Uganda’s mental health crisis: Why more hospitals won’t fix it

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OPINION

By Moses Mukasa Wasige

Since 2023, news that Butabika National Referral Hospital is full and turning away patients has shocked the Ugandan public. Yet I have not been surprised. The standard response is always predictable: calls for more hospitals, more beds, more psychiatrists.

But here is the uncomfortable truth: even if Uganda built a thousand new psychiatric hospitals, they too would quickly fill up. The problem is not a shortage of beds or doctors. The problem is that our mental health system is wrongly positioned for the needs of our people.

Institutionalised mental healthcare has deep roots in European history. From medieval asylums like Bedlam to the reformist “Moral Treatment” movement of the 18th and 19th centuries, institutions were once seen as humane solutions. By the mid-20th century, however, it became clear that asylums often caused more harm than healing, producing dependency, stigma, and what came to be called “institutional syndrome.” Many countries moved away from institutions and invested instead in community care, integration into primary health services, and approaches that emphasise dignity and inclusion.

Uganda, however, remains stuck in the colonial asylum model. Butabika remains both the symbolic and practical centre of mental healthcare. Our system is centralised, hospital-based, and dominated by outdated psychiatric training. Professionals are taught to rely heavily on diagnostic manuals and pharmaceuticals, while dismissing traditional and community-based healing systems that most Ugandans trust. In doing so, we have built a system that undermines cultural and social resources, which could otherwise serve as protective buffers against distress.

The crisis at Butabika is a symptom of this misalignment. People distressed and depressed by poverty, displacement, unemployment, drug use, violence, erosion of culture, disconnection from faith, or breakdowns in social safety nets often end up in psychiatric institutions. Yet many of these cases do not require hospitalisation. They require social repair, collective support, and community-based psychosocial care. This is not to deny that severe mental illness exists.

Globally, one in eight people lives with a diagnosable disorder. In Uganda, that translates to more than five million people. Among the nearly two million refugees we host, as many as one in three carry PTSD. The scale of suffering is undeniable. But most cases are linked more to lived hardships than to brain disease alone.

What Uganda urgently needs is an intentional paradigm shift. Institutionalisation should be reserved as a last resort for those with acute, complex, and severe mental health conditions requiring specialised care. Everyone else should be helped where they live with interventions that strengthen dignity, social bonds, and resilience, preventing escalation to the point of hospitalisation. This means moving resources from centralised hospitals into communities.

Community-based psychosocial support offers the most promising path forward. It works both through formal structures such as schools, clinics, workplaces, and faith institutions and through informal networks that sustain daily life, from families and neighbours to youth groups and burial societies. By equipping these networks with basic psychosocial skills, we can create multiple layers of safety nets that catch distress before it turns into a mental health crisis.

Village Health Teams, community counsellors, and peer educators can be trained to offer early support. Primary health centres should be resourced to detect and respond to distress in its early stages. Schools and workplaces must be supported to nurture resilience. Refugee settlements must treat psychosocial support as essential as food, water, or shelter. Importantly, Uganda must reclaim positive traditional healing practices as legitimate partners in promoting wellbeing, instead of relegating them to the shadows. 

Evidence from around the world shows that such approaches are not only more dignified but also more cost-efficient than hospital-based care. They dramatically reduce the need for expensive admissions and ease the pressure on overstretched national facilities.

Building more hospitals will only deepen the crisis. Rethinking the very nature of care is the only way forward. Mental health is not simply about drugs or diagnoses. It is about how societies understand suffering, how communities respond, and whether people can find belonging and hope.

Uganda stands at a crossroads. We can continue pouring resources into institutions like Butabika, knowing they will always overflow, or we can embrace a vision of mental health care that is decentralised, community-based, culturally grounded, and oriented toward resilience. The choice we make now will determine whether Uganda remains trapped in crisis or becomes a global model for humane and effective mental health care

The writer is an expert in humanitarian mental health