Monday July 17 2017

Ugandans suffer mental illness around Christmas

Graphic about patients treated at Butabika

Graphic about patients treated at Butabika Hospital 


KAMPALA. Majority Ugandans and particularly men - suffer mental breakdown or book into health facilities with mental illness-related complications during the festive season, this newspaper can reveal.
Our analysis of records at Butabika, the country’s only national referral hospital for specialised psychiatric care, shows a year-to-year spike in the number of patients admitted between November and January.

The number of patients has more generally increased each successive year since 2010, a trend health workers attribute to growing population, better awareness and health-seeking behaviour contrasting earlier practices of people seeking healing at churches or shrines of traditional healers and witchdoctors.

The Butabika statistics do not capture mental illness cases handled at other health facilities or elsewhere and, as such, offers less-than-complete picture or burden of mental illness on the country and families such as loss of lives, disruptions from productive work and caregiving expenses.

For instance, a young man with a history of mental illness, but whose name we are withholding on the request of his family, after watching a video game reportedly committed suicide in Namugongo, near Kampala, on the eve of taking up a new job after staying unemployed for two months.
He was buried last Saturday amid growing concerns about the fate of other family members with similar conditions. And there are hundreds of Ugandan families in similar predicaments due to the unpredictable behaviour of mentally-ill patients and or recurrence of their condition.

On average 22,000 patients, more than half of them men, check at Butabika every November, December and January for conditions ranging from alcohol and or drug abuse, bipolar disorder, depression, dementia, schizophrenia, epilepsy and bipolar, childhood mental and post-traumatic stress disorders. More women than men are admitted or treated as out-patients due to HIV-related psychosis.

In other months, slightly fewer patients seek treatment at the national referral hospital, according to its financial year-based data sets for 2013, 2014 and 2015 (ending June 2016).
Dr David Basangwa, the executive director of Butabika Hospital, said the numbers are highest towards end of year due to excitement and anxiety ahead of the festive season.
“Toward the festive season, men get excited, drink and smoke too much while some others [without means] are stressed about providing for their families in the festive days,” he said.

There is another downside to the festive season; of families’ budget overruns on merrymaking resulting in financial hardships when tuition and other school demands knock in late January or early February.
Uganda’s patriarchal society has traditionally placed the responsibility of providing for the family on men and allowed them a freehand at fun, in part explaining their vulnerability to mental breakdown, although more empowered and financially-able women are increasingly sharing or singularly picking family expense and, with it, stress.

In January, 2013, Butabika registered 13,303 male patients the highest number in the entire year. Men comprised more than half of the 247,278 patients treated at the facility that year.
A similar pattern is discernible from 2014 statistics. In November of that year, the hospital admitted 13,538 men, far higher than the 9,229 female in-patients.

Overall, the number of female patients increased in July 2013 and October 2014.
Alcohol and drug addiction are the major triggers of mental disorder in Uganda, Dr Basangwa said.
“In our culture, women tend to shy away from taking alcohol and using drugs but we are [now] seeing an increase in the number of females using drugs,” he said.

Mental illness among women, according to Butabika executive director Basangwa, is triggered mostly by pregnancy and childbirth, domestic violence, loss of a job or loved one.
The signs and symptoms of mental illness manifest in various forms and differ from one person to another, according to Mr Kizza Derrick Mbuga, the executive director of Mental Health Uganda, a patients’ rights group.
As such, its early manifestations may be hard for the inexperienced to detect. Mr Mbuga lists unbearable anxiety, self-isolation or withdrawal attitudes, suicidal or violent tendencies, loss of appetite and change in sleeping patterns plus amnesia, among the symptoms.

During our investigations, our reporter spotted some of the adult patients walking around on Butabika Hospital compound dressed in their green short and round-necked tops. The children wore pink and one of them could be heard loudly singing local musician Ben Kakooza’s (Ziza Bafana) track Tuli maje (we are the army).
The freedom of movement on the premises has been exploited by some of the recovering patients to vanish altogether. For example, 3,138 patients scaled up the chain-link perimeter fence between 2013 and 2015 and escaped from the facility, which overlooks Lake Victoria.
A breakdown of the statistics indicates that the patients are of all age groups, socio-economic background and education.
“Mental illness doesn’t discriminate and we have made an attempt to provide care and treatment to all,” said Dr Basangwa.

The all-accommodating character of Butabika is in its infrastructure. The 550-bed facility has fourteen wards assigned separately for women, men, children and minor or severe cases while the Private Wing, which has 86 self-contained rooms, caters for the wealthy who can afford to pay for more privacy and better comfort.
Early this month, the Children’s Ward had 23 patients aged five to 17. Fifteen were girls.
Ms Ahmad Rehema, a nursing officer, said the children mainly suffer from retarded cognitive disorders, epilepsy and mood disorders.

A 2006 Uganda Bureau of Statistics (UBOS) study estimated that 7 per cent of the households in the country had disabled members, with more than half having at least one person with a mental disorder.
According to the World Health Organisation (WHO), mental disorders are characterised by combination of “abnormal thoughts, emotions, behaviour and relationships with others”. WHO reported in 2012 that 35 per cent of Ugandans suffer some form of mental disorder.
“Stress, genetics, nutrition, peri-natal infections and exposure to environmental hazards are also contributing factors to mental disorders,” noted the global health agency. Some of the conditions such as schizophrenia, depression and intellectual disabilities can be treated.

Whereas thousands have healed from Butabika, some 116 patients died there in 2013 alone, and according to health workers, due to natural causes and advanced HIV/Aids cases.
This claim contrasts with findings by the Mental Disability Advocacy Centre (MDAC), an international non-governmental organisation, which in a report early this month highlighted malnourishment, untreated skin conditions and cuts on bodies among plights of patients at the specialised psychiatric hospital.
The researchers noted that the wards were dirty, crowded and lacked basic protections for human dignity such as privacy and personal beddings.

Dr Sheila Ndyanabangi, the principal medical officer in-charge of Mental Health and Control of Substance Abuse at the Health ministry, said crowding at Butabika has been caused by lack of medicines at the mental health units in the 13 regional referral hospitals across the country. She proposed that lawmakers, who allocate national resources, should ring-fence funds for procuring specialised drugs for mental health care.

Because of drug stock-outs at lower mental health facilities, Dr Ndyanabangi said, relatives in the countryside sell livestock and other property to raise money to transfer patients to Butabika in Kampala.
Parliament is yet to consider a Mental Health Bill designed to improve mental health care in the country.

Tomorrow, read about drug abuse in the country and how to manage a mentally-ill patient

How to detect/handle mental illness


  • Unbearable anxiety
  • Self-isolation or withdrawal attitudes
  • Suicidal tendencies
  • Violent tendencies
  • Loss of appetite
  • Change in sleeping patterns
  • Total lack of sleep.
    How to handle Mental illness
  • Speak to the family member with the tendencies.
  • Calm them down by listening to them
  • Don’t tie them with ropes or chains
  • Take them to hospital as opposed to traditional healers
  • Encourage them to adhere to their prescribed medications
  • Take them for medical checkups
  • Show them care and love
  • Keep alcohol and drugs away from them
    Source. Mr Kizza Derrick Mbuga, the executive director of Mental Health Uganda

Numbers. An analysis of the records at Butabika shows number of patients has more generally increased every successive year since 2010
Causes. According to Dr Basangwa, alcohol and drug addiction are the major triggers of mental disorder in Uganda.
Cases. The Butabika statistics do not capture mental illness cases handled at other health facilities or elsewhere and, as such, offers less-than-complete picture or burden of mental illness on the country and families such as loss of lives, disruptions from productive work and care giving expenses.