Interview with Wairimu Githahu on Suicide and Cognitive Behavioral Therapy

Thank you for taking the time to speak to us. Given the rise in suicide rates among teens globally and in honour of Suicide Awareness Month, we will like to ask you a few questions to help inform parents on what they need to know to help them care for their child’s mental health and reduce the likelihood of suicide.

1)  Tell us a bit about yourself? What is your background and qualifications?

I went to school in Kenya till I did my std 8, then left for England for high school. I went to University of Hertfordshire where I did my nursing. I had chosen General nursing at first but I knew that I wanted to change when I did my first placement in an acute psychiatric unit. I have always been interested in how the mind works and what contributes to mental health illnesses. The beauty of my course is that for the first 18 months you did placements in all four fields of nursing that is Mental Health, Adult, Child and Learning Disabilities. From my first hour in the ward, I knew that this is where my heart lay. (Story for another day). I have worked with children in schools for behavioural issues, using tried and tested programs, I have also worked with children in the juvenile system.

2)  What made you choose to be a psychiatric nurse?

Being part of the journey to get someone from a place where they felt that death is the only option in extreme cases or someone who is experiencing a psychotic episode and seeing them leave and back to ‘normal’ though normal is relative, is one of my greatest joys. More so when working with children who for various reasons have ended up in a psychiatric unit but they leave having sorted out whatever issues got them there is fulfilling.

3)  What are some of the challenges you have faced in your career here in Kenya?

Kenya has been a hard nut to crack. We as a society still talk about mental illnesses like they are a curse and not an illness that can be treated. We treat the mentally ill like pariahs and make it harder for people to ask for help. The ones who do get help are bunched into one group, where the truth is that they are individuals. We take our patients to churches or witch doctors and of course there is no change in them. Kenyans are willing to spend 10k on a night out but will not part with the same amount for their children for therapy. We have a long way to go. But the west also went through the same issues so I know we will one day live in a society where seeing a therapist or psychiatrist won’t be a thing of shame.

4)  Why do you think these challenges (3 above) came about?

Religion, culture and ignorance in a nut shell.

5)  Why do you think there has been a rise in suicide cases among the youth in Kenya?

We do not listen to our children. The old adage ‘children should be seen and not heard’ is still very evident in Kenya. Parents are also over compensating, so buying their children’s love. They will buy them all sorts of expensive gadgets, but will not sit through a meal with them and chat. We need to have an open door policy with our kids from the get go. Children are more intelligent than we give them credit for. Children do not wake up one day and decide to be ‘bad’. It is a gradual process and if you are not truly involved in your child’s life, you will miss all the signs.

6)  What is Cognitive Behavioural Therapy (CBT)?

CBT is a type of talking treatment that focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with different problems. It combines cognitive therapy (examining the things you think) and behaviour therapy (examining the things you do). CBT has been shown to be an effective way of treating a number of different mental health conditions. In addition to depression or anxiety disorders, CBT can also help people with, obsessive compulsive disorder (OCD), panic disorder and anger issues.

CBT can be carried out with a therapist in one-to-one sessions or in groups with other people in a similar situation to you.

If you have CBT on an individual basis, you’ll usually meet with a CBT therapist for between five and 20 weekly or fortnightly sessions, with each session lasting 30-60 minutes.

Exposure therapy sessions usually last longer to ensure your anxiety reduces during the session. The therapy may take place in a clinic, outside if the patient has specific fears, in your own home, particularly if you have agoraphobia or OCD a specific fear of items at home.

Your CBT therapist can be any healthcare professional who has been specifically trained in CBT, such as a psychiatrist, psychologist, mental health nurse or GP.

7)  How does the program (5 above) work? At what age can a child enrol for the program?

CBT can be used with children as young as 3 years old. This of course can be challenging but there are specific programs that have been created for the age group 3-6.

CBT works by teaching patients new coping skills and providing opportunities, both in-session and between sessions, to practice these skills.

Skills taught in the sessions include

• Gaining a thorough understanding of factors maintaining emotional distress and situational avoidance
• Identifying and modifying negative patterns
• Developing problem solving skills
• Mastering relaxation and deep breathing techniques
• Learning to gradually face feared situations rather than avoiding them
• Developing organisational skills
• Improving social interactions
• Improving parent- child interactions.

It is very interactive and the therapist does 20% of the work/ talking and the kids do the rest. I find this helps with them remembering better. They also get a workbook at the end of the course which they have been using throughout. I also insist on working with the parents for some sessions as chances are if the kid is working hard to modify their behaviour but are going back to a home where behaviours aren’t changing the course will not help much.

8)  What are some of the benefits of enrolling a child for this program (5 above)?

Cognitive-behavior therapy (CBT) helps improve a child’s behavior by examining confused or distorted patterns of thinking. CBT therapists teach children that thoughts cause feelings and moods which can influence behavior. During CBT, a child learns to identify harmful thought patterns. The therapist then helps the child replace this thinking with thoughts that result in more appropriate feelings and behaviors.

For example, a child with depression has often developed automatic negative responses to life events. The child may call a friend to play and the child (named Isaac) might say “I can’t play right now.” The child with adaptive thought patterns will say to himself “Isaac can’t play right now. He must be busy. Maybe I should call a different friend and call him tomorrow.” The child with negative patterns of thinking and tendency toward depression may think “Isaac can’t play right now. He doesn’t like me anymore. No one likes me. I don’t have any friends.” Same life event, very different response. One goal of cognitive therapy is to help the child understand that he is interpreting the same life event in a very negative way due to assumptions that may not be true and that he is also generalizing the event to his whole life. The therapist will try to help the child recognize when he/she is doing this and redirect his/her thinking to a more adaptive approach.

9)  Why do you think parents are hesitant to enrol their kids for such programs?

Absolutely! And for a number of reasons, one which is ‘what will my friends, family, neighbours say?’ Any therapist worth their salt signs a confidentiality agreement, where the only time anything spoken about during sessions can be revealed is if a child is a threat to themselves or others. I take this very seriously, as I do not believe I can have a therapeutic relationship with my client if I reveal everything they say to me without their implicit permission.

Another reason I believe is parent’s label their child from an early age as bad, naughty, clumsy etc and therefore the way they deal with it is through punishment and humiliation as opposed to gunning for behavioural change.

10)  What can the government do to cater to the mental health of the youth to help reduce the cases of suicide?

Children have a right to enjoy the highest possible standard of mental health. They have a right to enjoy a sense of well-being, control over their lives and the ability to realise their potential. Good mental health comes from having a balance between all aspects of life – social, physical, spiritual and emotional. To vindicate the right to mental health, children need supportive environments for themselves and their families, and appropriate supports and services when they experience difficulties.

The urgent delivery of child mental health services and supports must now become a political priority. Failure to do so will cost more in the long run. It is impossible to put a price on health, and too many in our communities have experienced the pain of mental health problems and suicide. And yet the economic argument is clear, early intervention to promote mental health and address childhood mental health problems will reduce, in later life, devastating ill-health and consequences such as social exclusion, addiction, deliberate self-harm and suicide. It really is just common sense!