Mental health inseparable from SRHR

Mental health has been recognised as inseparable from sexual reproductive health and rights (SRHR) especially among the young people.

The recognition has been made by SRHR Alliance Uganda, a consortium of organisations that stand for and promote young people’s SRHR, as the world commemorates May, the mental health awareness month.

“As SRHR Alliance Uganda, our message centres on the vital connection between SRHR and mental-wellbeing. We recognise that mental health is inseparable from SRHR as stigma, discrimination, and lack of access to SRHR services can deeply impact young people’s mental health,” Denis Lewis Bukenya, SRHR Alliance Uganda Project Coordinator, says.

Bukenya reasons that there is need for communities to foster open conversations and challenge harmful norms as the pressures of societal expectations, gender-based violence, and limited sexual reproductive rights resources can take a toll on youth’s mental well-being.

“We advocate for a society where young people are empowered to make informed SRHR choices in safe, supportive environments free from judgements. Therefore, we call for breaking the silence around mental health stigma particularly in communities where cultural norms discourage open conversations,” he adds.

Young people aged between 10–24 face a myriad of mental health challenges shaped by their unique socio-cultural and economic environment.(World Health Organization (WHO, read more)

 Anxiety among this age group is pervasive driven by academic pressures, unemployment, and societal expectations around early marriage or family responsibilities. (UNICEF, "The State of the World’s Children 2021: On My Mind – Promoting, protecting and caring for children’s mental health," more info).

Additionally, economic uncertainty, a reality for many Ugandan youths, amplifies these anxieties, as young people worry about securing a stable future.

“Depression is another significant issue, often triggered by poverty, loss of loved ones due to HIV&AIDS, conflict and social isolation. The stigma surrounding mental health discourages youth from seeking help, deepening feelings of hopelessness,” Bukenya argues.

Resultantly, chronic stress is widespread, as young people juggle school, work, or household duties, particularly in rural areas where resources are scarce.

This is exacerbated by the lack of recreational outlets that further intensifies stress, leaving youth with few healthy coping mechanisms.

“Trauma and post-traumatic stress disorder affect many, especially those exposed to gender-based violence, domestic abuse, or the lingering effects of past conflicts in regions like northern Uganda.

Substance abuse, including the use of alcohol, drugs like marijuana is a growing concern, as some young people turn to these as coping mechanisms in the absence of mental health support. Most alarmingly, untreated depression and isolation contribute to rising rates of suicidal ideation and self-harm, with stigma and limited services increasing the risk,” Bukenya states.

Manifestations

Mental health challenges among Ugandan youth manifest in ways shaped by cultural norms, socioeconomic realities, and limited awareness. Emotionally, young people may appear withdrawn, irritable, or overly quiet, often suppressing their feelings due to cultural expectations that equate emotional expression with weakness, particularly for boys.

Girls may express distress through sadness or fearfulness, but societal pressures often discourage open dialogue.

Behaviourally, these challenges can lead to declining school attendance, reduced participation in community activities, or engagement in risky behaviours like substance use or aggression. Some youth may isolate themselves, avoiding social gatherings altogether.

Physically, mental health issues often present as unexplained complaints like headaches, fatigue, or stomach problems, as stigma leads youth to somaticize their distress rather than articulate emotional struggles.

In Uganda, phrases like “Mpulira setegera”, “Nkooye ensi” or “my heart is heavy”, “I feel lost” are common ways young people describe mental distress, reflecting cultural reluctance to use clinical terms.

In rural communities, mental health issues may be attributed to spiritual causes, such as being “cursed” or “bewitched,” prompting youth to seek help from traditional healers rather than professionals.

Addressing mental health challenges

Addressing the mental health crisis among Ugandan youth requires culturally sensitive, youth-centred and community-driven approaches that leverage existing structures and address systemic barriers. SRHR Alliance Uganda proposes the following strategies:

Raising awareness and Reducing stigma: widespread stigma is a major barrier to mental health care. Community sensitization campaigns, delivered through trusted platforms like radio, local leaders, and religious institutions, can enhance normalization of mental health discussions and challenge myths that equate mental illness with weakness or spiritual affliction.

Expanding Access to youth-friendly Services: Uganda’s mental health infrastructure is limited, with only 1 major psychiatric hospital (Butabika) and a shortage of trained professionals.

To bridge this gap, SRHR Alliance Uganda recommends training peer educators within youth existing networks to provide basic mental health support and referrals. Additionally, expanding toll free help lines.

Strengthening support systems: Creating safe spaces where young people can share challenges and learn coping skills is critical. Community centres and school clubs can serve as hubs for such activities, offering youth a sense of belonging.

Advocating for policy change: Uganda’s mental health budget, currently less than 1% of health spending, is inadequate to meet youth needs. SRHR Alliance Uganda calls for increased funding and implementation of policies like the draft National Mental Health policy to strengthen mental health systems.

Promoting recreational activities: like sports, drama, or music provides healthy outlets for stress, particularly in rural areas where such opportunities are scarce. Community organizations, including SRHR Alliance Uganda, can partner with local governments to establish these programs.

Effects on sexual decisions

Impaired Decision-making. Mental health issues can impair judgement and decision-making capacities, affecting choices related to contraception, partner selection, and safe sex practices.

Youth with mental illnesses in Uganda, as observed in a study at Mbarara regional referral hospital, demonstrated significantly lower knowledge about sexual and reproductive health which can lead to uniformed impulsive reproductive decisions such as early or unplanned pregnancies.

Vulnerability to gender-based violence: Mental health challenges can increase vulnerability to gender-based violence, which in turn influences sexual behaviour and reproductive choices. Young people with mental health issues may struggle with self-advocacy making them more susceptible to coercive relationships or sexual exploitation.

Social and cultural Influences: mental health issues are often exacerbated by socio-ecological factors like poverty, cultural norms and gender inequalities, which are prevalent in Uganda. These factors can pressure young people into early sexual activity or marriage hence limiting their autonomy over reproductive decisions.

Barriers to accessing SRHR services: Mental health challenges, such as stigma or low self-esteem can deter young people from seeking sexual and reproductive health services.

Need to fund Specialised Mental Health Spaces

Severe shortage of specialized mental health facilities, professionals with approximately one psychiatrist per million people (1:1000,000) exacerbate the situation, particularly in rural areas where access to services is nearly non existent.

A case in point, Butabika National Referral mental hospital, established in 1955, serves as Uganda’s sole psychiatric referral facility for over 40 million people. With a bed capacity of 550, it routinely manages 850-1000 inpatients daily highlighting severe overcrowding.

As a facility for specialized care, training and research, Butabika provides inpatient and outpatient services, supports regional hospitals, and advises on mental health policy.

However, it grapples with a rising mental health burden driven by post-traumatic stress, HIV&AIDS-related psychosocial issues, poverty, and urban migration.

A critical shortage of specialists as it has only 40 psychiatrists nationwide who are mostly in Kampala combined with limited funding and drug shortages. This hampers its ability to deliver quality care.

As SRHR Alliance Uganda’s mission is to strengthen partnerships that promote young people’s SRHR, we call for increased funding, integrating SRHR into mental health frameworks so as to explore and curb mental health challenges resulting from SRHR related factors.