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Reflecting on Mental Health Care in Uganda

shackling 3
September 1, 2017

Recently, I read an article in the New York Times, entitled The Chains of Mental Illness in West Africa, which discusses the common practice in Togo of shackling individuals with mental illness. The article motivated me to reflect on how people with mental illness are perceived and treated in my country, Uganda. I wondered: what challenges do people face in accessing mental health care? What can possibly be done to change the perception of mental illness in Uganda?

Although there have been important developments in Uganda’s mental health policy and services, a number of shortcomings remain, especially in terms of resources and service delivery. The current Mental Health Act, last revised in 1964, is outdated, and there have not been any efforts to improve mental health legislation. Meanwhile, mental health services are still underfunded, with only 1% of the government’s health expenditure dedicated to them. Worse, this funding is only directed towards urban centers, excluding rural areas where there is a greater need for these mental health services.

There are also few mental health care professionals in the country, and most of them lack adequate training, with only 0.8% of the country’s medical doctors and 4% of its nurses specializing in psychiatry. This limits families’ treatment options, causing some to turn to traditional healing approaches and even chaining as a form of treatment. Furthermore, the state of the few mental health facilities in Uganda is very alarming. For instance, at Butabika hospital, Uganda’s second largest mental health institution, patient numbers range from 700 to 800 while its capacity is 550.

History and culture play an important role in the perception of mental health in Uganda. Historically, families perceived people with mental health illness as ‘insane’ and ‘barbaric’, and it was often assumed that mental illness was caused by evil spirits. Having a mental illness was considered to be a sign of “misfortune” for entire families. This leaves individuals struggling with mental illness in a very vulnerable position.

The Ugandan media plays a key role in molding national perceptions of mental illness, often portraying it negatively. According to a report by the Daily Monitor, many patients who have received treatment at Butabika hospital say that going for treatment is a challenging experience, characterized by fear and marginalization. Such negative stereotypes also contribute to families’ negative attitudes towards members with mental illnesses, hence creating an atmosphere where chaining as treatment is enforced. If public stigma is to be overcome, it is essential to clarify how the media informs and misinforms people about mental illness. Public awareness campaigns can help tackle this stigma and foster a greater sense of connection within communities.

There is an urgent need for more research on the causes and effects of mental illnesses and on improving mental health programs and services in Uganda. Unfortunately, only about 2% of all the health publications in Uganda over the past 5 years were on mental health. In addition, mental health care in Uganda should be integrated into the primary health care system. This can be achieved by offering proper training to primary care workers, and by making mental health education part of the curriculum in schools in order to help promote awareness. Finally, community-based approaches, which bring together relevant professionals to work closely with families and non-governmental organizations, are paramount in creating awareness and improving mental health care conditions in Uganda.