Mental illness is common around Kagando and, as in many other countries, seems to have increased over recent years.
This is a poor area and many families face financial pressure, aggravated by economic problems since the pandemic. There is also the constant threat of unrest from over the border in Congo and several recent attacks. Alcohol is cheap and readily available, and drugs are becoming more of a problem.
In the past, there has been a poor understanding of mental illness in the community. Families caring for relatives with severe mental illnesses like psychosis or schizophrenia face very difficult challenges in rural Uganda. Traditional ways of dealing with this include locking the person in a hut, applying ankle manacles to prevent them running away, or wrist restraints to stop them harming themselves or other people. If the family cannot cope then these unfortunate patients often end up living on the streets in bigger towns, begging for scraps and with very little care.
Anxiety is common, as is self harm, usually by poisoning with weedkiller or rat poison. Domestic abuse occurs here, as everywhere else, and is still considered in some way acceptable to many people.
The mental health team is headed by Clinical Officers based in OPD who have had extra training as well as a lot of experience. Severely ill patients are admitted and assessed by the medical team for urgent treatment then care is taken over by the psychiatric team. Most of their work is in the community, with weekly outreach clinics in the villages and health centres to review patients and provide medication.
One important role of the team is raising awareness and educating families and community leaders. Mental illness can be very frightening to live with but, with effective drugs and regular support, most of these patients are able to remain in their homes. There is also a role in challenging the acceptance of domestic violence as well as counselling and a listening ear for those with anxiety.
In Uganda Epilepsy is a treated under the same umbrella as a psychiatric illness so the Mental Health team manage adults and children with epilepsy too. Again, medication can often enable fits to be controlled so children can attend school and adults are able to participate in normal life.
Significant funding for many of these services including the dedicated clinical psychiatric officer have been provided by a charity called Jamie’s fund, to the tune of about 26 million UGX a year (£5,000) , but unfortunately this has recently been withdrawn so the Mental health Service is now in urgent need of more financial support.
A young woman with post-natal psychosis who has been restrained by her family for her own safety
