Mental illness is far more common than we think

Mildred Nangobi, a fourth year student at Mulago Paramedical School is studying neurology. In 2014, she suffered from severe depression while she was about to sit her UACE exams and was admitted to Butabika National Referral Mental Hospital.
“The depression was triggered by the death of my parents. I reached a point that I could not talk although I would understand everything. I would clearly hear people speak to me but would find it hard to respond,” she says.
Three weeks after being admitted to hospital, a group of people from Strides of Hope, a non-governmental organisation, visited her.
“I would communicate by writing in a notebook. They prayed with me and after counselling, I felt much better. I had longed to hear words of hope and encouragement from someone,” she says.
After a few sessions, Nangobi says she started murmuring a few words.
“Everyone at the ward was happy that I was responding well to treatment. After about two weeks of interaction with the people from Strides of Hope coupled with treatment, I was able to recover my speech and was discharged,” she recalls.
Nangobi was then able to sit her final exams and has remained in contact with her counsellors.According to Frank Olong, a mental health activist at the foundation, there are only 33 psychiatrists in Uganda yet the number of people that suffer from mental problems in the whole country totals 11.5 million.
Olong remarks that persons with mental disorders suffer many setbacks with the most common being discrimination due to stigma. The negative attitude towards persons with mental health problems has greatly crippled efforts to obtain medical and psychiatric support, especially at the early stages of the condition.
“Stigma against mental illness is observable at various levels ranging from individual to institutional. This has interfered with recovery and hampered the fight against achieving monumental results in the mental health field,” he says.
This has resulted in loss of jobs, school dropouts and divorce since mental conditions are not understood by many according to Olong. At extremes, some of the sufferers are forcefully “imprisoned” in their homes, bound with chains and ropes in a bid to keep the family reputation. Children are considered an intergenerational burden and are denied some basic rights such as the right to education and to play.
Olong says, “With creative approaches to advocacy and awareness creation, stigma against mental disorders can be curbed thus enabling persons with mental illness live dignified lives, free from discrimination and be acceptable in the community.”
He says some of the approaches that can be used to reduce stigma against mental illness and create awareness include walks, marathons, soccer tournaments, dance, music and drama. These activities have an impact on community members as they are simple but carry a strong and important message that is tailored to meet the needs of every member of the community.

The challenges
Last year, SoHope, a nonprofit vorganisation based in Luzira, Kampala, Uganda, organised its first mental health awareness walk dubbed Siri Mulalu (I am not mad) since most people with mental problems are referred to as mulalu which is both stigmatising and demoralising. “This interferes with the self-confidence, acceptance and proper integration of the mentally ill into the communities,” says Olong.
Insufficient access to information about mental illness is partly a contributing factor to the stigma around mental illnesses. Therefore, having an open platform to provide this information will help change people’s perception about mental illness.

What is mental health?
According to Dr Edward Sempiira, a psychologist at Lifeback Foundation Uganda, mental health includes our emotional, psychological and social well-being. Mental illness therefore involves changes in the brain structure or chemistry that lead to a different perception of reality, abnormal thoughts, emotional disturbances, and unusual behaviours
Many factors contribute to mental health problems, including, biological factors, such as genes or brain chemistry, life experiences such as trauma or abuse as well as family history of mental health problems. Symptoms of mental illness include eating or sleeping too much or too little, avoiding people and usual activities, low or no energy, or having excessive non-constructive energy, unexplained aches and pains, feeling helpless or hopeless, smoking ,drinking or using drugs more than usual and feeling unusually confused, forgetful on edge, angry, upset, worried or scared.
Others include, experiencing severe mood swings that cause problems in relationships, having persistent thoughts and memories you cannot get out of your head and hearing voices or believing in things that are not true (delusions and paranoia or hallucinations), thinking of harming yourself or others and inability to perform daily tasks like taking care of your children or getting to work or school.

Triggers
Factors that could trigger mental problems include alcohol and drug use, loss of someone, accidents, work related challenges, financial challenges and many others. The commonest examples of mental problems include drug abuse, depression, generalised anxiety disorder, panic disorder, obsessive –compulsive disorder, post-traumatic stress disorder (PTSD) and epilepsy.

Treatment
Mental illnesses treatment involves a range of interventions but mainly psychological therapy is very important according to Sempiira.
It involves professional health talks with the person about their symptoms and concerns and discussing new ways of thinking about and managing them.
“Medication for people with mental problems may be ongoing depending on the condition and the doctor often explains the benefits and possible side effects of the medication before or after prescription. Medication helps the brain to restore its usual chemical balance so that the symptoms are reduced or even eliminated,” he says.
Community support programmes may include information, accommodation, help with finding suitable work, training, education and more important is psychosocial rehabilitation and mutual support groups.

Shortfalls
Ugandan mental health services have been characterised as inadequate with Butabika Hospital as the only national mental referral hospital which registers more than 100 patients every day. The World Health Organisation (2014) estimates that 90 per cent of people with mental illnesses receive no treatment in Uganda.

“This situation is exacerbated by limited health facilities to handle this challenge and little support (one per cent budget allocation) from the government,” says Dr Edward Sempiira, a psychologist at Lifeback Foundation Uganda.

Vulnerability
Dr Edward Sempiira, a psychologist at Lifeback Foundation Uganda, says a complex combination of genetics, environment, and family history can put a person at greater risk for mental illness. Children whose parents had a substance use disorder are at greater risk for developing mental illnesses due to that experience.

The National Institute on Mental Health found that, more men than women report any mental illness: 21 per cent of men compared to 14 per cent of women report mental illness in general. However, certain conditions such as mood disorders, are more likely to affect women than men.

Young people transitioning from adolescence to adulthood are the most at risk for substance abuse, which affects their long-term mental health.