How Covid-19 scourge  hurt mental healthcare

An ambulance transports a patient into Butabika Hospital in June 2020. Many mental health patients were not able to access treatment during the lockdown. PHOTO/FILE

When Uganda’s healthcare facilities began experiencing a surge in Covid-19 cases in June 2020, mental health units at most regional referral hospitals were converted into Covid Treatment Units (CTUs).

“We resorted to the mental health unit because of the nature of how it had been constructed. It could easily be zoned. Sooner or later, we realised we had run into trouble with mental patients. We did not have where to put them. We tried putting them in other ordinary wards but the other patients were complaining,” Dr Nathan Onyachi, the Masaka Regional Referral Hospital director, told Daily Monitor yesterday. 

The district allowed the hospital to temporarily relocate the mental health unit to Kyabakuza Health Centre II, a new and complete structure.  

In June, Arua Regional Referral Hospital shifted their mental health unit to the Ear, Nose and Throat (ENT) admission ward after the unit was turned into a CTU. About 20 mentally-ill people were relocated. 

Four months later, two patients escaped from the new unit at ENT back to the old unit that was turned into a CTU. 
Other referral facilities have had to adapt and change their method of operation to avert such challenges. 
Masaka hospital realised that after shifting their mental health unit to Kyabakoza Health Centre II, they needed to adopt counselling of relatives to manage their patients from home rather than admitting them at the health facility. 

“Fortunately, our mental health staff found innovative ways of avoiding admission of mental health patients. Probably, the worst thing they have done is to detain a patient for a day and then let them go home. It is also a good thing for them (staff). They did not think they could do it but they have done it,” Dr Onyachi said.

At Lira Regional Referral Hospital, service models also changed during the Covid-19 period.

“We are now doing community outreaches to have mental health patients access care. Our team of professionals go out to the patients in areas that we have mapped. There are just a few people (with mental health illnesses) coming to the health facility,” Dr Steven Oboo, the director of Lira Regional Referral Hospital, said last Thursday.

Mental health medics say the lockdown measures made some patients miss out on their medications.

“Somehow, there were relapses. Once there is a relapse, people sometimes have to be admitted to first normalise and calm them down, The medicines became available after the lockdown,” Dr Hasifa Nkwata, the commissioner in-charge of Mental Health at the Ministry of Health, told Daily Monitor last week.

Since the phased lifting of the lockdown began on June 4, Butabika National Referral Mental Hospital received a high number of patients.

Dr Juliet Nakku, the deputy executive director of Butabika National Referral Mental Hospital, told Daily Monitor in July 2020 that between July 12 and July 18, the hospital received about 1,050 cases requiring admission, yet previously they received between 800 and 900 patients per week.

Butabika hospital has a bed capacity of 550.  
“We do not know exactly what is causing the surge, but we suspect it could be due to two reasons. One is the fact that mental health services are not being accessed in other parts of the country,” Dr Nakku said.

But currently, the referral facilities are adapting to the change in service delivery.

“For the referrals, it is not true that people were being referred officially to Butabika. Only that when services were not available, those who were taking care of those patients had to get other alternatives and that is how we saw the people getting into Butabika hospital. Whoever would fail to find proper care, they were shifting to Butabika,” Dr Nkwata said.

There are no clear statistics to show the current number of patients seeking mental health care are both regional and national levels. 

Uganda has 14 regional referral hospitals in Arua, Fort Portal, Gulu, Hoima, Jinja, Kabale, Old Mulago, Lira, Masaka, Mbale, Mbarara, Moroto, Mubende and Soroti. 

Epilepsy, bipolar, schizophrenia, depression and dementia are the main disorders for which people seek treatment at the hospital.

In 2019, Butabika registered about 12,855 patients seeking treatment for epilepsy, 11,354 for bipolar, 10,344 for schizophrenia and 2,437 for depression. 
Daily Monitor was unable to get figures for 2020 from the hospital.

Patient ordeal
“She has to take medicine every day. She cannot skip. They are treating her for mental health. She used to speak to herself. I have come to pick medicine for my mother. She was admitted here for many years but when she was discharged, I took the responsibility upon myself to get her medication from here,” Ms Namudu Lillian, a 20-year-old daughter of a mentally ill mother of seven from Mukono District, told to Daily Monitor from Butabika Mental Rehabilitation Hospital on December 2, 2020. 

She has seen her mother struggle with mental illness for about 15 years after her father remarried.