KAMPALA – In Uganda, mental illness tolerance is about 35% of the population with severe mental health taking a porting of 3%, the study has revealed.
Funded by the National Institute for Health Research (NIHR-UK) with Queen Mary University of London (QMUL) as the prime institution, the study, which intended at developing psycho-social interventions for severe mental illness in Uganda was disseminated on Tuesday at Sheraton Hotel Kampala.
The study objectives were to test the feasibility of each intervention in the regional context, test the acceptability of each intervention in the regional context and also test the effectiveness of each intervention in the regional context.
The study, which explored alternative forms of care for people with severe mental illness utilizing existing personal and social resources, tested three psycho-social interventions for severe mental illness in Uganda i.e DIALOG+, Volunteer Support and Family Involvement.
Prof. Nelson K. Sewankambo, the Principal Investigator said that as one of the most neglected areas of health globally, mental health percolates and severely impacts people’s wellbeing and livelihood.
“Given that some of the mental health conditions are chronic, their management cannot be tackled in silos. Oftentimes, patients are plagued with many social anxieties and mental symptoms.”
He explained that they opted for the DIALOG+ App because it can be an effective tool for assessing physical health, job situation, and relationships among other important aspects of one’s life.
“With the help of the App, a four-step solution can empower patients to identify and execute practical solutions from resources available to them. Low-cost approaches of dealing with severe mental illness such as family involvement and volunteer support programs are effective in places with limited mental health human resources.”
The study was conducted at four referral hospitals i.e Butabika Hospital, Masaka Hospital, Jinja Hospital and Mityana Hospital.
Prof. Seggane Musisi said that they wanted a uniform population so that they don’t attribute the results to different colours, cultures, and other differences.
In Butabika Hospital, Dr. Racheal Alinaitwe explained that each arm had seven clinicians and 84 patients. For the active control (DIALOG scale), each clinician was assigned 12 patients and the clinician met each patient once a month for six months.
“The patients rated their level of satisfaction with 11 life domains namely; mental health, physical health, job situation, accommodation, leisure activities, friendships, relationship with family/partner, personal safety, medication, practical help and meetings with mental professionals on a tablet computer and no further discussion was done about their rating.”
“However, in the intervention arm (DIALOG+), each clinician was assigned 12 patients randomly. Every month, the clinician met with the 12 patients once for a clinical assessment that was carried out following a scale on a tablet computer (DIALOG+). The tablet allowed patients to be actively involved in the meeting, with it (tablet) being passed between the clinician and patient. Each satisfaction item was rated on a scale of 1 (“Totally dissatisfied”) to 7 (“Totally satisfied”), and followed by a question on whether the patient wanted additional help with that domain. The ratings were followed by a four-step solution-focused approach to identify the patient’s existing resources that could be used to address the concerns raised,” she said.
Prof. Musisi revealed that mental illness is much extent as a result of lack of human resources and finance, high clinic-patient ratios, loss of income productivity, and long hospital stays among others.
He said that they used family involvement study to refine family psycho-social involvement intervention in Ugandan context.
“Can this involvement be used to support clinic and mental healthcare in Uganda and how do patient outcomes change when we involve families?”
By six months, Prof. Musisi said there was a much better quality of life in patients who are the intervention group but in the control arm there was no change in the quality of life.
“By end of the year, there has been some change but not as significant as where there was the intervention.”
“The only thing which came out significantly was just the differences in the groups but also employment status. Employment became a very important factor in patients with severe mental illness. In other words, being unemployed was a stressor to them,” he said.
He revealed that the social outcome which measured accommodation, social relations did not change at all in both control arm and the intervention arm.
“…the reason we thought was because, in our community in Uganda, there is still social connectedness and family cohesion. None of our patients was homeless. They all lived in homes.”
Dr. Lukwata Ssentongo, Acting Commissioner mental health at the ministry of health said that the study was timely because it is through some of these interventions that the government changes policy.
“In the last ten years, we had the first health policy which identified mental health as a basic minimum package and which had to be provided from primary health care level to the specialized even in Butabika. At that time, we really emphasized that services are provided at all levels, we emphasized that we train healthcare workers, we tried to make sure that medicines are available at all levels to be able to provide services to people with mental illnesses.”
“In this current policy, we are looking at improving the community mental health as well. We have done quite a lot for the health facility-related and now we need to get back in the community because mental health is a chronic illness and it has episodes; sometimes people are well and sometimes not and it can even be prevented,” she added.
According to her, in order to prevent mental illness, both health facilities and also the community level care are needed.
In the communities, she said they want to emphasize is strengthening family where members of the family can help a person who is having mental problem.
“We are also trying to increase mental health literacy in schools for students to either prevent stigma since it related to knowledge. Also, under the community mental health, we want to emphasize is to improve mental health within workplaces to help people especially those that already have the problem.”
Key researchers of the study include
Prof. Nelson Sewankambo, a professor of Internal Medicine at Makerere University, a physician and clinical epidemiologist, and a past Principal, Makerere University College of Health Sciences.
Professor Stefan Priebe, a graduate in Psychology and Medicine, and qualified a Neurologist, Psychiatrist and Psychotherapist in Germany.
Dr. Victoria Bird, a lecturer in Mental Health Care at Queen Mary University of London.
Prof. Seggane Musisi, a Senior Consultant and the former Chair of the Department of Psychiatry at Makerere University College of Health Sciences.
Assoc. Prof. Nakasujja, the Chair for the Department of Psychiatry at the College of Health Sciences, Makerere University.
Dr. Harriet Birabwa-Oketcho, a senior consultant psychiatrist with a special interest in mood disorders, the role of religion and spirituality and psychosocial interventions for mood disorders.
Dr. Dickens Akena is a psychiatrist and senior lecturer at the Department of Psychiatry, Makerere University College of Health Sciences in Kampala, Uganda.
Dr. Racheal Alinaitwe is a psychiatrist.
Mauricia Kamuhiirwa, a Medical Social Worker at Butabika National Referral Mental Hospital.
Dr. Turiho, a Clinical Social Worker who specializes in mental health.