The availability and quality of mental health care varies from one district to another in Uganda.

Not much money has been invested in fully functioning mental health units in district hospitals. Whilst there is newly constructed mental health infrastructure in Hoima district, there is no infrastructure for mental health at all in Masindi and Sembabule districts and only a very small unit in Masaka district.

In Masindi the psychiatric nurse works from home and sometimes from the Uganda Society for Disabled Children’s office veranda or a tree shed within the organisation’s compound. She says, “It’s a tough working environment. There is no place to which you can direct patients to find you.”

Mental health services in Uganda were decentralized in the 1960s, and prison-like mental health units were built at regional referral hospitals.

In 1996, the Ministry of Health began to strengthen mental health and integrate it with primary health care. Standards and guidelines were developed for care. Health workers were trained to recognise and manage or refer common mental and neurological disorders. The Mental Health Act was revised, and efforts made to raise the awareness of mental health in the general population. Psychotic and neurological drugs are now in the essential drugs list. Mental health was also made a part of the Health Ministry’s budget.

To date, there are mental health units in the ten regional referral hospitals in the country and the capacity of the 900-bed national psychiatric hospital is to be reduced by half to reflect the decentralised mental health services and encourage mental health care in the community.

Despite all these positive steps such as the decentralized mental health service delivery, the reality of mental health care on the ground is still undermined by weaknesses in the system, competing priorities (especially malaria, HIV/AIDS and tuberculosis), stigma by planners and decision makers, and meagre budget allocations.

For example, there are only thirteen practicing psychiatrists in the country. Twelve of them are practicing in Butabika hospital in the capital, Kampala. This means that it is virtually impossible for people living in rural areas to easily access a psychiatrist and get the help they need unless they travel long distances, which can be very expensive.

There is also a need for a regular supply of psychiatric drugs. Even though districts are allowed to purchase drugs as per their needs, some still feel that the drugs for mental illnesses are expensive and that those who need them are few. BasicNeeds and partners are now lobbying and providing field evidence to demonstrate the need for these drugs.

As well as this, some of the drugs that are available are not easily accessible. Some drugs are only allowed to be dispensed at major Health Centres. If there is demand for such drugs at lower levels, these patients should be referred to bigger hospitals for better management. However, the distances and access to these major hospitals coupled with the poverty that mentally ill people face makes referral difficult. BasicNeeds is therefore lobbying for the provision of drugs by government health workers at the lowest level health centres.

BasicNeeds works in four rural communities and an urban slum called Kamwokya in the capital, Kampala.

As well as facilitating mental health camps and consultation meetings, BasicNeeds has established five user groups. These groups help mentally ill people and their carers cope with their illnesses. They receive training in illnesses, treatment and side effects. As a result, far fewer relapses have been reported.

The volunteer-led village health teams are an important feature of care. The volunteers are responsible for checking on the mentally ill people and making sure that treatment and care is followed up in their homes. They are also responsible for identifying mentally ill people in the community and helping to educate the community about mental health.

Psychiatric drugs are important in treatment, but without close follow-up and monitoring, they can frequently be ineffective. Village Health Teams help us ensure that mentally ill people get the best treatment possible.

So far we have helped 1167 mentally ill people achieve their basic needs and secured their basic rights.

We work closely with partner organisations, who help us reach out to help mentally ill people far beyond the limits of our organisation. Our partner organisations in Uganda are:

• Kamwokya Christian Caring community
• Mental Health Uganda
• Development Research and Training
• Traditional and Modern Practitioners together against HIVAIDS
  and other Diseases
• Ministry of Health

Uganda
Tina Ntulo, Africa Director
Rohi Courts, Plot 1744, Kisugu Gabba Road, Kansanga Trading Centre,
P.O Box 29582 Kampala, Uganda
Tel: +256 41 269558