The New Vision on 13th May 2022 carried a cover story that 14 million Ugandans had mental disorders. This revelation took the nation by surprise, with questions around how the figure was arrived at, even when there is evidence to suggest a looming mental health crisis in Uganda, if the country does not provide an appropriate early response.

Cecilia Okoth who wrote story, said the 14 million figure came about after converting 35 percent against Uganda’s total 42 million people; based on data from the Ministry of Health presented at the press briefing on 9th May 2022, to launch the mental health week for a campaign intended to create public awareness around the social problem.

The figure quoted by the Ministry of health however, comes from previous estimates of a 2004 study which reported that up to 35 percent of Ugandans suffer from a mental disorder and 15 percent of these required treatment. No scientific study has been made recently to validate these findings, though there’s fear currently that the crushing effects of covid-19 could’ve descended Uganda into a mental health crisis.

Studies confirm that the covid pandemic exacerbated the intensity of the social problem of mental health: for individuals with pre-existing or underlying psychiatric conditions, the environmental changes and effects of the covid measures severed their health conditions, while social isolation, restrictions on movement, being away from loved ones, financial insecurity, misinformation and curfew all propagated mental health issues.

Globally, reports show that there are over 500 million people suffering from a mental or behavioural disorder. According to projections made by the World Health Organisation (WHO), mental disorders contribute up to 14 percent to the global disease burden, estimations that have now gone higher with the complex interaction of physical and mental illness and the lasting impacts of the covid-19 pandemic.

The World Health Organisation defines mental health as ‘the state of well-being, in which the individual realises their own abilities, can cope with the normal stresses of life and can work productively and fruitfully to make a contribution to the community’. However, at the legislation of the 2019 Mental Health Act, there was contention in Uganda, as to what human condition amounted to be a mental and behavioral disorder. This legislation was passed before covid-19 and a lot of perceptions have changed.

Although the law is in place, government has received criticism for its dismal attention given to mitigating and combating the mental health crisis around the country. This has meant that people with mental disorders in Uganda are on their own: many of them are said not to receive treatment either because their conditions are not severe enough to be easily noticeable or because their families do not know where to take the for help.

Even within the communities in Uganda, people with serious mental illnesses are referred to as “mad”, are rejected, isolated and denied participation in social activities, leading to trauma for victims and denial for those who genuinely need support and treatment. Mental health problems have persisted or worsened in the country in the recent past. This is attributable to lack of facilities and personnel to deal with the health

As of 2010, Kigozi says that Uganda had less than one psychiatrist for every 100,000 people. This gap today has only worsened. Even with the current staffing gaps within our health system and terrible doctor to patient ratio in Uganda, only 1.13 for every 100,000 medical workers work in mental health facilities or private practices. These few psychiatrists are also camped within urban centres, decreasing the mental health treatment options for rural communities both in terms of access and affordability.

Kigozi’s study further notes that the disparity in our investment priorities contributes to the social inequality in available treatment, as 87% of Uganda’s population in live in rural areas, for a country that had only 28 inpatient psychiatric units and only one mental hospital as of 2010. The WHO found in 2016 that Uganda spends 9.8% of gross domestic product on healthcare, and less than 1% of this goes into mental healthcare, majority of which goes to the national mental hospital at Butabika that had 500 beds
and 430 staff.

While there is social backlash and limited funding from government, victims of mental health also suffer rights abuse both in community and health facilities in Uganda. The human rights committee from Mental Health Uganda (MHU) and the Mental Disability Advocacy Center (MDAC) in 2014 found gross abuse of rights of victims of mental health.

Butabika Hospital was found to detain without assessment, house patients in seclusion rooms without toilets, fail to distinguish between compulsory and voluntary admissions, offer no separate facilities for children, and relied heavily on pharmacological treatment, which often results in heavy side-effects. These were some of the policy concerns that the Mental Health Act of 2019 was meant to address.

The same committee also noted that cycles of abuse appeared to continue in relation to treatment, both in conventional psychiatric facilities and in traditional healing centres and churches, where people with mental health issues were frequently taken by force. Serious violations of dignity were reported in psychiatric hospitals, these experiences having a lasting impact on some. Some of the victims complained about the humiliation of being placed in “cold rooms” in psychiatric hospitals where they were stripped naked and placed in concrete seclusion rooms without toilets and forced to sleep amongst their own waste.

Women with mental health issues were also said to be subjected to additional abuses. Women reported not being provided with sanitary pads and had to wear dirty underwear and were left without access to clean clothes or washing facilities. Cases were also reported of women’s hair being shaved against their wishes to prevent the spread of lice and sometimes even pubic hair was shaved by male staff.

The report makes a number of recommendations to strengthen respect and fulfilment of human rights. The recommendations focus on reducing coercion, violence and abuse in hospitals and tackling the causes. Recommendations also include training mental health practitioners in providing human rights-based care and support, and shifting away from the overwhelmingly institutional and pharmacological approach to mental health care, instead investing in the development of respectful, community-based alternatives.

Whole discussion here:

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