Mental health is a world that few truly understand. It is also a world in which I have been privileged to work for the last four years. In this time, I have trained and worked at the largest mental health institution in East and Central Africa – the Mathari National Teaching and Referral Hospital, with a bed capacity of 700 patients and an outpatient department that runs 24/7 year-round. This institution was officially opened in 1901.
I have also had the opportunity to work in a smaller setting in a different part of Kenya. Over these years, I have attended to thousands of patients, both those suffering from diagnosed mental illness and those experiencing poor mental health.
During this time, I have been well-positioned to observe and experience the attitudes towards mental health as held by the community, other health workers, and the patients themselves. I gain these insights through experiences with patient relatives, discussions with colleagues, and interactions with people who discover that I work in mental health.
For many, mental health work sparks curiosity: they ask what mental illness is like, what it is like working with mentally ill people, whether I can tell if they themselves are mentally ill, whether I can “read their minds,” how they can improve their mental health, and most commonly, why I chose this field. These insights give a glimpse into the perception of mental health.
I chose to join this discipline because of my academic interest in psychology and human behavior, because I recognized a desperate need for mental health services and personnel, and because there was an opportunity to pursue the discipline while helping those who needed support. I believed I could join others “holding hands in service” and offer something, even if I was no superhero.
Having already trained in biological sciences and practiced general health for several years, I might have assumed I knew a lot about mental health. I couldn’t have been more wrong.
I would describe working in mental health as a cliff dive into the ocean of real life. There can be no gentle entrance, because mental health work immediately thrusts you into experiences alternate and sometimes alien to those we frequently experience in our daily lives.
Every day is different. Each experience is uniquely intense.
The emotional weight from the story of a divorce, then one who is bereaved, then one who has suffered trauma of war. Sometimes they are the first three encounters before tea.
The ambiguity of hearing voices, from nowhere and no one in particular. Troublesome voices, sometimes dangerous voices that no one else can hear and that refuse to be silenced.
The internal conflict of empathizing with a tragic story while having to maintain professional boundaries (distance) and authority.
The unpredictability of a session that begins lighthearted but erupts into violence almost without warning.
Perspective, perhaps, has been the deepest lesson. If you have lived a shielded, carefully curated life, mental health work suddenly disrobes you, demanding comfort with the unknown, unseen, and unexpected. The word “normal” becomes the most abnormal concept, and anything becomes expected—or at least accepted.
These experiences made me realize how much we do not know, how many people do not know, and how much we all need to learn. Conversations around mental health, illness, trauma, and recovery are gaining momentum, but stigma remains significant. Subtle discrimination, mingled with deep love and compassion, is often what I witness from families of those living with mental illness. Poor access to affordable, sustainable care continues to be the greatest challenge.
Working in mental health is a journey that continually reveals, just as it confuses, draws excitement and despair in equal measure, humbles unapologetically, and teaches an effortless fusion of science with art.
It is this journey that I will try to share. I hope to help those who wish to understand, those who may wish to participate and make a difference, and those who simply wish to know. We in the discipline have a responsibility to strengthen the human connection in mental health, advocate more fiercely, show the hidden face of mental health within medicine, fight for better access to quality care, and influence communities to support each other.
So here I am. Trying.