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Mental health crisis

New report shows that investment in mental health is still lacking

Kampala, Uganda | PATRICIA AKANKWATSA | Uganda spends 9.8% of its GDP on healthcare and only 1% of that is spent on mental healthcare.

Dr. Juliet Nakku, the Executive Director of Butabika National Referral Hospital, says that the current lack of public funding to the mental health sector greatly contributes to the mental health crisis in Uganda. Many mental health patients face stigma and are discriminated against in a country where the psychiatrist to patient ratio is 1 to 900,000.

COVID-19 has also exacerbated the intensity of the social problem of mental health. Regarding individuals with pre-existing or underlying psychiatric conditions, the environmental changes and effects of the coronavirus can significantly increase symptoms for many of these people.

Dr Florence Baingana, WHO Regional Advisor for Mental Health and Substance Abuse, explains that while most African countries have mental health and psychosocial support in their COVID-19 response plans, very often additional budget was not fully allocated to implement these plans. There are insufficient health workers, medical supplies, medicines and personal protective equipment.

“Because of the insufficient financing available before the onset of the COVID-19 pandemic, alternative care models were never fully developed,” she says.

In Uganda, like most African countries, mental healthcare was already weak before the epidemic. The country has only 47 psychiatrics, most of who are based in Kampala, for a population of 42 million. Mental health services are mainly concentrated around the capital city.

Dr. Raymond Odokonyero, a medical doctor and psychiatrist at Mulago National Referral Hospital in Kampala, says that because of poor funding, many skilled healthcare workers are leaving Uganda for higher wages in high-income countries. That means there are not enough trained medical staff.

“The lack of trained medical staff also means that communities also lack prescribable medications,” he says.

Derrick Kizza, the Executive Director Mental Health Uganda, says that there is also an absence of publicly funded programs that aid individuals or their families for any mental health coverage. So families must bear the financial burden of taking care of the mentally ill. With much of the family’s time preoccupied, this can also cause significant social costs.

Paul Nyende, a lecturer at Makerere University in the department of mental health and community psychology, says that even though many people experience mental health issues because of systemic and societal reasons that are interwoven with many other social problems, misconceptions largely inhibit people from seeking treatment.

“Many Ugandans believe spirits and witchcraft to be the cause of mental illness, so they will commonly seek traditional healers before, if ever, seeking evidence-based medical help. While traditional healers are generally patient-centered and caring, their practice is not based on science and often applies harmful practices, including chaining and tying the patients down for long periods of time to ‘ward off’ the spirits,”

According to the UN World Health Organisation report, approximately 450 million people suffer from mental health, neurological, and substance use disorders. Statistics show that close to 20% (6.8 million) out of the 42 million people in Uganda have some degrees of mental illness, ranging from anxiety and depression to severe mental illness.

The World Health Organisation’s new Mental Health Atlas 2020 shows that there has been failure to provide people with the mental health services they need, at a time when the COVID-19 pandemic is highlighting a growing need for mental health support.

The latest edition of the Atlas, which includes data from 171 countries, provides a clear indication that the increased attention given to mental health in recent years has yet to result in a scale-up of quality mental services that is aligned with needs.

Issued every three years, the Atlas is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilisation of services and data collection systems.

It is also the mechanism for monitoring progress towards meeting the targets in WHO’s Comprehensive Mental Health Action Plan.

“It is extremely concerning that, despite the evident and increasing need for mental health services, which has become even more acute during the COVID-19 pandemic, good intentions are not being met with investment,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation.

“We must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health, because there is no health without mental health.”

“The new data from the Mental Health Atlas shows us that we still have a very long way to go in making sure that everyone, everywhere, has access to quality mental health care,” said Dévora Kestel, Director of the Department of Mental Health and Substance Use at WHO.

“But I am encouraged by the renewed vigour that we saw from governments as the new targets for 2030 were discussed and agreed and am confident that together we can do what is necessary to move from baby steps to giant leaps forward in the next 10 years.”

Kizza advises that more substantial funding is required to scale up community mental health services, integrated care, and the Safe wards model.

“This scale-up will ensure that after the COVID-19 pandemic, health systems can help reduce the possibility of a second pandemic, this time of mental illness,” he says.

“We can do this by investing in our own mental health, supporting the mental health of those around us and by demanding that our leaders invest in mental health across the world. COVID-19 gives us a once in a lifetime opportunity to move mental health forward,” he adds.

“By investing now and building mental health into all COVID-19 response and recovery plans, we can build back better,”

Nakku says that all persons should be in position to access mental health services at all facility levels, government should invest in mental health and support research.

Nyende says that there should be a community focused mental health treatment and awareness programmes established that links closely with functional recovery through work and family networks.

Monsignor David Cappo the Chief Executive Officer of You Belong;  a community based mental rehabilitation organisation, says that government should start training and deploying mental health workers in all health centres across the country.

He also says that they should teach about mental health in schools.

“If we can teach about sexuality, why not mental health?” he says.

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