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IMPROVING REFERRAL FOR ADOLESCENTS WITH MENTAL HEALTH DISORDERS IN NAIROBI: A PILOT STUDY

KENYA, 2024
Health and Well-Being (HaW)
Daniel Mtai Mwanga
Last modified October 02, 2025 Page views 69 Documentation in PDF Metadata DDI/XML JSON

Identification

IDNO
DDI-KEN-APHRC-RAMH-2025-V1.0
Title
IMPROVING REFERRAL FOR ADOLESCENTS WITH MENTAL HEALTH DISORDERS IN NAIROBI: A PILOT STUDY
Country
Name Country code
KENYA KEN
Abstract
Recent findings from the Kenya National Adolescent Mental Health Survey (K-NAMHS) show that over two-fifths (44%) of adolescents in Kenya experienced a mental health problem in the past 12 months, yet only 11% sought services for emotional and behavioural problems. Among those who sought help, 34% turned to religious or faith leaders, while 32% sought support from school staff. Very few consulted doctors or nurses (10%). While some mental health conditions can be adequately addressed by religious leaders and school teachers through counselling, others require specialised treatment and care in mental health facilities. For example, psychiatric and neurological conditions such as epilepsy, schizophrenia, and psychosis need specialist intervention. However, in Kenya, there is no clear referral pathway linking religious and faith leaders with clinical services for such conditions.
The general objective of this study was to determine the acceptability of establishing referral pathways between religious/faith leaders, school teachers/resident nurses, and professional mental health services in Nairobi. The specific objectives were:
(i) To identify barriers and facilitators of adolescent referrals from religious leaders and secondary school teachers/resident nurses to professional mental health providers or facilities; and
(ii) To identify mental health services and facilities in Nairobi City County as well as the existing referral services.
The study was conducted in Nairobi County using a mixed-methods approach. We carried out key informant interviews with Nairobi mental health service focal persons and in-depth interviews with religious/faith leaders, secondary school nurses, and guidance and counselling teachers. Quantitative methods were also employed to abstract data from facilities offering mental health services in Nairobi County. Data abstraction was conducted through interviews with the Nairobi County mental health department. Qualitative data were analysed deductively using a pre-specified framework and inductively to incorporate emerging factors identified by respondents. Quantitative data were analysed descriptively and summarised in tables.
The study lasted one year and cost approximately US$10,000. The outcomes included insights on feasibility, acceptability, and existing gaps in establishing referral pathways for adolescent mental health conditions between religious/faith leaders, schools, and clinical services in Kenya. It also assessed the readiness of the healthcare system to manage referred cases. The findings will contribute to the development of a comprehensive mental health referral pathway linking professional mental health services with other providers, thereby improving care for adolescents with mental health needs.

Version

Version Date
2025-09-30
Version Notes
N/A

Scope

Keywords
Keyword
Adolescent mental health
Referral pathways
Mental health services
Barriers and facilitators
Religious leaders
School staff
Nairobi County

Coverage

Geographic Coverage
Capital city (Nairobi County, Kenya)
Unit of Analysis
Individual
Institutional
Universe
The study targeted:
-Religious/Faith Leaders (Protestant, Catholic, Seventh Day Adventist, and Muslim)
-Secondary School Staff (guidance and counselling teachers, and school nurses) from both public and private schools in Nairobi County
-Nairobi City County Mental Health Focal Persons responsible for mental health service provision and referral coordination

The primary beneficiaries of the study are adolescents aged 10–19 years in Nairobi County, who are the focus of referral pathways for mental health care.

Producers and sponsors

Authoring entity/Primary investigators
Agency Name Affiliation
Daniel Mtai Mwanga African Population and Health Research Center (APHRC)
Producers
Name Affiliation Role
Frederick Murunga Wekesah African Population and Health Research Center (APHRC) Co-investigator
Elizabeth Wambui Mwaniki African Population and Health Research Center (APHRC) Co-investigator
Joan Watiri Kinuthia African Population and Health Research Center (APHRC) Co-investigator
Peter Otieno African Population and Health Research Center (APHRC) Co-investigator
Simeon Kintu Paul African Population and Health Research Center (APHRC) Research and Data Documentation Officer
Bonface Butichi Ingumba African Population and Health Research Center (APHRC) Data Governance Officer
Funding Agency/Sponsor
Name Abbreviation Role
African Population and Health Research Center APHRC Funder
Other Identifications/Acknowledgments
Name Affiliation Role
Stella Wangari Waruinge Nairobi County Government Mental Health Technical Advisor

Sampling

Sampling Procedure
We used convenience and purposive sampling approaches to identify the study participants for the qualitative interviews. Purposive sampling was used to select the key informants among mental health focal persons in Nairobi County. We used convenience sampling to select religious/faith leaders and secondary schools guidance and counselling teachers and nurses depending on their availability for interviews during the study period. The sample size for the qualitative interviews depended on response saturation.
We spread the sampling to get representation from all sub-counties in Nairobi City County. Mental health service data abstraction was conducted through desk review and interviews with a representative of the mental health department in Nairobi City County. The study extracted as much information as possible using the resources available for all facilities in the Nairobi County mental health department database.
Deviations from the Sample Design
There was no deviation from the original sample design.
Response Rate
The response rate was 98%.
Weighting
N/A

Data Collection

Dates of Data Collection (YYYY/MM/DD)
Start date End date Cycle
2024-04-29 2024-05-09 Phase 1 (Quantitative)
2024-06-10 2024-08-07 Phase 2 (Qualitative)
Mode of data collection
Other [oth]
Supervision
Data collection activities were supervised by the Principal Investigator and Co-Investigators from the African Population and Health Research Center (APHRC). The Qualitative Team Leader, who initially joined the project as a Research Intern, coordinated the fieldwork, ensured adherence to the study protocol, and monitored the progress of both quantitative data abstraction and qualitative interviews. Regular debriefing sessions were conducted with the data collection team to review challenges, clarify procedures, and ensure data quality. Completed interview transcripts and facility data abstraction forms were reviewed by supervisors for accuracy, completeness, and consistency prior to data processing and analysis.
Type of Research Instrument
Data collection was conducted in two phases. The first phase involved quantitative data abstraction from facilities providing mental health services in Nairobi County. The second phase applied qualitative methods, including KIIs and IDIs, to explore barriers and facilitators of adolescent mental health referrals and to identify existing referral pathways. A total of 62 respondents were recruited: 12 mental health focal persons, 30 religious leaders, and 20 secondary school guidance and counselling teachers and resident school nurses.

1) Key Informant Interviews with Mental Health Focal Persons
>The key thematic areas included:
-Burden of mental health conditions in the community (extent, types of conditions, affected groups)
-Mental health services provided (types of care, available interventions, unmet needs)
-Mental health among adolescents and youth (knowledge levels, sources of care, services sought)
-Facilitators of access to mental health services (enabling factors at individual, community, and system levels)
-Barriers to access and service provision (knowledge gaps, stigma, financial constraints, resource limitations, system-level barriers)
-Challenges in providing care for adolescents with mental health conditions
-Capacity of community and health facilities to provide mental health care (school nurses, counsellors, religious leaders, etc.)
-Referral processes for adolescents and youth (existence, clarity, gaps, and possible improvements)
-Strategies to strengthen referral pathways (recommendations for system, community, and provider-level improvements)

2) In-depth Interviews with Secondary School Guidance and Counselling Teachers and School Nurses
>The key thematic areas included:
-Burden of mental health conditions among students (extent, comparison with general public, most prevalent conditions)
-Types of services provided in schools (treatment, counselling, referral, outreach, screening, rehabilitation, unmet needs)
-Challenges in providing mental health care (resource constraints, stigma, difficult cases, barriers encountered)
-Students’ challenges in seeking care (awareness, stigma, financial constraints, perceptions)
-Referral practices and attitudes (perceptions of referral as part of role, existing referral practices, facilitators, barriers)
-Training and support needs (skills, resources, or support required to improve referral and care capacity)
-Strategies for improving referral pathways (recommendations to overcome barriers and strengthen links with health facilities)

3) In-depth Interviews with Religious Leaders
>The key thematic areas included:
-Knowledge and perceptions of mental health (awareness, conditions affecting community, perceived causes)
-Role of religious leaders in providing mental health support (types of care/support offered, age groups served, situations prompting care-seeking)
-Barriers faced in addressing mental health needs of adolescents (conditions or circumstances difficult to manage, challenges in practice)
-Facilitators of providing support (cultural/religious practices, enabling factors, successful experiences)
-Collaboration with the healthcare system (experience with referrals, perceived role, training/resources needed)
-Attitudes towards referrals (comfort with referring adolescents, factors that encourage or discourage referral)
-Stigma and misconceptions (community beliefs, stigma in adolescents vs adults, role of leaders in stigma reduction)
-Community education and awareness (leaders’ role in raising awareness, strategies to reduce stigma, leveraging religious/cultural practices)

Data Processing

Cleaning Operations
Quantitative data from facility records were entered into Excel spreadsheets and were mainly descriptive, focusing on the mental health services offered, the types of mental health conditions managed by the mental health focal persons in each sub-county, and the designated clinic days. Qualitative data were audio-recorded, transcribed verbatim, and anonymized to protect participant confidentiality. The transcripts were reviewed against the original audio recordings to ensure accuracy, and data cleaning involved verifying consistency across facility abstraction forms and qualitative transcripts. Coding of qualitative data was conducted using NVivo version 15 software, guided by a codebook framework developed specifically for this study. All cleaned transcripts were securely stored and prepared for analysis.
Other Processing
All qualitative transcripts were anonymized by removing personally identifiable information prior to analysis to ensure participant confidentiality. Transcripts were reviewed and standardized to maintain consistency in formatting. A codebook framework was developed and refined iteratively during the qualitative data analysis process. Coding was conducted using NVivo version 15 to facilitate thematic analysis. For the quantitative dataset, variables were checked for consistency and clarity, and descriptive tables were generated to summarize the distribution of mental health services offered, the types of conditions managed, and the designated clinic days across sub-counties.

Data Appraisal

Estimates of Sampling Error
N/A

Data access

Contact
Name Email URI
African Population and Health Research Center (APHRC) datarequests@aphrc.org/info@aphrc.org aphrc.org
Conditions
APHRC data access condition

All non-APHRC staff seeking to use data generated at the Center must obtain written approval to use the data from the Director of Research.
This form is developed to assess applications for data use and facilitate responsible sharing of data with external partners/collaborators/researchers. By entering into this agreement, the undersigned agrees to use these data only for the purpose for which they were obtained and to abide by the conditions outlined below:

1.Data Ownership:
The data remain the property of APHRC; any unauthorized reproduction and sharing of the data is strictly prohibited. The user will, therefore, not release nor permit others to use or release the data to any other person without the written authorization from the Center.

2.Purpose:
The provided data must be used for the purpose specified in the Data Request Form; any other use not specified in the form must receive additional or separate authorization.

3.Respondent Identifiers:
The Center is committed to protecting the identity of the respondents who provide information in its research. All analytical data sets (both qualitative and quantitative) released by the Data Unit MUST are stripped of respondent identifiers to protect the identity of the respondents. By accepting to use APHRC data, the user is pledging that he/she will not, under any circumstance, regenerate the identifiers or permit others to use the data to learn the identity of any individual, household or community included in any data set.

4.Confidentiality pledge:
The user will not use nor permit others to use the data to report any information in the data sets that could identify, directly or by inference, individuals or households.

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The user will promptly notify the Head of the Statistics and Survey Unit any errors discovered in the data as soon as the errors are discovered.

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The Center requires external collaborators to work with APHRC staff on all publications resulting from its data. In order to facilitate this, lead authors should send a detailed concept note of the paper (including the background, rationale, data, analytical methods, and preliminary findings) to the Principle Investigator (or Theme Leader) for the project (with a copy to the Director of Research), who will circulate the abstract to concerned researchers for possible expression of interest in participating in the publication as co-authors. Any exception to the involvement of APHRC staff should be approved by the Director of Research, APHRC.

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The user will take responsibility for the security of the data by ensuring that the data are used and stored in a secure environment where access is password protected. This will ensure that non-authorized people should not have access to the data.

8.Loss of privilege to use data:
In the event that APHRC determines that the data user is in violation of the conditions for using the data, or if the user wishes to cancel this agreement, the user will destroy the data files provided to him/her. APHRC retains the right to revoke this agreement or informs publishers to withhold publication of any work based wholly or in part on its data if the conditions for using the data are violated.

9.Acknowledgement:
Any work/reports from this data must acknowledge APHRC as the source of these data. For example, the suggested acknowledgement for NUHDSS data is:
"This research uses livelihoods data collected under the longitudinal Nairobi Urban Health and Demographic Surveillance System (NUHDSS) since 2006. The NUHDSS is carried out by the African Population and Health Research Center in two slums settlements (Korogocho and Viwandani) in Nairobi City."Additionally all funders, the study communities that provided the data, and staff who collected and analyzed or processed the data should be acknowledged.

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11.Change of contact details:
The user will promptly inform the Director of Research of any change in your personal details as contained on this data request form.
Citation requirement
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download

Metadata production

Document ID
DDI-KEN-APHRC-RAMH-2025-V1.0
Producers
Name Abbreviation Role
African Population and Health Research Center APHRC Documentation of the DDI
Date of Production
2025-09-30
Document version
Version 1.0 (September 2025)