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Fighting mental health: Uganda’s tough choice between prevention and ensuring youth adhere to treatment

Uganda is among countries that continue to grapple with mental-illness with neurological disorders, and substance abuse weighing heavily on public health.

A seminal study by Mugisha et al. (2019)  highlights the severity of the situation.

The prevalence of depression and elevated stress levels often spirals into suicide attempts, shedding light on the grim reality faced by many.

Miller et al. (2020) positions Uganda among the top six African countries with a 4.6% prevalence of depressive disorders, while anxiety disorders affect 2.9% of the population.

Despite the evident crisis, the allocation of resources by the Ugandan government paints a concerning picture.

A measly 1% of the annual healthcare budget, which stands at 9.8% of the gross domestic product, or $246 annually per person, is earmarked for national mental healthcare, primarily channeled to the Butabika Hospital and other referral hospitals across the country.

Butabika was established in 1955 and has 500 beds, although there is frequent overcrowding.

Its annual budget is $2.25m and it has approximately 430 staff, according to Emerald Project, 2016.

Concerns have been raised about conditions, including detention without assessment, the prolonged and dehumanising use of seclusion, and very low levels of specialty staffing.

The proposed legalisation of cannabis (marijuana) cultivation as an alternative treatment option has sparked debates, with legislators and health ministry representatives cautioning against potential negative repercussions-its use might fuel drug addiction and further escalate mental-illness among the youth.

The urgency of the situation has prompted various organisations and stakeholders to call for action.

The American Centre in Kampala in December last year hosted an essential workshop on mental health awareness.

It was aimed at reducing stigma, initiating discussions, and equipping individuals with practical strategies to foster a mentally healthy population.

Angela Nsimbi, a mental health activist and guest speaker, emphasised the heightened vulnerability of the youth to mental health issues due to their exposure to various causative factors.

The event also emphasised promotion of mental well-being including connecting with nature.

Spending time in nature has been found to help with mental health problems such as anxiety and depression.

For example, research into eco-therapy (formal treatment which involves doing activities outside in nature) has shown it can help with mild to moderate depression, http://,https://www.mind.org.uk/information-support/tips-for-everyday-living/nature-and-mental-health; seeking professional help from trained counselors, and adopting a brain-healthy diet were highlighted as essential strategies.

There is also a clarion call to cultivate a community that values and prioritises mental health.

Unsettling statistics released by the Ministry of Health on World Mental Health Day on October 10, 2023, unveiled a harsh reality: one in three Ugandans struggles with poor mental health.

Shockingly, only one in ten seeks help from qualified medical professionals, with religious leaders and traditional healers often serving as the first line of support.

This disturbing trend underscores the critical need for a comprehensive mental health infrastructure.

In collaboration with Makerere University School of Public Health, Butabika Hospital conducted a detailed study across different regions, including Adjuman in the north, Bushenyi in the west, Butambala in the central region, and Kapochorwa in the eastern region of Uganda.

The research identified various stress factors contributing to mental health challenges, such as drug and alcohol abuse, domestic violence, poverty, head injuries leading to cognitive impairment, and stress from work, school, and personal relationships.

By introducing professional support at an early stage, the government can proactively address and prevent mental health disorders among the youth, providing a glimmer of hope for a brighter future.

Real-life accounts from individuals, like Richard Atiku, a teacher at Duhaga Secondary in Hoima City, Western Uganda, further highlight the gravity of the situation.

Atiku recounts a case of a senior six student in 2022 who experienced a mental breakdown due to academic pressure, highlighting the toll that stress and anxiety can take on the youth.

The Makerere University School of Public Health findings prompted a crucial recommendation: the incorporation of social workers in universities and schools across the country.

Exploring the challenges in accessing mental health care, most Ugandans turn to Butabika, a Kampala-based National Referral Hospital and 13 regional referral hospitals for medical assistance.

Upcountry mental units have equally faced overcrowding coupled with poor funding and lack of enough psychiatrists.

The other challenge is that despite the existence of mental health units, adherence to prescribed treatments becomes a stumbling block, leading to relapses.

The solution proposed involves Village Health Teams (VHTs) actively tracking individuals, encouraging them to continue medication to prevent relapses.

There is also a complex interplay of cultural beliefs and mental health. Stories of individuals attributing mental illness to witchcraft highlight the need for a nuanced approach.

While traditional healers are acknowledged for their role in healing, Atiku who has also had one of his relatives get mental health challenges on a pretext that it was witchcraft, emphasises the importance of understanding mental health as a result of stress, post-traumatic stress disorder, harsh economic conditions, lost dreams, and domestic violence.

The rise of mental health issues among the youth, fueled by factors like drug abuse, alcoholism, and failed relationships, raises concerns about the future.

Experts contend that Uganda stands at a crossroads, facing a formidable challenge that demands immediate attention and comprehensive strategies.

“From policy changes and increased budget allocation to grassroots initiatives and community involvement, the nation must embark on a united front to combat the mental health crisis,” Atiku added.

The path forward lies in a commitment to destigmatise mental health, prioritise preventive measures, and ensure accessible, effective, and culturally sensitive mental health services for all.

Atiku said the reluctance of mentally ill youths to adhere to prescribed antidepressant medications, leading to a troubling cycle of relapses demands attention.

He said understanding the reasons behind this non-compliance and devising effective strategies to address it is paramount for ensuring the well-being of this vulnerable demographic.

The antidepressant challenge

Antidepressant medications play a crucial role in managing mental health disorders, offering relief from symptoms such as depression and anxiety.

However, the reluctance of some mentally-ill youths in Uganda to take these prescribed medications presents a formidable obstacle to their recovery.

Several factors contribute to this complex issue, ranging from cultural stigmas surrounding mental health to concerns about potential side effects, while others are deferred by high costs of antidepressants and a lack of awareness regarding the importance of consistent medication.

Stigma and cultural beliefs

Mental health stigma remains deeply ingrained in many societies, including Uganda. Some individuals, influenced by cultural beliefs and misconceptions, may view mental health disorders as a result of spiritual or supernatural forces, leading to resistance against medical interventions.

Overcoming these ingrained attitudes is crucial for fostering an environment where seeking professional help and adhering to prescribed medications are embraced as essential steps towards recovery.

Fear of side effects

Common side effects, such as weight gain, drowsiness, or changes in libido, can be daunting for individuals already grappling with the challenges of mental illness.

“Education and open communication about these side effects coupled with the reassurance that many are temporary and manageable, are key components in dispelling these fears,” Atiku told The Albertine Journal on January 3.

A lack of awareness about the nature of mental health disorders and the role of medications in their treatment is also a contributing factor.

Initiatives aimed at community education and destigmatisation can play a crucial role in disseminating accurate information, fostering understanding, and encouraging individuals to prioritise their mental health through consistent medication adherence.

Strategies for improvement

Atiku said there is need to implementing targeted community education programmes to raise awareness about mental health, debunk myths, and emphasise the importance of consistent medication use.

Others he said are engagement of local leaders, schools, and community influencers can amplify the impact of such initiatives.

Providing cultural sensitivity training for healthcare professionals to better understand and address the cultural factors influencing mental health perceptions.

This can enhance the effectiveness of communication between healthcare providers and their patients, fostering trust and collaboration.

Establishing peer support networks where individuals who have successfully navigated mental health challenges share their experiences, providing insights into the benefits of adhering to prescribed medications, has also been flagged.

Others are peer support which can be a powerful motivator, offering a sense of understanding and solidarity.

Joan Kaahwa, a psychiatrist in Masindi municipality said ensuring the availability and accessibility of mental health services, including affordable medications and counseling, can reduce barriers to treatment.

She said encouraging family involvement in the treatment process, fostering a supportive environment where open discussions about mental health are normalised and strengthening the mental health infrastructure would be a step for providing comprehensive care to those in need.

Addressing the challenge of non-compliance with antidepressant medications among mentally ill youths in Uganda demands a coordinated effort including tackling stigma, providing education, and fostering supportive environments, to pave the way for a more inclusive and effective mental health landscape.

Eunice Ngonzi a resident of Buswekere cell in Hoima City who battled depression for five years avers that it should be not only to provide access to treatment but also foster empowerment of individuals to actively participate in their mental health journey, breaking the cycle of relapse and fostering long-term well-being.

2 replies on “Fighting mental health: Uganda’s tough choice between prevention and ensuring youth adhere to treatment”

There is need for more concerted effort in Mental health awareness and treatment. The world is fast paced and many people are still grappling with effects of the COVID pandemic!
Government should interest itself more in this very challenging aspect of the Mind!

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