Changing Perspectives on Mental Health in Uganda

31 July 2015

Guest blogger, Talia Augustine, discusses shortfalls in mental healthcare in Uganda and the role of NGOs in bridging this gap, as well as avenues for policy improvement.

Uganda has an estimated population of 40 million people, with approximately 20% of its citizens suffering from mental health disorders. Since there is only one national referral psychiatric hospital, the Butabika hospital, and a total of only 32 psychiatrists practising in Uganda, WHO estimates that 90% of Ugandans suffering from a mental health disorder never receive treatment. This results in the deterioration of vulnerable people’s conditions, and the stigma attached to mental health often leads to their abandonment by family and friends. However, views on mental health in Uganda are changing as more Ugandans begin to speak out about their experiences with mental health, and partnerships between UK and Ugandan mental health care centres continue to develop.

What is it like to live with a mental illness in Uganda?

Depression almost took the life of Mr Joseph Atukunda, an individual who has overcome many of the battles faced when affected by Bipolar Affective Disorder. Through his interview with the BBC, Mr Atukunda informs us of the harsh reality that he and fellow patients face in Uganda. “There are some people who see me coming and they branch off” he tells when describing walking along a street. He states “they just fear completely without any compromise…. but I’m not blaming them!”. Mr Atukunda also discusses his diagnosis by a traditional healer, who informed him that witchcraft was involved. The healer says “Some demons were on your head, so I cut your head to put the medicine in it, I slaughtered a cock and bathed you in blood.” This account highlights that mental health is widely misunderstood in Uganda, and believed to be associated with entities such as demons. Now a full time activist for mental health issues and co-founder of the mental health support group Heartsounds, Mr Atukunda has been able to flourish, and believes it is the aid he received from psychiatrists at Butabika hospital and his traditional healer that have enabled him to live a happy life today. More information about Heartsounds, and an interview with Mr Atukunda’s who discusses his life experiences can be found by clicking here.

Governmental strategies in place for mental health care

In recognition of mental health as a critical public health concern, Uganda’s government have spent the past decade improving mental health care services. In 1996 the Ugandan mental health program commenced, followed by the integration of a Health Sector Strategic Plan (HSSP) in 2000. The latter includes aims to provide health care packages for all people in need of one, including persons suffering from mental health disorders. Full details can be found from page 45 onwards of ‘The Republic of Uganda, Ministry of Health, Health Sector Strategic Plan 2000/01 – 2004/5’ publication. Despite these efforts, Uganda still has mental health legislation dating back to pre-1960s. This means the rights of people with mental health issues are not officially protected, increasing their vulnerability and the likelihood they will be subjected to abuse in both community and hospital settings.

Improving understanding and mental health care in Uganda

Mr Atukunda’s account reveals the stigma attached to mental health. BasicNeeds, an international mental health focussed non-governmental organisation, indicate that this stigma is also responsible for making healthcare workers unwilling to specialise in psychiatry. BasicNeeds have been working since 2004 to challenge this stigma, and have successfully implemented a model for mental health and development in Uganda’s capital city Kampala and town Hoima. A key focus of the model is to support vulnerable children, and former child soldiers of Uganda’s previous civil conflicts, in their attempts to connect with their local communities and develop financial security.

Moreover, provision of psychiatric specialist training to Ugandan healthcare workers has been the focus of East London NHS Foundation Trust and Sheffield Health and Social Care Trust partnership with Butabika Hospital. Psychiatric Clinical Officers (PCOs) form the link between nurses and doctors at Butabika hospital, and are key to implementing holistic care and encouraging patients to carryout activities beneficial to their mental and physical wellbeing. As only 0.7% of Uganda’s total health budget is spent on mental health compared to 10% in the UK, this partnership has enabled PCOs to take part in exchange programmes during which they can observe how care is delivered to patients with mental health issues, and associated behaviours, in the UK.

It is truly inspiring to read the story of Mr Atukunda, and to hear of the joint efforts made by Uganda and the UK to develop a robust mental health care system that is able to support the growth of patients, their families, and healthcare workers as they face the social and economic difficulties that surround mental health.

Disclaimer: This blog is a space for discussion and personal reflection. Any opinions expressed within the blog are those of the author and are not necessarily held by HART. Individual authors are responsible for the accuracy of statements made within the blog.

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