Title: Disparities in Knowledge, Attitude and Practices on Mental Health among Healthcare Workers and Community members in Meru County, Kenya

Background Mental health (MH) remains a neglected priority in many low and middle-income countries. Currently, there is inadequate data on the prevalence of mental health in Kenya. This is compounded by huge inequity in the distribution of skilled human resources for mental health services. Inadequate knowledge about mental health and negative attitudes towards people with mental health disorders is widespread among the general public. Methods This was a descriptive cross-sectional survey that utilised mixed methods for data collection. A total of 535 community members and 109 healthcare workers (HCWs) were targeted for the study. All cadres of healthcare workers in the selected health facilities who voluntarily consented to participate were recruited through simple random sampling. Data were collected using household surveys, Key Informant Interviews (KIIS) with facility in-charges; Focus Group Discussions (FGD) with community members particularly community Health Volunteers (CHVs) and youth; and In-depth Interviews (IDI) with community gate keepers such as religious leaders, Religious leader, Chiefs/sub-Chiefs, and traditional leaders. Data analysis included simple univariate frequencies of questions chosen to reflect the key concepts on mental health. Descriptive statistics were used to determine frequencies and percentages for the different variables under study. For qualitative data, thematic analysis was applied to generate themes through deductive and inductive methods. Triangulation of qualitative and quantitative data was conducted. Results Approximately 39.1% of respondents reported to have had a family member with mental illness and 68% of HCWs reported to have diagnosed a patient with mental illness. 64% of respondents cited causes of mental disorders as witchcraft; generational curses in some families; genetic factors; drug and substance abuse especially marijuana; social and economic/financial pressures; and injuries from accidents. 93.3% of the HCWs reported to have referred patients to a mental health facility. Only 29.4% of the HCWs . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 10, 2022. ; https://doi.org/10.1101/2022.03.09.22270872 doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. 2 reported having counselling services in the facilities for patients with mental health needs. Majority (90.8% HCWs and 62.3% community members) reported that it is convenient for patients with MH needs and illness from the community to access the health care facilities and that MH services were available and mainly offered at the Meru Teaching and Referral Hospital (81.7% HCWs and 53.8% community members). Majority of HCWs (89.9%) reported that MH services were affordable to community members. On the contrary, only 44.4% of community members reported that MH services are affordable. The HCWs reported that the drugs were given for free at the health facilities while community members reported that sometimes stock-outs in drugs for MH existed in which case they would purchase drugs from pharmacies. Majority (96.4% HCWs and 62.5% community members) reported that patients with mental health needs and illness are treated with respect in the facilities. Aside from health facilities, community members also seek mental health services from: religious leaders; traditional healers including the Religious leader who were approached for cleansing if one believed that the mental health issues were a curse for committing certain offenses. It was also evident that some families did not seek any kind of help for their relatives with mental health illness and needs, with some even detaining them. Conclusion This study adds to the global knowledge on mental health among healthcare workers and community members providing vital data at service delivery level from an African developing country perspective. There is evidence of high burden of MH in the county with very few facilities offering MH services for patients. The existence of myths and misconceptions around the causes of MH is evident and needs to be addressed. There are also evident disparities in the perception of HCWs and Community members in MH with regards to availability and affordability of MH services and access to MH drugs. Communities still seek MH services from traditionalists and some people still neglect MH cases. Sustained poor mental health of individuals, families, the communities including healthcare workers has an enormous contribution towards negative health seeking behavior as well as social capital, an important determinant of health not just in Kenya but in many rural settings across the world. With this therefore, there is need to build the capacity of health care workers and create awareness to the community members as well as strengthen health systems to tackle MH.