Following a 10-year war of liberation (fought by the Mau Mau against the British), Kenya attained full independence from colonial rule in 1963. For 10 years the country enjoyed rapid economic growth (6–7% per annum) but this slowed steadily to near stagnation in the 1990s. Poor governance, abuse of human rights, internal displacements of citizens, large numbers of refugees from neighbouring countries and the AIDS pandemic conspired to reduce Kenyans’ life expectancy to 47 years (in the UK it is presently 77 years). Some 42% of the population now live below the poverty line, and 26% of Kenyans exist on less than US$1 per day. The annual per capita income in Kenya is US$360 (in the UK it is $24 000) (World Bank, 2002). AIDS currently has an estimated prevalence rate of 12%. In large parts of rural Kenya many sexually active adults are unable to work, and elderly grandparents are left to look after orphaned children (some already infected with HIV), as they struggle to deal with their own grief for the loss of many of their own children. In December 2002 a new government was elected, which gives some grounds for optimism in an otherwise bleak situation.

Mental health policy and resources

Given the circumstances, it is unsurprising perhaps that mental healthcare was relegated to near oblivion; at present there is no mental health policy. Little or no thought was given to mental health as the country struggled with more life-threatening conditions, including diarrhoeal diseases, measles, malaria and tuberculosis. Commendable efforts are, however, in place to develop a policy with the assistance of the UK's Department for International Development and the Institute of Psychiatry in London, which are now working on a collaborative project with Kenya, Tanzania and Zanzibar.

Existing programmes are hampered by the shortage of commitment, personnel and funds. There is a tangible lack of commitment to mental health in Kenya, reflected in the fact that it receives less than 1% of the Ministry of Health's budget, which is itself less than 7% of the national budget.

Kenya has only 47 psychiatrists for a population of 30 million, although there is the prospect of this number increasing, albeit slowly.