KAMPALA-In May 2022, a report from the Ministry of Health (MoH) and the Uganda Counseling Association (UCA) indicated that an estimated 14 million Ugandans are suffering from a certain form of mental illness.
This therefore means that every 35 out of 100 Ugandans you meet daily maybe battling a mental illness.
Addressing journalists at this year’s launch of the Mental Health awareness month, Dr Charles Olaro-Director curative services at the MoH revealed that the statistics are of those who reported to health facilities with acute conditions.
“If each of the 14 million people interacts with at least two other individuals, then almost the entire population (42 million) Ugandans are affected by mental health directly or indirectly. Today, this number has grown exponentially because of the events of the last two years,” he said.
Understanding mental health and mental illness
The World Health Organisation (WHO) defines mental health as a state of well-being in which every individual realizes their own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to their community.
On the other hand, mental illness refers to a diagnosable mental condition that alters a person’s mood, thoughts or behavior. These include among others depression, stress, anxiety, Disruptive behaviour and dissocial disorders, bipolar disorder.
A 2020 report from WHO stated that mental illness are increasing worldwide mainly because of demographic changes with a 13% increase in illnesses and substance use in the last decade.
Approximately 7% of the global disease burden has been attributed to mental and behavioral disorders with mental illness being the leading causing of ill-health and disability according to WHO.
Uganda is ranked among the top six countries in Africa in rates of depression disorders (4.6%) while 2.9% live with anxiety disorders, according to 2017 statistics from WHO. About 5.1% of females and 3.6% of males are affected by depression and anxiety. The number of people affected by mental illness greatly varies from source to source as well, as there is little pre-existing research on mental health in Uganda.
Dr. Hafisa Lukwata Ssentongo, the Acting Assistant Commissioner of Mental Health and Substance abuse at the Ministry of Health says mental health is a very important component of health and is part of the minimum health care package that has to be delivered in each and every health facility in the country.
“It has to be done in an integrated way especially with the lower facilities we do not expect specialist at that level but the services are provided somehow,” she says.
Mental health services, according to Dr Lukwata are supposed to be provided at all levels of care. However, there are specialized services that start at the hospital level where there are psychiatric clinical officers and nurses. At the regional referral hospital is where psychiatrists are found.
Out of the 17 regional referral hospitals and over 60 general hospitals, there are only four of them (regional) that have psychiatrists deployed therefore the bulk of the services are being offered by the psychiatric clinical officers and nurses.
Currently, there are over 700 psychiatric clinical officers and nurses and about 53 psychiatrists. Psychiatrists are specialists who first become medical doctors and specialize later in psychiatry. But even within their specialty, there is super specialistation.
Dr Lukwata reveals that in their 2000-2015 strategic plan, major effort was put in improving access to mental health services and as a result, 14 mental health units at the regional referral hospitals were constructed.
In addition, the ministry improved on the medicines list. “Initially we had a very narrow range of medicines and we have increased it over time to cater for specific conditions because there are quite a number of mental illnesses and each of them requires a different kind of medication,” she explains.
Following the COVID-19 pandemic, Dr Lukwata says there was a lot that unfolded as far as mental health is concerned which affected people’s mental health.
Whereas there were people who had mental illnesses already, she says the pandemic escalated the situation which made people became more aware about mental health.
Seeking for help
Dr Lukwata explains that there are different forms of mental illnesses and there are different levels of these illnesses such as mild, moderate and those that are severe.
“The severe are the ones that come out and go to facilities but those with mild and moderate just stay home and suffer with their illnesses. They may all not need treatment as it were, because we know that some people can heal and some people can take on certain interventions that are not necessarily medicines but they help themselves through the conditions they are going through,” she tells this website.
Butabika hospital is the only national mental health referral hospital therefore it is at the peak of mental health service delivery in the country.
In an interview with PML Daily, Butabika Hospital Executive Director Dr Juliet Nakku reveals that they provide a whole range of mental health services among others general psychiatry services, child and adolescent psychiatry, forensic psychiatry, rehabilitation facility and general primary health care service.
She notes that ideally the facility is supposed to admit referrals sent from lower levels by the health workers, or by the law and justice system, sometimes also by police.
“Any Ugandan who feels they have a mental illness is eligible to come to Butabika hospital but we would wish that these people are referred to us so that the simpler conditions are treated at the lower levels. However many times people walk in because they do not know where else to go,” she says.
Whereas there are private organisations that offer paid mental health services ranging from shs 20,000 per session, there are others that offer free services to those who may not afford the prices.
StrongMinds is an international mental health Organization that empowers impoverished African women and adolescents by treating depression at a scale to enable them and their families to lead healthier, productive, and satisfying lives.
Mr Hudson Bujo, the organisation’s Programs Officer Partnership notes that over 160,000 women and men and 12,000 adolescents have been treated by StrongMinds in Uganda since 2014.
The organization provides free Treatment for depression using talk therapy as well as awareness creation services and psycho education about mental health. This is done through media and through community-based sensitization engagements.
In 2020, because of the rising cases of mental illness among Ugandans, StrongMinds initiated tele therapy services in a bid to continue reaching out to their clients.
“Tele therapy is a free tele phone-based talk therapy and counseling service aimed at treating depression and anxiety via the phone. All you need to do is dial *252# and select option 10 for free counselling services, then follow prompts to register,” says Mr Bujo.
He further explains that the tele therapy strategy of solving mental health issues is effective in a way that clients have been able to sign up for free therapy and many have been pre group assessed for depression.
“They have been taken through series of talk therapy sessions and have been post assessed and results have shown high healing rates with lower levels of depression at the end of 8 to 10 weeks of talk therapy. I can say over 10,000 people have benefited from the *252# strategy of getting talk therapy and they feel better,” he reveals.
One of the challenges hindering mental health awareness according to Dr Lukwata is the mental health illiteracy. “People do not know about mental health which is affecting us negatively. There is quite a lot of data that is coming out but it cannot be shared out. We do not have a prevalence study as we do not know the exact number of people who are sick we are just using approximations,” she explains.
She reveals that mental illness medicines are quite expensive for the country to afford so they tend to get mediocre medicines.
Dr Nakku says that some people think that mental illness is contagious which a misconception is. “They think when someone gets a mental disorder, they are a gone case which is not true because we treat people here and they go back to their normal lives.”
What needs to be done?
According to Dr Nakku, there is need to increase mental health literacy so that the population knows a lot about mental health and mental illness.
“When that happens, the community will be able to identify to some extent people who may not be too well just by having that index of suspicion so that they can refer them to the right places. Improving the literacy of the communities helps to dispel the misconceptions and reduce the stigma attached to mental illness and discrimination of people who would otherwise be treated,” she says.
She adds that government should develop mental health services better so that they can respond to the needs of the different populations. “We should be able to provide a whole range of services. We should be able to have medicines readily accessible and affordable by everyone.”
Additionally, Dr Nakku further notes that the mental health human resource needs to be improved so as to serve the country.
“We should have enough mental health personnel. At the moment, we have very few and with a population of 47 million to have only 53 psychiatrists it means that most of the populations is not served,” she advises.
The story is produced by PML Daily with support from the Media Challenge Initiative (MCI) and DW Akademie.