilities

❖Improved knowledge on prevention, management, and response among marginalized groups, including those living in remote/rural areas and informal settlements

❖Reduced stigma amongst persons with mental health conditions

2. Provide Psychosocial support and rehabilitation services with particular attention to marginalized groups living in remote/rural areas/informal settlements

❖Improved access to psychosocial support and rehabilitation services that enhance overall well-being.

❖Improved mental health and wellbeing

3. Enhance service delivery, care, and Support to Aging mental health.

❖Increased utilization of psychosocial support among older adults

❖Improve access to service delivery, care, and support for aging individuals with mental health conditions to promote healthy aging.

❖Improved quality of life and mental health wellbeing

4. Improve maternal and child mental health within target counties

❖ increased access to mental health services and support amongst mothers and children

❖ Improved maternal and child health outcomes.

5. Enhance mental health well-being in the workplace targeting institutions

❖Improved mental health wellbeing among employees and employers

6. Support the legal justice system (judiciary, prison, and Court Users) through the integration of mental health and GBV services

❖Improved positive coping mechanisms by persons in the legal justice

❖Increased number of successful rehabilitation and integration amongst the perpetrators

7. Capacity building of non-conventional healers (herbalists, religious leaders, traditional healers, spiritual healers) on mental health prevention, therapy, and referrals.

❖Enhanced rights based mental health practices

❖Strategic inclusion of non-conventional healers in mental health prevention, therapy and referral forums

❖Improved referral pathways between non-conventional and healers

8. Mental Health Disaster Preparedness and Response (MhDPR)

❖Improved mental health disaster preparedness and response

❖Improved preparedness and response to mental health disasters Improved mental health risk reduction

Alcohol and Drugs Abuse

Substance abuse is a major problem in Kenya, particularly among young people. According to data from the National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA), more than 3 million Kenyans aged between 15 and 65 years are estimated to be using drugs, with most of them being youth. In addition, the 2017 Kenya Alcohol Policy Status Report showed that alcohol is the most abused substance among Kenyan youth, with prevalence rates of up to 25%. This is a worrying trend as alcohol use is associated with a range of negative outcomes, including academic failure, risky sexual behavior, and mental health problems. This highlights the urgent need for effective prevention and treatment interventions to address substance abuse among young people in Kenya.

Through its evidence-based programs and services, TiYO continue playing a crucial role in addressing substance abuse among young people in Kenya and helping to mitigate the negative impacts of substance use on individuals, families, and communities. TiYO continue making a significant contribution to the effort to address substance abuse among young people. By providing education, support, and resources. TiYO focuses on supporting young people to build healthy, fulfilling lives and to avoid the negative consequences of substance abuse.

To achieve this goal, TiYO's offer a range of services that are tailored to the needs of young people. The organization provide education and conduct awareness campaigns that help young people understand the risks and consequences of substance abuse. We also strive to offer counseling and support services to young people who are struggling with addiction or who have experienced the negative impacts of substance abuse.

In addition, TiYO continue to work closely with community, partners, government and experts in the field to develop and implement evidence-based strategies for preventing substance abuse and promoting healthy lifestyles. This includes working with schools, youth groups, and other community organizations to provide young people with the tools and resources they need to make informed decisions about their health and wellbeing.

Below is key intervention for ADA that TINADA will invest in
GOAL: Enhance prevention, response, and rehabilitation on ADA (Alcohol and Drug Abuse) among children, youth, young women, and Persons with disability
Specific objectives Expected Outcomes
1. Promote the prevention of alcohol and drug abuse.

❖Reduction in the rate of alcohol and drug abuse among the youth

❖Increased productivity amongst the youth

❖Improved mental and physical health among the youth

2. Provision of Response to Alcohol and Drug Users.

❖Increased access to appropriate healthcare services for youth with alcohol and drug addiction.

❖Improved mental and physical health outcomes for youth with alcohol and drug addiction.

❖Reduced incidence of alcohol and drug-related harm among the youth

3. Establish and equip a rehabilitation center at Home of Brains Center for Mental Health.

❖Increased availability and accessibility of rehabilitation services for individuals with mental health and substance abuse disorders

❖Improved mental and physical health outcomes for youth undergoing rehabilitation services.

Chronic Diseases and Mental Health Integration

The prevalence of a mental disorder is elevated in people who live with noncommunicable diseases. Conversely, more than two-thirds of people with a mental disorder have been shown to have at least one other chronic noncommunicable disease. The epidemiological transition from low prevalence of Non-Communicable Diseases to increased prevalence is a great concern. 50% of all admissions and 43.5% of mortality in 2020/21 of mortality is as a result of NCDs. This is greater than 35.4% of which was the situation in 2027. Mortality from cancer alone increased from 3% in 2000 to 8% in 2019. This is a clear indication of the transition to high prevalence.

The relationships between mental disorders and other noncommunicable diseases are complex and bidirectional. Poor mental health exacerbates a number of noncommunicable disease risk factors, including poor lifestyle choices leading to obesity, inactivity, and tobacco use; poor health literacy; poor access to health promotion activities; and symptoms such as lack of motivation and energy. Mental disorders such as depression and alcohol use disorders often co-occur with other common non communicable diseases such as diabetes and heart disease. The pathways underlying the comorbidity of mental disorders and noncommunicable diseases are complex.

Building on the robust evidence base for effective treatments for a range of mental disorders, there is now a growing evidence base for how such treatments can be integrated into the care of people with noncommunicable diseases. The best-established delivery model is a team approach that features a no specialist case manager who coordinates care with primary care physicians and specialists. This approach maximizes efficiencies in person-centered care, which are essential for achieving universal health coverage for both noncommunicable diseases and mental disorders. A number of research gaps remain, but there is sufficient evidence for policy makers to immediately implement measures to integrate mental health and noncommunicable

The aging of populations around the world has been accompanied by marked increases in the burden of chronic noncommunicable diseases such as cardiovascular disease, chronic respiratory conditions, cancer, diabetes, and musculoskeletal disease.  With effective interventions, mortality associated with many of these conditions has continued to fall. However, the interventions do not reach everyone and may not be universally affordable. 

TINADA Youth Organization looks at a future where families are supported to survive and thrive beyond the state of illness that they and or their family members are going through. This is by building their resilience and that of their families. TINADA puts forth in prevention of NCDS and mental health support for the people living with NCDs.

Specific objectives and expected outcomes

Goal: Enhance prevention, response, and rehabilitation on ADA (Alcohol and Drug Abuse) within the targeted group (children, youth, young women, and Persons with disability )
Specific objectives Expected Outcomes
To promote the prevention of alcohol and drug abuse.

❖Improved knowledge on the ADA preventive measures.

❖Increased awareness on the negative effects of alcohol and drug abuse Reduction in the rate of alcohol and drug abuse among the target population

❖Improved mental and physical health due to reduced substance abuse

Provision of Response to Alcohol and Drug Users.

❖Increased number of recovering Alcohol and drug users..

❖Increased access to appropriate healthcare services for individuals with alcohol and drug addiction.

❖Improved mental and physical health outcomes for alcohol and drug addiction users.

❖Reduced incidence of alcohol and drug-related harm within the target population

Establish and equip a rehabilitation center at Home of Brains Center for Mental Health.

❖Increased number of recoveries of alcohol and drug addicts receiving the services.

❖Increased availability and accessibility of rehabilitation services for individuals with mental health and substance abuse disorders

❖Improved mental and physical health outcomes for individuals undergoing rehabilitation services.

❖Increased capacity of the Home of Brains Center for Mental Health to provide comprehensive mental health and substance abuse treatment services.

Reproductive Health Rights & Mental Health Integration

Mental health and Sexual and Reproductive health are two sides of a coin and the role of both need to be addressed in a young person’s life. The magnitude of sexual and reproductive health challenges (an early or unwanted pregnancy), HIV and gender-based violence among so many others impact greatly on the overall wellbeing of the young person.

Furthermore, a young person suffering from depression due to HIV will possess both a negative physical and mental health negative outcome that may aggravate their overall health and wellbeing. With regard to this, following a positive HIV diagnosis, a young person may develop prolonged stress that may eventually hinder their ability to adhere to their HIV medication effectively hence progressing their clinical stage to further negative outcomes.

A focus on integration of mental health education and literacy with existing sexual and reproductive health programs will be a successful prevention approach for mitigating the adversity of both these challenges in the life of a young person. Popularizing and creating awareness about the role of positive mental health in a young person’s life to various relevant stakeholders and actors in the public health sector will champion efforts of having an empowered and productive population.

In recognition of the role sexual and reproductive health plays on a young person’s health, policy makers and health service providers could leverage on the already existing health interventions to incorporate mental health awareness and prevention strategies for young people. By doing so, more young people will be cognizant of their physical and mental health and make healthier decisions that can enable them to cope with life stressors as they transition into and beyond adulthood. We are focused to deliver holistic SRHR and mental health integrated program with focus to see:

  1. Enhanced access to and uptake of friendly gender responsive and inclusive SRHR information and services with improved referral pathways for holistic service delivery among youth, and youth, persons with disabilities and young women.
  2. Reduced teenage pregnancies in Kisumu and Homabay County
  3. Increased dialogue and engagement among communities, families and leaders (decision bearers) to support adolescent and young people around their mental health, sexuality and reproductive health
  4. Adolescent girls and young women have increased agency, leadership and peer networks to influence and position gender equality and inclusion with improved quality and holistic SRHR
  5. Young people especially girls and young women actively challenge and prevent all forms of violence and abuse against them, children and youth
  6. Schools and collages providing safe and conducive environments for adolescent’s girls, children and youth and leaners with disabilities
TINADA focus to implement below intervention to address Mental Health and SRH integration:
GOAL: Enhance Access to quality and holistic sexual and reproductive health and rights among young people
Specific objectives Expected Outcomes
Promote holistic reproductive health education among the youth, young persons with disability, young women and vulnerable children .

❖Increased knowledge application on holistic reproductive health .

❖Reduced cases of reproductive health and MH Improved mental wellbeing among young people

Promote access to equitable Menstrual Hygiene management (MHM) commodities and services among young women in schools, young persons with disability and communities reached with menstrual hygiene information.

❖Enhanced holistic menstrual hygiene management (MHM) among young people.

❖Increased access to menstrual hygiene commodities

❖Communities have adequate, knowledge, skills, capacity and resources to access menstrual justice

Promote mental health integration in STIs prevention and response among adolescents.

❖Reduction in risk associated with STIs & mental health.

❖Improved mental health wellbeing among young people

Promote access to quality service delivery on RH & mental health through effective linkages &referrals

❖Increased access to quality equitable and affordable SRHR services .

❖Improved effective and complete referral

Promote Family planning (FP) and mental health education with information on uptake and wellbeing

❖Increased knowledge, access and uptake of Family Planning services.

Provide evidence-based information on SRHR and mental health through research.

❖Availability of evidence-based information to improve RH and mental health integration through policy framework.

❖Improved RH and mental health wellbeing among the youth

Support mental health integration in RMNCAH advocacy

❖xistence and application of mental health and SRHR integrated policies, programs and initiatives within health ministry and CSOs.

Gender-Based Violence and Integrated Mental Health

Gender equality is not only a fundamental human right, but a necessary foundation for a peaceful, prosperous and sustainable world. There has been progress over the last decades, but the world is not on track to achieve gender equality by 2030. The social and economic fallout from the COVID-19 pandemic has made the situation even bleaker. Violence against women and girls remains endemic. And despite women’s leadership in responding to COVID-19, they still trail men in securing the decision-making positions they deserve.

The present state of violence against women is still grim, according to KDHIS 2023, about 54% of women who are in marriage have ever experienced violence against them by their present partners and 30% from their previous relationships. This is contrasting for men who about 20% experienced physical violence from their current partners and about 19% from their former partners.

Physical violence is also experienced by women and men who had never been married and often this is thought as less important, however this is still important with teachers and mothers as leading perpetrators. Teachers account for 33% and mother/step mother for 25% of physical violence against girls and women who had never been married. In this circumstance 46% of violence against men who had never been married is inflicted by teachers while 22% by peers.

Sexual violence is also high among women, KDHIS 2023 says that in the past year about 7% of women and 4% of men had experienced sexual abuse. Over their lifetime 13% of women and 7% of men had experience sexual violence. On this account, there is a need to launch a response that meets the needs of women and men while putting more effort into taking care of the gender disparity involved.

Girls and women hold unlimited potential but not given space.  Gender-based violence remains pervasive decades after independence, women are underrepresented in decision-making processes at all levels.   They have less access to and control over the benefits from land tenure, education, and employment opportunities. TINADA Youth Organization is committed to attainment of gender equality and elimination of all forms of violence holding women back. This informs the objectives of ending violence and promoting equitable relations.

Goal: End violence, empower women and girls, and promote nonviolent, equitable, and respectful relationships
Specific objectives Expected Outcomes
Enhance knowledge on Gender Based Violence and mental health to the community.

❖Increased knowledge application, skills and ability for the vulnerable young women& girls to voice their needs and claim their gender rights.

❖Reduced cases of GBV.

❖Improved mental health and wellbeing among GBV survivors.

Provide psychosocial support, referrals and reintegration for persons affected by gender-based violence.

❖Improved access to quality, equitable and affordable health services, psychosocial support and legal support through a Right Based Approach

❖Increased successful reintegration of survivors of GBV .

❖Reduced cases of GBV.

❖Improved mental health and wellbeing among GBV survivors.

Promote rights and voices of Vulnerable young women, girls, boys, and youths with disability, prevent GBV to enhance mental wellbeing.

❖Increased agency of vulnerable young women, girls, boys, and youths with disability to claim their rights .

❖Enhanced voice of vulnerable young women & girls.

❖Increased family and public participation among vulnerable young women, girls, boys, and youths with disability.

Rehabilitation and reintegration of reformed perpetrators into the community .

❖The rehabilitated and reintegrated perpetrators become productive and active in the community to see the reduction of GBV cases.

Support women, young people, children and PWDs to have access to justice.

❖Improved access to legal justice system among vulnerable young women, girls, boys, and youths with disability.

HIV and Mental Health Integration

People living with HIV are at high risk of mental, nervous system and substance use disorders and mental health disorders can affect general health, adherence to ARV drugs and retention in care. Although chronic HIV care settings provide an opportunity to support and integrate the management of mental health disorders among people with HIV, this is often overlooked by health systems.

HIV continues to be an important communicable condition. Not only because of the prevalence but because of the burden and socioeconomic impact. Awareness on HIV prevention and treatment has been extensively done, however, there is still need for further awareness creation. According to KDHIS 2023, 54% and 55% of young women and men have had information on HIV prevention in Kenya. Knowledge on prevention is lower between the ages 15-17 with percentage knowledge at 47% and 48% for girls and boys respectively.

Education is also an important social determinant of HIV knowledge with 13% and 14% of women and men having knowledge on HIV prevention while 69% and 80% had similar information and knowledge when they have higher than secondary education. This shows how social and demographic and geographic exclusion affects level of knowledge.

This is the bridge that the TINADA Youth Organization wishes to build and link all the excluded information. The goal of this is to achieve the goal of 95%, 95% and 95% with effective mental health integration. According to KDHIS 2023, about 85% of women and 73 % of men of reproductive age have ever been tested for HIV. In the last year, 47% and 39% of women had been tested for HIV. This shows that more women compared to men have been tested all time and over the past year. The goal of the 95% test has not also been achieved and thus hindering the rest of the 95% targets.

TINADA Youth Organization also seeks to integrate mental health information and services to improve uptake of HIV services since, the influence that this plays in ensuring testing, enrolment to care, adherence to medication and eventually viral suppression is enormous.

Goal: Enhance mental health integration into HIV support, prevention, and response interventions
Specific objectives Expected Outcomes
Improve knowledge and information on the integration of mental health in HIV/AIDS .

❖Increased knowledge on HIV infection, prevention, and mental health.

Support mental health services among Orphans and vulnerable children (infected and affected) with HIV/AIDS.

❖Enhanced awareness/information for orphans and vulnerable children (affected or infected) on mental health prevention, response & management in HIV/AIDs.

Enhance mental health referral and linkages for persons infected & affected with HIV/AIDS .

❖Established referral pathways of HIV/AIDS and mental health.

Enhance provision of psychosocial support for persons (age, sex, and gender) infected with and affected by HIV/AIDS for their mental wellbeing.

❖Reduced stigma and discrimination on PW HIV/AIDS.

Enhanced evidenced-based advocacy on mental health integration into HIV.

❖Increased knowledge and understanding among healthcare providers and policymakers about the importance of addressing mental health needs in the context of HIV/AIDS car.

Primary Healthcare and Mental Health Integration

Primary health care is about providing 'essential health care' which is universally accessible to individuals and families in the community and provided as close as possible to where people live and work. It refers to care which is based on the needs of the population. It is decentralized and requires the active participation of the community and family (WHO, 1978: Declaration of Alma-Ata).

Providing mental health services in primary health care involves diagnosing and treating people with mental disorders; putting in place strategies to prevent mental disorders and ensuring that primary health care workers are able to apply key psychosocial and behavioral science skills, for example, interviewing, counselling and interpersonal skills, in their day-to-day work in order to improve overall health outcomes in primary health care (WHO, 1990).

Alma-Ata Declaration of 1978 was the key opening point for achieving health for all. TINADA Primary Healthcare Program is in line with Kenya Primary Health Care Strategic Framework 2019-2023 and Kenya Health policy 2014-2030 which are in accord with Alma- Ata Declaration.

TINADA is looking into making more people able to access quality, equitable and affordable healthcare. This is in the backdrop that 7.1% of Kenyans still incur catastrophic health expenditure hindering health equity in relation to economic status. About 26% and 27% of women and men have a form of insurance cover leaving about 75% of Kenyans without a form of health insurance having to access treatment out of pocket. This implies the need to strengthen access to the National Hospital Insurance Fund (NHIF).

We are also looking at strengthening community led surveillance and disease prevention on the premise that access to healthcare is not limited to secondary and tertiary prevention. TINADA lays emphasis on primary prevention as a vital line of defense. For that matter, TINADA seeks to invest time and resources to strengthen community-based disease surveillance, prevention and response

Goal: End violence, empower women and girls, and promote nonviolent, equitable, and respectful relationships
Specific objectives Expected Outcomes
Support CHVs to lead health promotion and disease prevention activities with focus to mental health, pandemic diseases, immunizable diseases and Maternal, newborn and Children's diseases .

❖Reduced maternal mortality ratio to less than 70/100,000 live births maternal and under five mortalities to less than 12/1000 live births.

❖Reduced postpartum depression among mothers

Support community led disease surveillance and response for endemic diseases, potential outbreaks and mental health conditions.

❖Members of the community disease surveillance team are able to interpret and utilize information generated from community health information systems and sound the first alarm in the event of a spike of an endemic disease .

Support CSOs and Champions and communities to conduct integrated multi sectoral PHC advocacy with focus on Mental health RMNCAH+N and adolescent AYSRHR policy and financing.

❖Integrated PHC advocacy into mental health, RMNCA+N and Adolescent SRHR advocacy in LRED counties.

❖Enhanced capacity of CSOs championing for integration of mental health in to PHC

Strengthen community strategies nutritional support for households as a component of PHC.

❖Reduction in prevalence of nutritional deficiency disease and stunting among under 5..

Support CSOs, services users and health providers to, participate in PHC, policy and planning, processes.

❖PHC issues highlighted in the budget and policy documents in the county.

Support communities to access quality, affordable and equitable health services in their communities.

❖Increased accessibility and affordability of holistic and comprehensive health care without experiencing catastrophic health spending.