Re-thinking budgetary constraints in mental health

By Solomon Mbubi

The month of May is a mental Health month world over; I would like to make some highlights about how best we can work with in minimum budgets to respond to mental health challenges in Uganda.  

It is estimated that three quarters of the world mental health burden lies within the low and middle income countries (Hunter and Reddy 2013) and over 30% of the world population experience a mood, anxiety or substance use disorder in their life time ( Steel et al 2014) yet many countries world over have minimal budgets for mental . The Mental Health Atlas 2014 reveals that public expenditure for mental health in low and middle income countries is less 2$ per capita and much of this goes to fund inpatient care in public hospitals where need is not much felt.

This situation is not any different in Uganda, the last mental health atlas report published in 2014 revealed that Uganda with an estimated population of 38,844,626 people has one of the lowest total health expenditures in the world with 59.8$ per person. With this minimal budget Provision, mental health service in Uganda faces a number of contextual and system barriers across all the districts, from budgetary constraints, lack of information on existing treatment coverage to inadequate trained mental health personnel. 

However Uganda remains with one advantage over other countries and that is there is a political will to respond to the challenges posed by mental health. Stakeholders in this sector should ride on the good political will to respond to the challenges posed by mental health in Uganda.

Stakeholders should think about how to use the available resources efficiently and effectively to reach out to the vast majority of people with mental illnesses than providing services in a more conventional way which is expensive and unsustainable. Using what Vikram Patel calls task shifting mental health and mental health democratization I suggest cost effective strategies that can be used to improve mental health.

With a small number of specialized mental health human resource amidst great number of village health team members spread across the country, Uganda can use the specialized personnel to train the village health team members and other community members to deliver mental health services. It is estimated that since the inception in 2001 Uganda has 179,000 village health team members spread in all the districts of Uganda (Mays et al 2017). If these village health team members are trained to offer mental health services with technical support from psychiatric nurses at Health centre iv that are distributed across every sub county in the country access to mental difficulties will be solved. Bolton et al (2003) using randomized control trials revealed that group psychotherapy amongst village communities in Uganda were high effective in reducing depression and dysfunction in a more feasible village setting.

The ministry of health mental health program should simplify mental health message to do away with complex medical jargon in order to enable less trained people like village health team members to deliver mental health services to the people. The intervention should be unpacked into small easily understandable procedures that can be transferred to the local people in a local language.

 Lastly delivery of mental healthcare should be moved from institutions to communities shifting the roles of the few trained mental health practitioners to capacity building and supervision. 

Writer is a student of Glocal International Community Development at the Hebrew University of Jerusalem, Israel