Nairobi Mind Empowerment Peer Support Group

1. Introduction

Version followed: the Nairobi peer support groups of Users and Survivors of Psychiatry in Kenya (USP Kenya / USPK), as described in published accounts from about 2008 to 2017. The main sources are USPK's own study The Role of Peer Support in Exercising Legal Capacity (Elizabeth Kamundia for USPK, undated, data to September 2017, based on ten Nairobi meetings observed in 2016–17), USPK's 2015 shadow report to the UN CRPD Committee, the in2mentalhealth visit report (January 2013), a Daily Nation feature, and the Mental Health Innovation Network and Devex profiles. The group name, USPK's founding year (2007), meeting practice in 2016–17 and how peers support decisions are documented in these sources. How the groups run today, and the text of the 2013 KNCHR briefing paper, are not public. [uncertain: current practice]

What it is. This is a mutual-aid, peer-run support group, not a therapy that a clinician delivers. USP Kenya is a membership NGO registered in Kenya and described as peer-managed and peer-led. It is affiliated with the World Network of Users and Survivors of Psychiatry and the Pan-African Network of People with Psychosocial Disabilities. Its mission is to promote and advocate for the rights of persons with psychosocial disabilities so that they can live and work in their communities. Establishing and facilitating community-based peer support groups is one of its stated objectives. It calls these groups "Experts-By-Experience" groups. [source: Devex profile; MHIN profile; in2mentalhealth 2013; USP-Kenya 2015 report]

Name and origins. A group called "Nairobi Mind Empowerment" did exist. USPK's peer support study lists it as one of USPK's support groups, with 11 members as at 25 September 2017. The same list names a separate, larger "Nairobi Support Group" with 60 members. [source: USPK/Kamundia, p. 9, fn. 4] No published source describes how the Mind Empowerment group itself meets, who it serves, or when it started. This guide therefore describes the USPK Nairobi peer support model as documented for its Nairobi meetings. That account may mainly reflect the larger Nairobi Support Group. Treat the format details below as USPK practice in Nairobi, not as confirmed practice of the Mind Empowerment group. [uncertain]

The sources disagree on founding:

• USPK's own 2015 report to the CRPD Committee says the organisation was established and registered in Kenya in 2007 (para. 1). Devex and the 2013 visit report also give 2007. This is the best-supported founding date.
• A Daily Nation feature names Susan Catherine Keter as founder and chairperson of USP Kenya. It says she formed the network after her own experience of depression from 2001, and that it was registered "in December" of the year before the article. At that time the network was housed at the Presbyterian Church of East Africa compound in Kangemi, with initial support from BasicNeeds and the Schizophrenic Foundation. The page prints only the date "Friday, October 31"; that weekday fits 2008, which would give a December 2007 registration, consistent with USPK's own 2007 date [uncertain: article year inferred]. USPK's 2015 report and its peer support study do not name a founder, so the founder attribution rests on this one press source [uncertain]. [source: Daily Nation]
• In 2013, Kanyi Gikonyo (CEO) and Michael Njenga (Head of Programs) led the organisation as volunteers.

A further conflict concerns the groups. USPK's peer support study says USPK set up its first peer support group in Nairobi in 2012 (p. 9). But the Nation feature already lists groups in Kangemi, Wangige and Kikuyu, and at the January 2013 Nairobi meeting some members had been coming for years. One possible reading is that 2012 marks the start of the current city-centre Nairobi group, while earlier groups met elsewhere. No source says this. [source: Daily Nation; in2mentalhealth 2013; Devex; USP-Kenya 2015 report; USPK/Kamundia] [uncertain: founder, and start date of the Nairobi group]

How change is understood to happen. USP Kenya does not publish a formal theory of change for its groups. From its published aims, change happens through several routes:

• people with lived experience ("experts by experience") and their carers share experience and practical coping knowledge with one another;
• members learn about and claim their rights under the UN Convention on the Rights of Persons with Disabilities (CRPD) and Kenya's Constitution;
• members build collective strength through leadership training and income-generating projects;
• members speak publicly to reduce stigma.

The Kenya National Commission on Human Rights (KNCHR) researched how to implement CRPD article 12 in Kenya. USP-Kenya sat on the technical committee. The resulting briefing paper (2013) pointed to local models of supported decision-making involving peers, networks of friends and families. USPK presents its peer groups as one form of this support. [source: USP-Kenya 2015 report, paras 10–11; the KNCHR paper itself has no public copy] USPK's later study describes in detail how members help each other reach their own decisions (see A10). [source: USPK/Kamundia] [synthesis: the summary of how change happens]

What this guide covers. It is written for a clinician who refers clients to such a group, works alongside it, or adapts its principles. The clinician does not run the group.

2. Framework

There is no published phased protocol, session count or manual for USP Kenya groups. [uncertain] What the sources describe:

Group network

• Around 2013, USP Kenya ran six community peer support groups: one in Nairobi County, two in Nyeri County, one in Nakuru County and two in Kiambu County. [source: MHIN profile]
• The visit report lists groups in Nairobi, Karatina and Kikuyu, with groups in Nakuru and Eldoret being set up. [source: in2mentalhealth 2013]
• The earlier Nation feature lists groups in Kangemi, Wangige and Kikuyu. [source: Daily Nation]

By September 2017, USPK's study reports 15 groups in its text, in Nairobi, Nyeri, Kiambu, Nakuru, Eldoret, Makueni and Machakos. Its footnote names 13 groups: Nairobi Support Group, Nairobi Mind Empowerment, Kiambu, Kayaba, Karindundu, Kiamabara, Kiamariga, Karatina, Create (Machakos), Itambya, Nakuru, Jalikaz (Nakuru) and Uasin Gishu (Eldoret). There was also a WhatsApp support group with 124 members. The groups are community-based, run outside Kenya's mental health system and are not linked to any mental health institution. [source: USPK/Kamundia, p. 9] [uncertain: 15 vs 13 groups]

Format of the Nairobi group

• It met every two weeks, on a Saturday, in a hired room in Nairobi city centre.
• At the meeting observed on 26 January 2013, 18 people attended. They included experts by experience and caregivers. Some had come for years; others were at their first meeting.
• The observer described the atmosphere as quiet, gentle and respectful.
• Discussion covered:
  • ups and downs;
  • coping strategies;
  • work;
  • medication side effects and stopping medication;
  • experiences with psychiatrists;
  • hopelessness;
  • accepting one's condition while finding hope.

[source: in2mentalhealth 2013]

Nairobi meetings observed in 2016–17. A USPK researcher observed ten Nairobi meetings between 28 May 2016 and 25 February 2017. Details:

• Eight meetings were indoors. Two were outdoors, at Karura Forest and Nairobi Arboretum, and ended with yoga.
• Across the ten meetings there were 164 attendances: users, carers, friends, USPK staff and others. Most attendees were users and long-standing members.
• Members introduce themselves and may name their diagnosis if they wish. Staff explained this as a way of showing there is no judgement in the room, not as labelling.
• Members share experiences and coping strategies. Two meetings included human rights training.
• Rural groups differ: some split into men's and women's groups, include livelihood activities, have more carers, and offer more informal support between meetings.

The study does not give a meeting schedule or agenda. [source: USPK/Kamundia, pp. 17–18, fns 45, 49, 50]

Membership

• Membership is open to people who have experienced mental illness or psychiatric treatment.
• Carers and family members are encouraged to join.

[source: Daily Nation]

Implied stages of involvement [synthesis, inferred from the sources and not published by USP Kenya]

1. Newcomer: attends open meetings and listens or shares.
2. Regular member: takes part in mutual support, visits unwell members, and joins income-generating projects.
3. Leader: receives USP Kenya training in leadership, group dynamics, financial management and business enterprise.
4. Advocate: takes part in rights education, media work and policy work.

No entry or progression criteria are published. Involvement is voluntary and continues for as long as the member wants it.

Certification and fidelity. There is no published licensing, certification or fidelity monitoring. The group is not a programme a clinician can deliver under its name. To start or join a group, contact USP Kenya. Devex lists its website as uspkenya.org; whether that site is still live is unconfirmed. The organisation also has an X account, @uspkenya. [uncertain: current contact details]

3. Guiding principles

Principles marked [source] are published by USP Kenya or reported by visitors. The practical meanings that follow each principle are [synthesis].

• Peer-led and peer-managed [source: in2mentalhealth 2013]. People with lived experience run the group. Clinicians attend only when invited and never chair.
• "Experts by experience" [source: MHIN; in2mentalhealth 2013]. Members' lived knowledge counts as expertise. Do not correct members' accounts from a clinical stance.
• Rights-based, grounded in the CRPD [source: USP-Kenya 2015 report; in2mentalhealth 2013]. USP-Kenya's report calls all CRPD rights "indivisible and interdependent". Support the client's legal capacity, choice and community inclusion. Do not frame the group as a compliance tool.
• Mutual help and information-sharing on managing mental illness [source: Daily Nation]. Members help each other to improve their lives. Expect practical, experience-based advice, and help the client weigh it against their own situation.
• Inclusion of carers and families [source: Daily Nation; in2mentalhealth 2013]. Carers attend alongside members. Prepare clients for carers being in the room, and invite carers to attend in their own right.
• Peers as decision supporters [source: USP-Kenya 2015 report, citing the 2013 KNCHR briefing paper; USPK/Kamundia]. Peers, friends and family can support a person's own decisions. In USPK groups the person keeps the final say, and peers speak from their own experience rather than telling the person what to do. When a client chooses, treat their peer network as a legitimate part of shared decision-making.
• Economic empowerment [source: Daily Nation; in2mentalhealth 2013]. Income-generating activity is part of recovery. Ask about livelihood as well as symptoms.
• Self-advocacy and public education [source: Devex; USP-Kenya 2015 report]. Members speak in their own voice against stigma. Respect members who go public, and never pressure a client to disclose.
• Outreach to members who are unwell [source: Daily Nation]. The group visits members who cannot attend. Discuss with the client in advance whether they consent to peers being told they are unwell, and how.
• Hope and acceptance [source: in2mentalhealth 2013]. Accepting one's condition while finding hope is a recurring theme. Build on this framing rather than on deficit language.

4. Intervention inventory

This inventory has two parts.

• Part A lists what the group itself does, as published. Members run these activities, not the clinician. No session scripts or manuals are published, so the steps in Part A are reconstructed from short descriptions. Where steps are inferred, they are marked [synthesis].
• Part B gives procedures for a clinician who refers clients to the group or works with it. Part B is entirely [synthesis].

Part A. Group practices (peer-run)

A1. Fortnightly open peer-sharing meeting

• Purpose: Regular mutual support among experts by experience and carers. Newcomers and long-standing members meet together. [source: in2mentalhealth 2013]
• Steps (as observed):
  • The group meets every two weeks on a Saturday in a hired room in Nairobi city centre.
  • Members and carers sit together and take turns to share.
  • Topics come from members.
  • USPK staff attend. When discussion drifts, they bring it back to the person who raised the issue, and they check whether the person is comfortable with a suggestion. Members open with introductions and may name a diagnosis if they wish. [source: USPK/Kamundia, pp. 18, 24] The full order of the meeting is not published. [uncertain]
• Example language (illustrative, for a clinician describing the group): "It's a room of people who've been through it. You can just listen the first time."
• Watch for: Whether the client feels heard and leaves with at least one practical idea or contact. Signs it is working: the client returns and starts to name peers. [synthesis]

A2. Experiential exchange on coping, medication and services

• Purpose: Members share first-hand knowledge on these topics:
  • coping strategies and work;
  • medication side effects and stopping medication;
  • experiences with psychiatrists;
  • hopelessness, acceptance and hope.
  [source: in2mentalhealth 2013]
• Steps: Members raise a current difficulty, and others respond with what worked for them. [synthesis: exact turn-taking not described]
• Example language (illustrative, peer to peer): "When the tablets made me sleepy at work, this is what I asked my doctor..."
• Watch for: The client may bring medication decisions back from the group. Use this as an opening for shared decision-making (see B4). [synthesis]

A3. Information-sharing and resource centre

• Purpose: Members share information on managing mental illness. USP Kenya kept a resource centre with newsletters, journals, periodicals and books on mental health conditions. [source: Daily Nation]
• Steps:
  • Members bring or borrow materials.
  • The organisation issues newsletters. Its first newsletter was issued around 2013.
  [source: Daily Nation; in2mentalhealth 2013]
• Example language (illustrative): "Did anything you read or heard at the group make sense of what's been happening?"
• Watch for: Whether the information is accurate. Discuss it respectfully, without dismissing the source. [synthesis]

A4. Carer and family participation

• Purpose: Carers and family members join the group to understand their relative's condition and to support them. [source: Daily Nation; in2mentalhealth 2013]
• Steps:
  • Carers attend the same meetings.
  • No separate carers' meetings are described. In rural groups, carers are more numerous and may dominate the discussion. [source: USPK/Kamundia, p. 17]
• Example language (illustrative, to a carer): "The group welcomes family members. You'd hear from people who've lived this and from other carers."
• Watch for:
  • The carer's voice crowding out the member's.
  • Confidentiality between relatives (see section 5). [synthesis]

A5. Home and hospital visits to unwell members

• Purpose: Members keep contact with people who are too unwell to attend. [source: Daily Nation] USPK's later study gives an example of crisis support between meetings. A member found a peer in crisis in Nairobi town. She phoned other peers to find his relatives and stayed with him, and he agreed to seek medical help with his brother-in-law. Peers sometimes give each other shelter, but the study calls this temporary and unsustainable. [source: USPK/Kamundia, pp. 16, 23]
• Steps:
  • Group members travel to visit the person.
  • Transport costs limited how far they could go. [source: Daily Nation]
• Example language (illustrative, clinician to client): "If you're unwell, would you like someone from the group to visit? Who should know?"
• Watch for: The client's consent about who is told and where they are. A visit can be protective against isolation after discharge. [synthesis]

A6. Income-generating activities (IGAs)

• Purpose: Economic empowerment and daytime structure. Example activities were poultry keeping, making detergent and making beads. USP Kenya wanted a city clubhouse or venue for daytime activities and income-generating work for unemployed members. [source: Daily Nation; in2mentalhealth 2013]
• Steps:
  • The group chooses a project.
  • Members receive training in financial management and business enterprise (A7).
  • Members run the project collectively. [synthesis: decision process not described]
• Example language (illustrative): "What would earning something of your own mean for you right now?"
• Watch for:
  • Disputes over money.
  • Workload during relapse.
  • Effects on disability benefits or entitlements (check locally). [synthesis]

A7. Leadership and group-skills training

• Purpose: USP Kenya trains groups to run themselves. The Daily Nation quotes Susan Keter, whom it describes as founder, as saying the network trains groups "in leadership, group dynamics, financial management". Business enterprise skills are also listed. [source: Daily Nation]
• Steps:
  • USP Kenya delivers the training to group members.
  • The format, length and curriculum are not published. [uncertain]
• Watch for: Whether leadership rotates or concentrates in a few members. [synthesis]

A8. Rights education (CRPD and Kenya's Constitution)

• Purpose: Members learn to understand and claim their rights under the CRPD and the 2010 Constitution of Kenya. In 2013 this work was funded by the Open Society Foundations' Disability Rights Initiative. [source: in2mentalhealth 2013; USP-Kenya 2015 report]
• Steps:
  • Rights topics are brought into group activity.
  • The format was not described. [uncertain]
• Example language (illustrative, clinician): "You have the right to be involved in decisions about your treatment. Let's look at how you want to use that here."
• Watch for: The client may start to question involuntary care or conditions of care. Treat this as legitimate and respond within the law. [synthesis]

A9. Self-advocacy and public education

• Purpose:
  • Members tell their own stories to reduce stigma. The organisation worked through TV, radio, newspapers, magazines, the internet and a short film.
  • Members and the organisation take part in policy and law reform. USP Kenya sat on a KNCHR technical committee on implementing CRPD article 12 and trained staff at the Judicial Training Institute.
  [source: Devex; in2mentalhealth 2013; USP-Kenya 2015 report]
• Steps: Organisation-led. Members volunteer to take part. [synthesis]
• Watch for: Ask whether the client is ready to disclose publicly, and what the consequences could be for work and family. [synthesis]

A10. Peer support as supported decision-making

• Purpose: Help a member reach and act on their own decision, in line with CRPD article 12. The 2013 KNCHR briefing paper on implementing article 12 named peers, networks of friends and families as local models of supported decision-making. [source: USP-Kenya 2015 report, citing the KNCHR paper] USPK's study documents the practice in its Nairobi groups. Decisions members reported making with peer support included stopping or resuming medication, changing doctors, taking a job away from home, marrying, having children, seeking therapy and declining ECT after learning about informed consent. [source: USPK/Kamundia, pp. 20–30, 36]
• Steps (as documented): (1) The person raises the issue and keeps the final say. (2) Peers often ask questions before offering advice, so the person is heard and can make sense of their experience. (3) Peers share information, for example on side effects, ECT and rights. (4) Several members give different views from their own experience, and the person weighs the options. Some members only say what worked for them and leave the choice to the person. (5) Members may also challenge or encourage the person. (6) For crises, members suggested a pre-arranged "help" text to a few trusted people, and some discussed advance directives. [source: USPK/Kamundia, pp. 21–31, 37, 53] The study lists its tools as sharing advice from experience, challenging, dialogue, encouragement and sharing information. Its detailed descriptions of these tools could not be read. [uncertain]
• Example language (illustrative, clinician): "Is there someone from the group you'd like with you when we go through the options?"
• Watch for: Make sure the supporter is not substituting their own view for the person's. [synthesis]

Part B. Clinician procedures [synthesis throughout unless tagged]

B1. Assess fit and offer the referral

• Purpose: Find clients likely to benefit, and offer the group as an option, not a requirement.
• Steps:
  1. Look for indicators that the group may help:
     • isolation;
     • stigma or self-stigma;
     • a wish to meet others with lived experience;
     • unemployment or a livelihood need (IGAs);
     • an interest in rights or advocacy;
     • a carer under strain.
  2. Check practical barriers: transport cost and distance were a documented limit [source: Daily Nation]; also Saturday availability and language.
  3. Explain that the group is run by people with lived experience. It is independent of your service and has a rights focus, which can include critical views of psychiatry [source: in2mentalhealth 2013].
  4. Give the contact route. Use USP Kenya's listed website (uspkenya.org, per Devex) or its X account @uspkenya; check first that they are current [uncertain]. Do not share client details without consent.
• Example language (illustrative): "There's a group in town run by people who've been through mental health problems themselves. Some people find it's the first place they feel understood. Would you like the details?"
• Watch for:
  • Acute risk or severe disorganisation. The group is not a crisis service, so put a crisis plan in place first.
  • A client agreeing only to please you.

B2. Prepare the client for the first meeting

• Purpose: Reduce drop-out after a first visit.
• Steps:
  1. Describe the format as published: fortnightly on Saturdays, a mixed group of members and carers, a quiet and respectful atmosphere [source: in2mentalhealth 2013].
  2. Plan what the client will and will not share. Rehearse a one-line introduction.
  3. Agree whether a carer comes, and whether the client wants carers present at all.
  4. Book a review after one or two meetings.
• Example language (illustrative): "You don't have to tell your whole story. 'I'm new, I'm here to listen' is enough."
• Watch for: Anticipatory anxiety. A paranoid client may worry about what others will know. Address confidentiality directly.

B3. Debrief and integrate group experience into treatment

• Purpose: Turn peer learning into treatment gains.
• Steps:
  1. At each review, ask what was discussed, what fitted, what didn't, and one idea to try.
  2. Link peer coping strategies to the treatment plan.
  3. Record the group as part of the client's support network, with consent.
• Example language (illustrative): "What did you hear on Saturday that you'd like to try this fortnight?"
• Watch for:
  • The client's language moving from deficit towards hope and acceptance (a theme of the group [source: in2mentalhealth 2013]).
  • More social contact.
  • Signs it is working: regular attendance and peers named in the client's safety or support plan.

B4. Shared decision-making on medication raised in the group

• Purpose: Respond to peer discussion of side effects and stopping medication, which the group discusses [source: in2mentalhealth 2013], while respecting the client's autonomy and legal capacity (CRPD art. 12).
• Steps:
  1. Ask what the client heard and what they are considering.
  2. Take the reported side effects seriously and review them.
  3. Set out options openly, including reducing or stopping with planned support. Refer to the prescriber.
  4. Offer to include a chosen peer as a decision supporter (A10).
  5. Agree early-warning signs and a plan if the client decides to stop.
• Example language (illustrative): "It sounds like others in the group had the same weight gain. Let's look at what your options really are. It's your decision, and I'd like it to be an informed one."
• Watch for:
  • Abrupt stopping without a plan.
  • Defensiveness in yourself.
  • The client hiding decisions from you.

B5. Supporting carers to use the group

• Purpose: Carers are welcome at the group [source: Daily Nation]. Support their own wellbeing and their understanding.
• Steps:
  1. With the client's consent, give the carer the group details.
  2. Discuss the carer's own goals.
  3. Agree boundaries on what the carer shares about the client in the group.
• Example language (illustrative): "You can go for yourself, not only for your son."
• Watch for: Conflict between the client's privacy and the carer's need to talk.

B6. Working alongside the group as a service

• Purpose: Partnership without co-opting a peer-led group.
• Steps:
  1. Attend only when invited. Speak on topics the group chooses, then leave the floor.
  2. Offer practical resources the group has said it needs, such as a venue, transport support or training space. A venue and transport were documented needs [source: in2mentalhealth 2013; Daily Nation].
  3. Set up a two-way referral route with consent forms.
  4. Invite group members to service-user forums and to service design.
• Example language (illustrative): "What would be useful from us, if anything?"
• Watch for: Pressure, from you or your service, to make the group a medication-adherence tool. This conflicts with its rights-based peer-led principles [source: USP-Kenya 2015 report].

B7. Adapting the principles where no group exists

• Purpose: Help a client or community start a peer group. USP Kenya's stated objective is to establish and facilitate community-based peer support groups [source: Devex].
• Steps:
  1. Connect interested people to USP Kenya or another organisation of persons with psychosocial disabilities. Do not start a group under USP Kenya's name yourself.
  2. If a clinic must host a group, keep the leadership with peers.
  3. One published comparator from South Africa, the PRIZE peer-led recovery groups, used a simple meeting structure:
     • a first-session confidentiality agreement;
     • check-in;
     • discussion of problems and coping;
     • group problem-solving;
     • information and signposting;
     • informal socialising.
     In PRIZE, professionals facilitated the first phase and peers led thereafter, with short peer-facilitator training and supervision [source: Asher et al. 2023, PRIZE protocol]. This is a different programme from USP Kenya's model.
• Watch for: Professional facilitation crowding out peer ownership.

B8. Rights-informed practice within your own work

• Purpose: Bring the group's CRPD stance into your clinical practice.
• Steps:
  1. Explain the client's rights in treatment.
  2. Use supported rather than substituted decision-making wherever the law allows.
  3. Document the client's will and preferences.
  4. Offer advance planning.
• Example language (illustrative): "If you become unwell again, what would you want us and the people you trust to do?"
• Watch for: Gaps between the client's stated preferences and what the service actually does. Name these honestly.

5. Handling problems

The USP Kenya sources name only two practical problems: transport and resources. Nearly all of the guidance below is therefore [synthesis].

• Transport and cost barriers [source: Daily Nation, which records lack of transport limiting reach; synthesis for the responses].
  • Help the client budget for fortnightly travel.
  • Ask whether a nearer group exists. Around 2013 there were groups in Nyeri, Kiambu and Nakuru counties [source: MHIN].
  • Ask whether the service can support fares.
  • Agree phone contact with a peer between meetings.
• The client won't go, or stops after one visit.
  • Explore what happened without pushing.
  • Common reasons: a mismatch with others' stage of recovery, fear of being seen, the presence of a carer, or not liking criticism of psychiatry.
  • Offer one more visit with a different goal ("just observe"), or leave the door open.
  • Non-attendance is the client's choice. Never make it a condition of care.
• Overwhelm from others' stories.
  • Before the meeting, agree a grounding plan and permission to step out.
  • Debrief afterwards.
  • Consider whether the client needs individual treatment before group exposure.
• Anti-psychiatry views or conflict with your service.
  • Treat criticism as feedback.
  • Ask what the client agrees with.
  • Avoid asking the client to choose between the group and you.
  • Keep repairing the alliance through shared decision-making (B4).
• Abrupt medication discontinuation after peer discussion. Follow B4:
  • non-judgemental review;
  • a relapse signature;
  • a rapid-access plan;
  • involvement of the prescriber;
  • respect for the decision once it is informed.
• Risk and crisis.
  • The group is not a crisis service.
  • Make sure the client has a personal safety plan with local crisis contacts, and that it names peers only with their agreement. For clients outside Kenya, crisis lines include 988 (US) and Samaritans 116 123 (UK and Ireland).
  • Use standard risk assessment. Lethal-means counselling covers safe storage and removal only.
  • If a group member is in crisis, peers may contact services. Agree in advance how the group can reach your service and what consent covers.
  • Kenya's law on attempted suicide was the subject of advocacy and litigation [source: Harvard CLP article]. Check the current legal position before advising. [uncertain]
• Confidentiality in a small community.
  • Members and carers may know each other's families.
  • Discuss what is safe to share, and that the client controls disclosure.
  • Do not confirm group attendance to others without consent.
• Carers dominating or disclosing.
  • Coach the carer (B5).
  • Support the client to ask the group for space.
  • The group's own leaders handle group process. The clinician does not.
• Money disputes in income-generating projects.
  • Encourage written agreements and the financial-management training USP Kenya provides [source: Daily Nation].
  • Help the client think through the risks of putting their own money in.
• Dependency or over-involvement.
  • Some clients may make the group or advocacy their whole life. That can be a healthy identity.
  • Watch for burnout, especially among volunteer leaders. In 2013 USP Kenya's leaders were volunteering "well over 40 hours" a week [source: in2mentalhealth 2013].
• Stigma or backlash after public disclosure (A9).
  • Plan with the client before media work: who will see it, how it could affect work and family, and how to respond.
• Rupture between clinician and group (for example, the clinician speaks over members at an invited session).
  • Acknowledge it directly.
  • Ask the group's leaders how to put it right.
  • Step back.
• Group no longer running or details out of date.
  • Group locations and details here date from roughly 2008 to 2015.
  • Verify through USP Kenya before referring.
  • If no group exists, see B7. [uncertain]

Sources

Sources

• Eight encounters with mental health care, Kenya (in2mentalhealth, 14 Feb 2013): account of a visit to the Nairobi USP Kenya peer support group.
• Users and Survivors of Psychiatry in Kenya (USPKenya), Mental Health Innovation Network
• Users and Survivors of Psychiatry in Kenya (USPKenya), Devex organisation profile
• Users and Survivors of Psychiatry-Kenya, Report to the Committee on the Rights of Persons with Disabilities on the Review of Kenya's Initial Report (Aug 2015)
• Bettering the lives of the mentally ill (Daily Nation, Friday 31 October, year not printed, probably 2008)
• Peer-led recovery groups for people with psychosis in South Africa (PRIZE): protocol for a randomised controlled feasibility trial. Asher L et al., 2023, Pilot and Feasibility Studies 9:19. Used only as a comparator in B7.
• The Pieces of Disability Rights Advocacy in Kenya (Harvard Law School Center on the Legal Profession)
• MDAC: Kenya, right to legal capacity: background only.

Further pages:

• The Role of Peer Support in Exercising Legal Capacity: Users and Survivors of Psychiatry Kenya, research by Elizabeth Kamundia, undated (data to Sept 2017).

Not publicly available [uncertain]

• KNCHR, How to implement article 12 of the UNCRPD in Kenya: a briefing paper (2013), cited in the USP-Kenya 2015 report; no public copy.
• USP Kenya's own website (uspkenya.org, listed by Devex); current status unconfirmed.
• USP Kenya group guidelines (none published).

Any description of the "Nairobi Mind Empowerment" group beyond its entry in the USPK study's list of groups (p. 9, fn. 4).