Neuroscientist’s mental health ‘headache’

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

The establishment of the centre that conducts research on mental health issues and treatment development 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 promote and to reengineer conversations around mental health by creating synergies with interested parties, a cause he has dedicated his career to.

In this conversation, he is emphatic that Kenya is in a mental health crisis and that the country must move with urgency to forestall a full-blown disaster.

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What the institute does.

Our approach is anchored on implementation science. We are developing new ways to understand how illnesses come into being and developing new treatments. We are also translating our research findings into care and influencing these treatments based on what the needs of the population are.

We have implementation teams in different domains 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 stems from multiple areas. The solutions we develop, therefore, need to be practical and contextually sensitive.

The state of mental health in Kenya.

Frankly, things are not good. People are suffering in silence. The situation is reaching a crisis. It is the case globally. Suicides are on the rise, and 80 percent of the time these are associated with depression. The problem is much bigger if you look at the issue in its entirety.

Trends around the world show that conditions such as heart disease are decreasing while mental health issues are increasing and the needs are enormous. This is why we started the Brain and Mind Institute to see how we could bring a difference.

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

It became clear to people that everyone is vulnerable. People were under a lot of pressure with many psychosocial issues such as unemployment and loss of income. There was also social isolation because people could not congregate at places of work or worship. This was a big stressor. People began to talk about mental health, which was a good starting point.

Where his career is at the moment.

I feel satisfied 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 to give back in terms of my knowledge and capacity.

I have to build a networking community that will help people who are suffering from mental health. My philosophy has always been to work with others because this problem is too big for anyone to combat it alone.

What speaks to his soul.

That human suffering is universal and for that we need to work towards finding the best ways of helping people. I think mental healthcare should not be a luxury and a preserve of wealthy people who can afford it.

It is a human right. Everyone is vulnerable, whether a millionaire or a penniless person, and they should access the right care and support during a bumpy period that they may be going through.

Why Kenya is solidly on course.

This country is very progressive in its approach to mental health illness. A taskforce that had been set up to look into mental health needs of Kenyans came up with a damning report that recommended Kenya be declared to be a state of emergency in mental health.

The government published the report without altering it. A work plan was developed to tackle the problem and this week, the Ministry of Health released an investment plan arguing that the country should not look at mental health treatment as an expense but as an investment.

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

What Kenya must do urgently.

The approach to mental health in the country and elsewhere in the world is very crisis-driven. People reach out only when they are very desperate. Some even do not. At this stage, it is difficult to help the patient.

Besides, specialised care and treatment is very costly at this point. While we must work to help critically affected patients, there needs to be a paradigm shift where we pay more attention to the larger, healthier population.

This would help to educate them on reducing stigma, advise them on engaging in healthy behaviour and to build their resilience so that they do not end up ill. For those who are at risk, they must be treated early enough to prevent severe mental illness.

Lessons on the human brain.

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

To understand how it operates, you must understand the different components such as the neurotransmitters, which are chemicals that drive different signals and functions.

The experience of interacting with mental health patients.

You could be talking to your friend, family or child. One could be an artist, lawyer, journalist or a scientist. These are intelligent people with the same dreams and desires like us. It is only that they are facing difficulties in life where help is needed.

Some of the productive people we interact with may be walking a journey of mental health problems only we do not recognise it. Mental health is a spectrum. For some, the signs are overt. For others, the signs are invisible. They are only pushed to the extremes when stressed.

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

To change the game and meet the needs of this country, we must find other ways by mobilising other workers in the healthcare system to join the fray. Pakistan is piloting a project called the ‘‘Lady Health Worker’’ where high school-educated women go into communities collecting data on vaccinations and illnesses.

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

On building a big tent.

Our desire is to bring on board different experts from the academia in our university and other universities, government, community organisations and other diverse fields to build a network and boost capacity. The ethos of our institute is ‘‘from neuron to the neighbourhood’’.

Community organisations help us to understand the needs of the people by bringing the research machinery down to the lowest level.

Why not talking about the crisis is not an option.

We cannot afford to hide it anymore. Instead, we need to begin to deal with it head-on. There is still a lot of stigma around mental illness in Kenya today.

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