When mental health struggles go unheard

• For Mable, the changes in her daughter Mary's behaviour began after she lost her three-month-old baby.

Some Kenyan families go through mental-health difficulties which start with changes they struggle to explain.

A daughter loses her baby and begins behaving differently. A son returns home after searching for work, struggling with substance use and behaviour his family finds difficult to manage.

Elsewhere, a young woman loses her parents, becomes pregnant at a young age and experiences psychological distress with little family support.

For these families, the challenge is not only coping with the changes but also understanding what is happening.

Is it grief? Is it substance use? Could it be a medical condition? Or, as some people believe, is it witchcraft or punishment for breaking a cultural tradition?

How these changes are interpreted can influence whether a person receives professional care, is isolated or is subjected to violence.

For Mable, the changes in her daughter Mary's behaviour began after she lost her three-month-old baby.

“Mary's behaviour changed after the burial,” Mable says.

According to Mable, her daughter became increasingly distressed and at times violent. She says some people responded by beating Mary because of her behaviour.

Mary disappeared from her matrimonial home for some time before returning to her father's home, but the difficulties continued.

Mable says Mary later became involved in a confrontation with the niece. When Mable tried to intervene, Mary allegedly struck her on the head with a metal rod.

Mary later died. "She succumbed from injuries of beating. They say she went into a sacred circumcision shrine, where she met her wrath. The custodians beat her blue and black," Mable describes.

For Mable, the loss of her daughter left grief and questions about what happened between the death of her grandchild and her daughter's own death.

Her account raises a critical question about mental-health care: what happens when changes in a person's behaviour are visible long before their cause is understood?

Linda Kayinzili, a clinical officer in mental health and psychiatry at Vihiga Teaching and Referral Hospital, says understanding a patient's experience is an important part of mental-health assessment.

A clinician needs to understand what a person is thinking, feeling and experiencing. Information from relatives can also help establish changes in behaviour, daily functioning and circumstances.

Kayinzili says the hospital commonly sees cases of schizophrenia, substance-induced psychosis, depression and epilepsy, with some cases of bipolar disorder.

She estimates that the facility handles between 160 and 190 mental-health cases a month. From April to September 2026, she says, the hospital recorded 117 new cases.

These figures reflect cases handled at the facility and should not be interpreted as the prevalence of mental illness across Vihiga County.

"Replacing labels such as “mad” with person-centred care is important because labels can obscure the circumstances behind someone's behaviour and discourage families from seeking help," Kayinzili says.

A person experiencing a mental-health crisis remains an individual with a history, relationships, fears and needs.

Mary's brother, John, has faced a different set of circumstances.

Mable says John travelled to Kitale to look for work. While there, she says, he became involved in a fight with a fellow worker who later died from injuries.

John subsequently travelled to Bondo, where he worked as a farmhand.

“He was using hard drugs, including cocaine,” Mable says of John's time away from home.

When he returned, she says, his behaviour had become increasingly difficult for the family to manage.

On one occasion, Mable recalls, John asked his brother for money. When he did not receive it, she says John threatened to lie on the road so that a vehicle could run over hm.His brother eventually bought him a ticket to return to Vihiga.

John is a father of three, with his youngest child in Grade One. Mable says his difficulties have affected his children as well. She recalls instances when he went to their school and was sent away, and alleges that he was sometimes beaten.

Kayinzili says substance-induced psychosis is among the conditions seen at the hospital.

"Substance use may contribute to psychological symptoms, worsen an existing condition or occur alongside another illness. A proper assessment is therefore necessary to establish what a person is experiencing and what care they require," Kayinzili implodes.

For many families, a medical explanation is not always the first interpretation when someone begins behaving differently.

Beliefs about witchcraft, spiritual forces or punishment for violating tradition can influence how unusual behaviour is understood.

Some families may first seek help from relatives, religious leaders or traditional structures. Others may try to manage the situation at home.

Healthcare workers must understand these beliefs while ensuring that people can access appropriate clinical assessment.

The challenge is to encourage communication without ridiculing families or allowing cultural explanations to substitute for medical assessment.

When one person experiences a mental-health crisis, the effects can spread across the household.

Someone must arrange transport to hospital. Someone may have to supervise treatment, worry about the safety of other children or assume responsibilities they never expected.

The emotional cost can accumulate quietly.

Kayinzili says caregivers should watch for signs that their own wellbeing is deteriorating, including persistent exhaustion, sleep problems, constant worry, irritability, withdrawal, hopelessness or feeling unable to cope.

Seeking help for the caregiver is not abandoning the person experiencing a crisis. It can make sustained caregiving more manageable.

Families can also share responsibilities rather than leaving one person to carry the entire burden.

Jemima Dembeko, a retired teacher, shared the story of her niece, whose life was shaped by loss and limited support.

The young woman had completed secondary school with a D plain and, according to Dembeko, wanted to continue her education.

She was an orphan. She later became pregnant and was forced into marriage at the age of 22.

Dembeko says the woman's mental-health difficulties became apparent when her child was about two years old.

Maternal mental health conditions, including postpartum depression and anxiety, can persist for two years or longer after childbirth. Although these conditions often begin during pregnancy or in the first weeks or months after delivery, some women continue to experience symptoms well beyond the first postpartum year.

Mental health difficulties do not automatically end when a woman reaches 12 months after giving birth. However, not every woman experiences symptoms for two years, and the duration varies depending on factors such as access to treatment, social support, previous mental health difficulties and life circumstances.

A 2024 systematic review of 21 studies found that maternal depression and anxiety remain prevalent beyond the first year after childbirth, although estimates varied considerably between studies.

A US National Institutes of Health study following about 5,000 women found that approximately one in four experienced high levels of depressive symptoms at some point during the three years after giving birth. These were screening results, not confirmed clinical diagnoses.

The World Health Organization (WHO) identifies maternal mental health as an important public health issue and notes that untreated mental health conditions can affect both mothers' and children's well-being.

Maternal mental health challenges can persist well beyond the first year after childbirth, with research showing that some women continue to experience symptoms of depression and anxiety two years or longer after delivery.

The young mother was eventually sent away from her marital home. Without parents to return to, she had limited family support. She left her son under the care of the grandparents.

According to Dembeko's account, the young woman lived with her difficulties until her death.

Her son has since grown up, married and had children of his own.

But what might have changed if the young woman had received support when her difficulties first became apparent?

Her experience illustrates why mental-health intervention cannot be separated from the social circumstances surrounding a person. Education, poverty, family relationships, pregnancy, bereavement and access to healthcare can all shape a person's experience of psychological distress.

Kayinzili says mental-health support does not always have to begin at a specialised psychiatric facility.

Primary healthcare can provide an entry point for identifying people who may need help. "Depending on their needs, patients may receive psychosocial support or psychological counselling, while those requiring specialised intervention can be referred to appropriate services," she reinforces.

Screening can help health workers identify people who require further assessment.

But screening alone is not enough. People identified as needing help must also be able to access the next stage of care, including functioning referral pathways, trained personnel, medicines and specialist services where required.

Recognising a problem early creates an opportunity to intervene before a situation becomes more severe.

The accounts shared by Mable and Dembeko are family testimonies, not medical diagnoses. They describe what relatives witnessed and experienced but cannot independently establish the causes of the individuals' difficulties.

Bereavement can cause profound psychological distress, but not everyone who grieves develops a mental disorder. Substance use can be associated with psychosis and other mental-health problems, but behavioural changes can also arise from neurological or other medical conditions.

Diagnosis requires professional assessment.

Families nevertheless remain important observers. They are often the first to notice when someone stops sleeping, withdraws from others, changes their behaviour or struggles with everyday activities.

Their observations can help clinicians understand the timeline and circumstances surrounding a person's difficulties. The person's own account can add another layer that cannot be captured by symptoms alone.

Under the theme “Lived Experiences Heard: Real Voices, Real Change,” the challenge is not simply to encourage conversations about mental health. It is to ensure that listening leads to meaningful support.

A mother who reports worrying changes in her child's behaviour should receive guidance rather than dismissal. A person who uses substances should still have access to a proper mental-health assessment. A caregiver should be asked how they are coping. And a person experiencing a crisis should have an opportunity to describe their own experience.

For Mable, it is the memory of a daughter whose behaviour changed after losing her baby. For John, it is a family trying to understand the intersection of substance use, distress and difficult behaviour. For Dembeko's niece, it is a life shaped by orphanhood, pregnancy, marriage and limited family support.

For the caregivers around them, it is the weight of trying to help without always knowing how.

Mental health is often measured through diagnoses and numbers. But before someone becomes a number in a hospital register, there may have been a mother who noticed a change, a sibling who became worried or a caregiver who quietly became exhausted.

Listening does not replace science. It helps science understand the person behind the symptoms.

And when those voices are heard early, families may have a better chance of finding appropriate support before distress becomes a crisis.