Mental illness: A case of forgotten identity

On March 21, Sarah Musiwa was admitted to Butabika Hospital for the mentally ill on recommendation by the police after she allegedly killed a five-year-old boy. She escaped from her asylum and in a repeat of a heinous crime, she allegedly killed another three-year-old girl last week using a knife.

Unfortunately for her this time, a mob waylaid her and lynched her. After the first killing, the police believed her to have a mental problem and referred her to Butabika for treatment. Musiwa represents a growing case of mentally ill persons in Uganda; some so obvious and visible but majority of cases are subtle with patients scattered in workplaces, in families or schools like time bombs waiting to explode.

On Kampala streets, onlookers make such comments like: “Those are mad people, and how can you talk to people who are not paying you any attention?” in reference to street preachers who hardly have an audience listening to them.

Common problem
Dr David Basangwa, a senior consultant psychiatrist and also the deputy executive director of Butabika Hospital, says mental illness which is the condition that disrupts a person’s thinking, feelings, mood, ability to relate to others and daily functioning is becoming a common problem in Uganda and globally.

The World Health Organisation estimates that by 2020, mental disorders will be the second most diagnosed and recognised illness second only to cardiovascular diseases. In Uganda, the estimate is that 20 to 30 per cent of the population suffers from one form or the other of psychological or mental illness. However, even in the most seemingly obvious cases of the disorder, police and other institutions of health do not seem to have the capacity to detect patients.

In the case of Musiwa, it is said she confessed killing her first victim and told the police she would repeat the act if she is released. She was referred to Butabika for diagnosis and treatment in March but last week she fulfilled her ‘promise’ before she got killed by a mob, itself a possible case of a ‘collective mental disorder’.

“Most of the common causes of mental illnesses are genetic passed on from a parent/s to the child. They are also caused by one’s personality and people who are at risk of suffering from mental disorders because of their personality are the kind that cannot stand disappointments, are short tempered and are difficult to deal with,”Dr Basangwa says.

“Old age also leads to this condition because as you grow, the brain stops functioning appropriately. Injury to the brain as a result of accidents can be an offset of mental illnesses. Drug abuse in form of alcohol, marijuana, cocaine among others also leads to these disorders.” he adds.

These illnesses are in form of mood disturbances, brain infections or injuries, epilepsy, schizophrenia and psychotrauma. “In our environment, factors like rampant infections in form of malaria, HIV/AIDS are sufficient contributors,” Dr Basangwa says. In 2003, the WHO reported that Uganda was the world’s highest per-capita consumer of alcohol, at 17.6 litres per person every year.

Uganda also has heavy use of drugs like marijuana which affects people’s brains and leads to mental illnesses. He also said the recent political turmoil involving the police and work-to-work demonstrators tend to push people to the brinks of mental illness. However, although mental illnesses cut across, Dr Sheila Ndyanabangi, the principal medical officer mental health and control of substance abuse at the Ministry of Health, says men are more prone than women and the worst hit areas with mental illnesses in the country are northern Uganda and West Nile. “These areas experienced war for a long time and in a research conducted in 2004 among people living in camps in the northern Uganda, 30 per cent of IDPs had symptoms of moderate severe depression because of alcohol, drug abuse and stress,” Dr Ndyanabangi says.

She adds that men tend to smoke drugs more than women, they are also more violent and aggressive which exposes them to accidents than their female counterparts which partly explains the 55 per cent and 45 per cent distribution for males and females respectively.

Butabika capacity
Despite the high threat of mental disorders in the country, the number of psychiatrists is alarmingly low. Uganda has only 26 psychiatrists, according to Dr Basangwa, who also says the ratio to the total population is 1: 1.5 million.

Seven out of these psychiatrists are stationed at Butabika which is the only mental referral hospital in the country treating more than 750 patients, four others are in Mbarara, one in Arua, four in Gulu, seven at Mulago and three are employed in the Uganda People’s Defence Force. “We now rely heavily on a low cadre staff to look after the patients, these are normally nurses who are offered further training for two years to become clinical psychiatric officers so that they can help handle mental illnesses within communities in general referral hospitals and these are only 150 across the country,” Dr Basangwa says.

However, Dr Ndyanabangi says because of the limited human resource in the psychiatric department, the community can always come in to help where possible because 50 per cent of the mental illnesses are curable, 40 per cent are recurrent whereas the remaining 10 per cent are not curable. “So whenever you notice someone within your surroundings showing signs like abrupt sadness or happiness, talking to themselves, isolating themselves, contemplating death, lack sleep, lack appetite and are restless, take them to a health personnel,” advises Dr Ndyanabangi.

It is important that families and communities understand that mental illnesses are a disease like any other to avoid cases such the unfortunate killing of Musiwa in Kanyanya village, in Wakiso District.
Like her, anyone who suffers a mental disorder, according to Dr Basangwa needs the support of their family and friends and not to be isolated or chases away.

Why I hate Butabika

nSteven Kusagala, 38, was brought at Butabika Referral Hospital on June 6, 2006 by the police. Although he can speak, he gets into a stupor now and then. He is “sure” he is not sick and he does not see why they have kept him at the hospital. Kusagala, a farmer in Kajjansi, says the police found him walking on the streets and the next thing he knew, they were calling him a mental patient and that’s how he ended at the hospital.

He cannot remember any of his relatives or friend’s names but he is hoping that at least one day someone comes for him because he hates the mental institution. “Although I get enough food and I am not forced to do anything, I hate this place, I am fed up of being here and yet I am not sick because these people do not let me walk around as I please.”

nPatrick Turyahabwe, 32, has been at the facility for seven months now. He was brought to Butabika by his brother whom he identifies as Justus Eric from Katona in Kabale District. Unlike most of his colleagues who are stuck at the hospital, the only reason Turyahabwe is still at the hospital is because he lacks transport to take him back home because he clearly knows his way back home. He says that he is fed up of being locked up and yet he is fine. He also wants to go back home to his wife and daughter.