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Mental health ‘headache’ from neuroscientist

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Brain and Mind Institute, Aga Khan University (AKU) Founder Dr. Zul Merali poses for a photo after the interview at AKU on June 29, 2022. PHOTO | FRANCIS NDERITU | NMG

When the Brain & Mind Institute at Aga Khan University came to life two years ago, no one could have been happier than Prof. Zul Merali, its founder.

The creation of the center that researches mental health issues and develops treatments was the culmination of a journey that began more than four decades ago when the Ugandan-born scholar joined the University of Ottawa in Canada.

The researcher and neuroscientist is determined to advance and reshape conversations about mental health by creating synergies with interested parties, a goal to which he has devoted his career.

In this conversation, he emphasizes that Kenya is in a mental health crisis and that the country must act urgently to avoid a full-blown disaster.

What the institute does.

Our approach is anchored in implementation science. We are developing new ways of understanding how diseases arise and developing new treatments. We also translate our research results into care and influence these treatments based on the needs of the population.

We have implementation teams in different fields such as psychiatry, psychology and social work. We also have anthropologists, health economists, data scientists and educators. This diverse expertise is based on the premise that mental health is a biopsychosocial construct.

It comes from multiple areas. The solutions we develop must therefore be practical and context sensitive.

The state of mental health in Kenya.

Frankly, things are not going well. People suffer in silence. The situation is reaching a crisis. It is the case worldwide. Suicide rates are on the rise and 80 percent of the time they are associated with depression. The problem is much bigger if you look at the problem as a whole.

Trends around the world show that conditions such as heart disease are declining, while mental health problems are increasing and the needs are enormous. That’s why we started the Brain and Mind Institute to see how we can make a difference.

The creation of the Brain and Mind Institute coincided with the Covid-19 pandemic.

It became clear to people that everyone is vulnerable. People were under great pressure with many psychosocial problems such as unemployment and loss of income. There was also social isolation because people could not gather in places of work or worship. This was a major stressor. People started talking about mental health, which was a good starting point.

Where is his career at the moment.

I feel content to be in the space where my calling was. It has always been to come back to the countries of my origin (Uganda and Kenya) and give something back in terms of my knowledge and capacity.

I need to build a networking community that can help people with mental health issues. My philosophy has always been to work with others, because this problem is too big to be tackled by one person alone.

What speaks to his soul.

That human suffering is universal and for that we need to work on finding the best ways to help people. I believe that mental health care should not be a luxury and should be reserved for rich people who can afford it.

It’s a human right. Everyone is vulnerable, be it a millionaire or a destitute, and they must have access to the right care and support during a bumpy period they are going through.

Why Kenya is firmly on course.

This country is very progressive in its approach to mental illness. A task force set up to investigate the mental health needs of Kenyans released a damning report recommending Kenya declare a mental health emergency.

The government published the report without amending it. A work plan has been developed to address the problem and this week the Ministry of Health released an investment plan stating that the country should view mental health treatment not as a cost, but as an investment.

A lot of time is lost when people struggle with depression. The president recently broke ground for the Mathare hospital expansion.

What Kenya urgently needs to do.

The approach to mental health in the country and elsewhere in the world is highly crisis-driven. People only get in touch when they are very desperate. Some don’t even. At this stage it is difficult to help the patient.

Moreover, specialized care and treatment is currently very expensive. While we must work to help severely affected patients, there must be a paradigm shift where we focus more on the larger, healthier population.

This would help educate them about reducing stigma, advise them on healthy behavior and build their resilience so they don’t get sick. For those at risk, they should be treated early enough to prevent serious mental illness.

Lessons about the human brain.

It is the most complex organism that ever existed. It has only three borders and billions of neurons (nerve cells). It is a network of interconnected circuits that are activated or deactivated based on what is going on.

To understand how it works, you need to understand its different components, such as the neurotransmitters, which are chemicals that control different signals and functions.

The experience of interacting with psychiatric patients.

You could talk to your friend, family or child. You can be an artist, lawyer, journalist or scientist. These are intelligent people with the same dreams and desires as we do. Only they have difficulties in life where help is needed.

Some of the productive people we interact with may be on a mental health journey, only we don’t recognize it. Mental health is a spectrum. For some, the signs are obvious. To others, the signs are invisible. They are only pushed to their limits when they are stressed.

How to deal with staffing and resource constraints in mental health.

To change the game and meet the needs of this country, we need to find other ways by mobilizing other healthcare workers to join the fray. Pakistan is conducting a pilot project called “Lady Health Worker”, where highly educated women enter communities to collect data on vaccinations and diseases.

These employees can be empowered to help communities by collecting mental health data. In this way, community members do not have to travel to the hospital for treatment, which comes with a lot of fear, stigma and expense. This helps to ease the burden of the already strained capacity.

About building a big tent.

It is our desire to bring on board various experts from academia in our university and other universities, government, civil society organizations and other diverse fields to build a network and increase capacity. The ethos of our institute is “from neuron to neighborhood”.

Civil society organizations help us understand the needs of the people by taking the research machines to the lowest level.

Why not talk about the crisis is not an option.

We can no longer afford to hide it. Instead, we should start right away. There is still a lot of stigma surrounding mental illness in Kenya today.

Suicide attempt in this country amounts to a crime with legal consequences. Yet these are people crying out for help. They are not criminals. What we need to do is be more empathetic to patients and help them.

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