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Mental Health- Over 11.5 million Ugandans suffer disorders

By Vision Reporter

Added 4th April 2010 03:00 AM

JOSEPH Musoke, a resident of Ndejje in Wakiso district, is said to have walked to Nakulabye Police post and turned himself in for burning Kasubi tombs on March 16.

JOSEPH Musoke, a resident of Ndejje in Wakiso district, is said to have walked to Nakulabye Police post and turned himself in for burning Kasubi tombs on March 16.

By Chris Kiwawulo
JOSEPH Musoke, a resident of Ndejje in Wakiso district, is said to have walked to Nakulabye Police post and turned himself in for burning Kasubi tombs on March 16.

According to Musoke, the ungodliness of the tombs was the cause of Uganda’s problems and had to be destroyed for peace to prevail. But the middle-aged man’s past life has been characterised by bouts of mental illness, which makes many doubt his confession.

Thus, some argue that he is capable of burning the tombs given his mental status while others say he could not. “If the man burnt his own family shrines, what about Kasubi?” asks George Ssentamu, a bodaboda rider in Mulago.

Is Musoke’s story authentic?
Mental health experts say one of the symptoms common among people with mental problems is believing in seeing or doing something that is non-existent (hallucinating). Musoke may have assumed he torched the tombs, yet he did not.

On the other hand, setting up fires is a warning sign among the mentally ill, medics point out. According to the Police Criminal Investigations Directorate’s deputy director Elly Womanya, it is too early to describe Musoke’s claims as a confession, though his statements are being probed.

Like Musoke, there are many patients with mental problems that are ignored. Some are taken to treatment centres like Butabika Hospital, but when they escape, it ends there. That aside, mental health facilities are not evenly spread and staffed countrywide, causing congestion at Butabika.

Mental health services in Uganda were decentralised in the 1960s and mental health units built at regional referral hospitals.

According to the World Health Organisation (WHO) report on mental health policy and service provision 2010, mental health units that were built at regional referral hospitals resembled prisons and were manned by psychiatric clinical officers.

WHO says the services were plagued by low staff morale, a chronic shortage of drugs and no funds for community activities.

“Most people had little understanding of mental disorders or did not know that effective treatments and services were available. Up to 80% of patients went to traditional healers before reporting to the health system,” the report states.

To date, upcountry mental health units have very low numbers of medics in the field of psychiatry, making them as good as useless.

The condition in Uganda
Dr. David Basangwa, a senior consultant psychiatrist at Butabika Hospital, says there are only 28 psychiatrists for a population of 33 million people in Uganda. Basangwa says most of the work is being done by clinical officers and nurses since specialists are few.

Basangwa says currently, mental cases constitute 12% of the global disease burden and are projected to reach 15% by the year 2020.

“Depression will be the most commonly diagnosed condition after heart diseases,” he states. He notes that in Uganda, at least 35% of the population (over 11.5 million people) suffer from different psychiatric disorders. Of these, 15% (about 5 million people) require treatment from mental health units.

Basangwa adds that at any one time, Butabika Hospital has 750 inpatients and receives about 100 patients who come for treatment everyday. Past records show a rising trend in cases of mental illness in the country.

The number of mental health cases treated at Butabika rose from 4,274 in 2005/2006 to 5,604 in 2006/2007, the hospital acting director, Dr. James Walugembe, says.

Basangwa notes that while neighbouring Kenya has at least 80 psychiatrists, most medical students in Uganda rarely opt for psychiatry because it is less lucrative. “Our patients do not pay. So even if one started a private clinic, it attracts few clients,” he says.

Thus, not even scholarships can lure students to pursue the course, Basangwa says. There were about 10 scholarships at the undergraduate and Masters levels for psychiatry students last year but nobody applied for the course.

What is mental health?
Mental health is how we think, feel and act as we cope with life. It also helps determine how we handle stress, relate to others and make choices. Everyone gets worried, anxious, sad or stressed sometimes.

But with mental illness, these feelings become severe and interfere with one’s daily life. Psychiatrists say mental illnesses are common, but patients do not get treatment. Disorders which include depression and irrational fear should not be ignored.

Post Traumatic Stress Disorder (PTSD), the most common mental ailment in northern Uganda, is a result of events that cause horror.

These include war, accidents, loss of loved ones and sexual abuse. The rate of PTSD recorded among refugees is 11.8% in Guatemala, 38% in Mexico, 4.6% on the Thai-Burma border, 5.6% in Croatia and 20-42% in Afghanistan.

In Uganda, this disorder emerged as a result of the protracted Lords Resistance Army war in which thousands of people were brutally killed.

This pushed mental illness cases in northern Uganda to a level where they are believed to be the highest worldwide.

According to a research paper that a team of British and Ugandan psychiatrists published in the journal BMC Psychiatry, out of over 1,200 adults in Gulu and Amuru districts who were assessed in 2006, more than half (54%) suffered from PTSD.

The researchers say more than a third of the individuals surveyed (67%) had signs of depression. A depressed person is irritable, persistently sad, unnecessarily tired, anxious, guilty, worthless and lacks sleep.

There is also schizophrenia, a mental disorder characterised by abnormalities in the perception or expression of reality.

It manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganised speech and thinking with significant social or occupational dysfunction.

Fortunately, mental illnesses are often treatable, although somewhat expensively. Prescriptions and therapy can improve the condition.

Basangwa says: “A patient with mental problems is handled by many experts including doctors, counsellors and psychologists, which makes the cost high.”

Someone who recently took care of a patient with a mental illness at a health facility says it cost them up to sh150,000 per month.

Hope for mental health
In 1996, Uganda’s health ministry, encouraged by WHO, strengthened mental health services and integrated them into primary healthcare.

Standards and guidelines were developed for the care of children and adults with epilepsy and other mental disorders from community level to tertiary institutions.

Health workers were trained to recognise and manage or refer common mental and neurological disorders. A new referral system was established along with a supervisory support network.

Linkages were set up with other programmes such as for those with HIV/AIDS, health education for adolescents. Efforts were made to raise awareness of mental health in the general population.

The Mental Health Act was revised and integrated into a Health Services Bill. Since then, mental and neurological drugs have been included in the essential drugs’ list.

Mental health is part of the national minimum healthcare package and is now part of the health ministry budget.
Basangwa says the health ministry has also equipped mental health units at 13 regional referral hospitals countrywide to help treat patients.

The move is aimed at reducing the capacity of the 900-bed national psychiatric hospital in Butabika by at least half.

The Uganda National Health Policy and Draft Mental Health Policy (2000–2005) also commits to prioritise mental disorder because it is a major contributor to the country’s disease burden.

Coping mechanisms for caretakers
Whereas some patients with mental problems may become aggressive, caretakers are advised to accept their condition and have a positive attitude towards them.

People looking after patients with mental illnesses need regular counselling, lest they develop psychological problems.

Make the patient your friend to avoid rejection so that it becomes easier to look after them.

Caregivers should bear in mind that the illness of a family member is nothing to be ashamed of.

Ignore comments from apprehensive members of the public and own the problem. Understand that mental illness, like any other disease, is part of life.

Seek medical interpretation of new developments that might happen to a patient in the course of treatment so you can easily address them.

Caretakers can read more data about mental disorders so that when a patient behaves in a queer way, it is not new to them.

They should share their thoughts, feelings and experiences with people who have had patients with mental illnesses before.

They can also seek family support and make family members understand that their colleague’s illness can be overcome with concerted effort.

Causes and signs of mental illness
Poor upbringing
Age: People who grow older tend to develop mental problems
Diseases like malaria and HIV/AIDS
Injuries as a result of accidents on sensitive parts of the body can also result into mental illnesses. Accidents that injure the brain are a leading cause of mental illnesses

Those with a history of mental illness in their family (genetic factors,
Persons exposed to stress
Those taking drugs like alcohol and marijuana

Exposure to traumatic experiences
A person with one or more of the following symptoms should be evaluated by a psychiatrist or other physicians immediately:

Marked personality change
l Inability to cope with problems and daily activities like work

Strange ideas and excessive anxiety
Prolonged depression
Loss of sleep
Change in eating or sleeping patterns.
Extreme highs and lows
Abuse of alcohol or drugs

Excessive anger, hostility, or violent behaviour
Suicidal tendencies
Setting up fires
Low self-esteem

Acting in a sexually provocative manner.
Loss of interest in pleasurable activities like sex or failure to concentrate on tasks and usually has problems remembering details.

One’s appetite may also rise or decline.
It is important that if people begin to behave abnormally, those around them should consult the nearest health worker

Elicit the services of a professional counsellor
Take the person to a mental facility for examination and treatment
Every practising medic has been equipped with skills to handle persons with mental illnesses

Mental Health- Over 11.5 million Ugandans suffer disorders

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