Mental health is one of the most neglected areas of health in Uganda yet it severely impacts one’s wellbeing and livelihood. According to the National Institute for Health Research, about 35 percent of Ugandans suffer from a mental disorder and 15 percent of them require treatment.
About 25 percent of the adult population in Uganda suffer from depression. The child population has not been explored but about 16 per cent of the student population has signs of depression. Schizophrenia is at two percent, epilepsy at three percent with children having a higher proportion and also varies in the different regions of the country. Children from the northern and central regions of the country have higher cases of epilepsy than other regions.
Prof Seggane Musisi, a researcher with Makerere College of Health Sciences, defines chronic mental health problems as a mental problem that lasts for more than two years, causing deterioration in personality, long term hospitalisations and treatment with mental disability. The person may have suicidal behaviour, cannot engage in gainful employment and is unable to take care of their basic needs.
“This usually causes distress to the individual, family and the community due to high costs involved in the treatment process. While 35 per cent of Ugandans have a mental health problem, severe mental disease takes about three percent of this. The commonest causes of severe mental health problems in Uganda include schizophrenia, bipolar disease, severe depressive disorder, epilepsy, dependency syndrome from substance use,” he says.
The need for extra support
The human resource in most mental health care clinics in Uganda is wanting with high patient ratios, late presentations and long hospital stays which have made treatment of mental health problems a bit challenging. However, there are interventions that can be low cost but effective in prevention, treating and fighting stigma among the patients.
Prof Nelson Sewankambo, at the Makerere College of Health Sciences, says, “Given the fact that some of the mental conditions are chronic, their management cannot be tackled in silos. Low cost approaches of dealing with severe mental illness such as family involvement and volunteer support programmes are effective in places with limited mental health human resources such as Uganda.
Oftentimes, the patients are plagued with many social anxieties and mental symptoms that cannot only be addressed by the medical team but also with the community where they come from.
He remarks that the family, for instance from which the patient comes plays a great role in the type of treatment the patient will get.
“If the family believes that the cause of the mental problem is witchcraft, they will be skeptical about seeking medical help. This is the reason why it is important to teach different communities such as families and schools about mental health such that when they have a patient, they treat them with dignity,” Prof Sewankambo says.
About 10 years ago, the ministry of health identified mental health as part of the basic minimum healthcare package, from the primary healthcare level to the specialised care according to Dr Noeline Nakasujja, a consultant psychiatrist.
Beside training healthcare workers and availing the medication required for treatment of mental health, we need to handle it at the community level as a way of preventing it but also educate people in the communities to solve stigma related issues.
She says, “A lack of knowledge is one of the things that are aggravating mental health problems. We need to strengthen families and homes so that they can support persons with mental problems. It is a good opportunity for children to know about mental health when they are still young. When they go back home, they can prevent them or even support the person to recover.”
At the workplace
Many people of working class spend most of their time at work. It becomes like their second home. It is, therefore, important for people at workplaces to know about mental health in order to reduce stigma against people who get mental health problems and later get back to work after recovery.
Prof Nakasujja says, “The community plays a crucial role in promoting mental health awareness, reducing stigma and discrimination, supporting recovery and social inclusion, and preventing mental disorders.”
For most of the graduates with mental health challenges, being unable to find employment was a big stressor that sent them into depression, and sometimes drug use, which later caused chronic mental illnesses. Other causes include accommodation, social relations, symptoms, medication adherence, how society treats them
Dialogue, according to Prof Seggane, can be very helpful and this is the reason involving family is important.
“During treatment, we task the patient to identify two family members who get trained on how to handle them. We inform these family members about the stressors that are likely to trigger an episode of a mental health challenge to the person,” he says.