Psychiatric Mental Health Practicum

Full Answer Section

Who is Affected by This Topic?

1. Patients with Severe Depression: This is the primary group affected. These individuals often experience debilitating symptoms such as profound sadness, loss of pleasure, severe fatigue, sleep disturbances, changes in appetite, feelings of worthlessness, cognitive impairment, and in severe cases, psychotic features (hallucinations or delusions) or suicidal ideation/attempts. For many, traditional treatments have failed, leaving them in a desperate state.
2. Families and Caregivers: The family members and caregivers of individuals with severe depression are profoundly impacted. They often bear the emotional, financial, and practical burden of supporting their loved one through a severe illness. The decision to pursue ECT can be a difficult one for families, fraught with fear due to historical stigma, but also hope for recovery.
3. Healthcare Professionals: Psychiatrists, anesthesiologists, nurses, and other mental health professionals involved in administering ECT or managing patients with severe depression are directly involved. They are responsible for patient assessment, treatment planning, procedure execution, and post-treatment care.
4. Policy Makers and Healthcare Systems: Decision-makers at governmental and institutional levels are affected as they determine funding, access, training, and guidelines for ECT services. The availability and affordability of ECT directly impact whether patients can receive this potentially life-saving treatment.

How Does It Affect the Community as a Whole?

The impact of severe depression and the availability (or lack thereof) of effective treatments like ECT extends far beyond the individual patient and their immediate family:

1. Economic Burden: Severe depression leads to significant lost productivity due to absenteeism from work, reduced work performance (presenteeism), unemployment, and premature mortality (including suicide). It also increases healthcare costs for long-term care, emergency services, and managing co-occurring physical health conditions. When individuals recover through effective treatment like ECT, they can return to productive roles, contributing to the economy.
2. Social Cohesion and Well-being: Untreated severe depression can strain family relationships, lead to social isolation, and reduce community engagement. When individuals recover, they can reintegrate into social networks, participate in community activities, and contribute to the overall social fabric.
3. Healthcare Resource Strain: Patients with severe, treatment-resistant depression often cycle through various ineffective treatments, emergency room visits, and hospitalizations, putting a strain on healthcare resources. Effective treatment like ECT, by leading to remission, can reduce this burden.
4. Stigma and Awareness: The historical stigma surrounding mental illness, and particularly ECT, affects community attitudes towards mental health treatment. Open discussion and understanding of ECT as a legitimate, often life-saving, medical procedure can help reduce stigma around severe mental illness and encourage help-seeking behavior.
5. Public Health: Severe depression contributes to the global burden of disease and disability. Effective treatments like ECT are crucial tools in public health efforts to reduce this burden and improve mental well-being across populations. In Kenya, with its unique mental health challenges and resource constraints, addressing severe depression effectively is a critical public health priority.

Cost Associated with the Issues (Focusing on Kenya)

The costs associated with severe depression and access to ECT in Kenya are substantial and multifaceted:

1. Direct Healthcare Costs:

   • Diagnosis and Consultation: Psychiatrist consultations (Ksh 5,000 per session).
   • Medications: Ongoing costs for antidepressants and other psychotropic medications, which can be significant, especially for treatment-resistant cases that require multiple trials.
   • Hospitalizations: For severe episodes, psychiatric hospitalizations are costly. Mathari Hospital, a major public mental health facility, requires a down payment for admission. Private hospitals charge significantly more (e.g., Ksh 3,000-5,000 per day for psychiatrist visits).
   • ECT Treatment: In Nairobi, ECT sessions can cost around Ksh 10,000 per session. A typical course of 6-12 sessions would thus cost Ksh 60,000 to Ksh 120,000 for the procedure alone, not including consultation, anesthesia, or hospital stay costs.
   • Other Therapies: Psychotherapy sessions can range from Ksh 2,000 to Ksh 6,000 per hour in private facilities.
   • Low Public Funding: Kenya's health budget allocates a disproportionately low amount to mental health (as low as 0.01% in past years), pushing many towards expensive private care. While NHIF may cover some mental health services, a spot check indicated this is not consistently applied across all facilities.

2. Indirect Costs (Societal and Economic Burden):

   • Lost Productivity: Kenya's Mental Health Investment Case (2021) estimated the total economic burden of mental health conditions on the Kenyan economy at KES 62.2 billion (US$571.8 million) in 2021, equivalent to 0.6% of the GDP. The largest share (KES 56.6 billion) was due to lost productivity from premature mortality, absenteeism, and presenteeism.
   • Caregiver Burden: The uncompensated time and emotional toll on family members caring for severely depressed individuals.
   • Impact on Education: For younger individuals, severe depression can disrupt schooling and future career prospects.
   • Suicide: The tragic loss of life due to suicide represents an immeasurable cost, both human and economic.

Short-Term Effects vs. Long-Term Effects of ECT

Short-Term Effects (during and immediately after a course of ECT):

1. Rapid Symptom Improvement: The most significant short-term effect is the rapid and often dramatic reduction in severe depressive symptoms. Many patients experience remission of symptoms within a course of 6-12 treatments.

Sample Answer

Your Topic: Electroconvulsive Therapy (ECT) in the Treatment of Severe Depression

ECT is a medical procedure that involves passing a brief electrical current through the brain to trigger a short, controlled seizure. This is done under general anesthesia and with muscle relaxants to minimize physical discomfort. It's primarily used for severe mental health conditions, particularly severe major depression that has not responded to other treatments like medication and psychotherapy (treatment-resistant depression), or when a rapid response is needed due to severe symptoms like psychosis or imminent suicide risk.