We need to improve mental health service delivery in Uganda

In Uganda, the disparity between available healthcare services and the need for mental health services is palpable. 

Although the country has made significant advances on challenging public health problems, health-related policy development, and legislation in trying to achieve health for all, there have been challenges with regards to mental health services including that of policy development and legislation, service delivery, financing, research, training and integration of mental health care into primary health care.

Undergirded by poor societal attitudes towards mental illness and inadequate resources, facilities, and mental health staff, figures suggest that about 80 percent of individuals with serious mental health needs in Uganda cannot access care. 

With fewer than 100 psychiatrists for a population of more than 45 million, most of whom are based in urban areas, nonexistent integration of mental healthcare at the primary healthcare level, caring for people with mental illness is typically left to family members. 

A paucity of community-based and primary healthcare services means that access to care is restricted to the most severe cases, usually in the form of psychiatric inpatient care or makeshift institutions. 

The result is a chronically and dangerously under-resourced mental health system catering for the needs of an estimated one in eight Ugandans who suffer from mental illness, poor awareness of the causes of mental health, widespread stigma and discrimination, poorly equipped services, and abuse of people with mental health problems. 

An exploration of innovative nuanced approaches to mental health service delivery is urgently needed to drive change.

While there is a benefit to the typical standard of care in mental health, there is also an over-reliance on psychotropic medication which serves to inhibit the utilisation of alternative forms of support. 

Furthermore, the startling lack of academic and political engagement with alternative non-Western perspectives about mental health problems means that Western narratives dominate over our local understanding of mental health.

How then can the gap be bridged using innovative, nuanced, and accessible

solutions?

It is of utmost importance to consider ‘integrated’ treatment packages that include both medications, traditional and psychosocial interventions that have been greatly soldshort by many medical professionals. 

The services offered should reflect the beliefs and practices of the local people. 

This is a quest that needs to be receptive to the wealth of beliefs and practices espoused by the diverse individuals that it seeks to serve. 

Greater credence should be given to diverse explanatory models of distress, socio-cultural influences while facilitating individuals to find meaning in their experience irrespective of their personal beliefs. 

Involvement of people with experiences of mental health problems; and emphasis on mental health promotion (rather than a narrow focus on mental illness) would also go a long way to facilitating greater efforts to produce innovation in mental health services.

As I conclude, I would like to emphasise the urgent need for a concerted effort between the government, policy makers, and international organisations to embrace a more nuanced approach to mental health service delivery. 

Jackline Nsanze Kisakye

Pharmacist | Mental health advocate | E-health enthusiast.