State of Mental health in Uganda Samuel Maling Mbarara University of Science and Technology [email protected].

State of Mental health in Uganda

Samuel MalingMbarara University of Science and Technology

[email protected]

About Uganda

Total Population (2014 Census)

34,856,813

Population aged < 15 years

50%

Population aged <18 67%Population > 60 years 4%

History of mental health services in Uganda

1920’s: Rudimentary services by confinement (Prison Asylums).

1935: Patients were transferred from Hoima to Mulago in Kampala

1954: Butabika Hospital was built, expanded in 1962

In 1970: OPD (ward 16) was started at Mulago Hospital

1964: Mental treatment act (1964).

1970’s: Mental health units in large Regional Referral Hospitals (OPD & in-

patient services offered)

!960: Butabika School of Psychiatric Nursing established

1979 PCO school was opened by Prof. Bbosa

Infrastructure improvementMental wards in Regional Hospital: Before Now

History and milestones of mental health development1996 Initiation of Mental Health Reforms to decentralize services

1999 Minimum health package included mental health as a component

2000 Development of draft Mental Health Policy

2001 Health Sector Strategic Plan I , mental health targets included.

2002 Review of staffing norms and inclusion of mental health nurses at health centre level.

2007 2005 Health Sector Strategic Plan target achieved: 100% Regional Hospitals with active Mental Health Units

2007 Drafting committee for new mental health policy establishedand process commenced

2010 Drafting committee for new mental health legislation established and Process commenced to review 1964 Mental Health Act

Mental Health Financing

Inequity within a limited resource setting

Health expenditure towards mental health

Mental health expenditure towards mental hospital

Human resources for mental Health

Mental Health workers in UgandaCadre Number

Psychiatrists 40 (About 75% in Kampala)

Psychiatric Clinical Officers (PCOs) About 200

Psychiatric Nurses About 1000

Clinical Psychologists 20

Occupational therapists 100

Psychiatric social workers ?

Regional Referral Hospitals in Uganda

Human resources for mental health in Uganda (Per 100,000 population)

21/04/23C. Abbo PhD Public Defense Seminar at KI 12

Provision of Mental Health Services

in Uganda. .

Health centre II

Health Centre III

Health Centre IV/Hospital

Regional referral Hospitals

National referral Hospitals

Barriers to uptake of formal mental health services

Barriers to development of formal mental health services

Hoúse holds/ Villages

Formal SectorInformal Sector

Traditional healers& Faith healers

Barriers to integration/ collaboration

Mental disorders seen by traditional healers in Uganda

Major depressive disorder 21 (5.4)

Mood disorder due to general 33 (8.5)

Dysthymia 3(0.7)

Suicidal 15 (3.9)

Anxiety disorders 22 (5.7)

Mixed anxiety depression 14 (3.6)

Mania 41(10.6)

Schizophrenia 28 (7.2)

Psychotic depression 46 (12.4)

Schizophreniform disorder 10 (2.6)

Abbo et al, 2009

Uganda is a traumatized Nation

Political transition in Uganda

1966 Crises

Coup

1971

Overthrow1986

Overthrow1979

Coup1985

LRA

NRA

ADF

FOBA

UNLA

HSM

UFM

Rebel Movements in (U)

Cattle Rustlers

PTSD in Uganda• Ovuga et al, 2008 (study of child soldiers): PTSD

55.9%, depression 88.2%• Nina W., et al, 2015 (study on former child soldiers)

PTSD at 32%• Buunaaim& Alexis Dun Bo-ib , 2014 (patients

attending orthopedic clinic): PTSD 17.8%• Musisi 2004: Mass trauma and mental health in

Africa• Musisi et al, 2008: Northern Uganda has one of the

highest rates of PTSD in the world: 54%

A collaborative effort in providing mental health services to refugee camps in Southwestern

Uganda

Collaborators: from 2005

Patients seen in refuge camps outreach(12 months/2011)

Refugee Camp Number %

Nakivale 323 37.2

Oruchinga 387 44.5

Rubondo 159 18.3

Total 869 100.0

Mental disorders seen in refugee camps in SW Uganda (2011)

Mental Disorder Number %

Depression 291 33.5

Anxiety 7 .8

PTSD 83 9.6

Bipolar Disorder 22 2.5

Schizophrenia 15 1.7

Psycotic diorder 15 1.7

Epilepsy 434 49.9

Mental retardation 2 .2

Total 869 100.0

Depression in Uganda

Prevalence of depression• Orley and Wing, 1979: Prevalence of

psychiatric disorders 25.3%• Kasoro et al, 2002, prevalence of depression

in one rural district in Uganda: 30.7%• Ovuga et al, 2005: Prevalence of depression in

two villages in Uganda at 17.4%• Bolton et al, 2004: Depression prevalence f

21%• Nakimuli-Mpungu et al, 2011: Depression

among HIV positives in a community 46.4%

Mental Illness in HIV

Psychiatric disorders in patients attending HIV Clinic at Mulago

Psychiatric Disorder No(%)

Adjustment disorder 1 (2.2)

Dysthymia 4 (8.7)

Major depression 25 (54.3)

Bipolar disorder 8 (17.4)

Panic 15 (32.6)

Agoraphobia 11 (23.9)

Social phobia 5 (10.9)

OCD 2 (4.3)

PTSD 9 (19.6)

Alcohol misuse 2 (4.3)

Non-affective psychosis 8 (17.4)

No diagnosis 8 (17.4)

Mental Health in Children

• Kinyanda et al, 2013: Point prevalence of depressive disorder syndromes (DDS) in children of 8.6%

• Kiiza Ruth (MMED Dissertation, 2004): Psychiatric disorders common in children admitted to general wards

• Kinyanda: Ongoing study: Mental health among HIV infected Children and Adolescents in KAmpala, Uganda (CHAKA)

Some studies in CAMH

• Abbo et al 2013: Prevalence, comorbidity and predictors of anxiety disorders in children and adolescents in rural north-eastern Uganda

• Okello et al 2014: The Association between Attachment and Mental Health Symptoms among School-Going Adolescents in NorthernUganda: The Moderating Role of War-Related Trauma

• Harms et al 2010: The orphaning experience: descriptions from Ugandan youth who have lost parents to HIV/AIDS

• Nalugya et al 2014:Depression in secondary school children in central Uganda

Mental health in the elderly in Uganda

Mental health in the elderly in Uganda

• Nakasujja et al (2007): 48% of elderly in general wards had diagnosable mental problems, Depression 18%, Dementia 8.3%

• Birungi & Nakasujja, 2015: Prevalence of depression doubles in HIV positive elderly.