Although we tend to view mental health as mental disorder, there is another perspective that the World Health Organization (WHO) defines nicely: Mental health is: “A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. Well-being!  As we move away from survival (covering basic needs such as security and shelter), greater emphasis is put on thriving.  Research seems to support the contention that well-being has a positive effect on happiness, resilience, achievement, performance, financial success, immunity and even life span.

The positive dimension of mental health is stressed in WHO’s definition of health as contained in its constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

However, many of us – the statistics indicate anything between 20% to 50% – will struggle with mental illness at least once in our lives. This is greater than the figures for cancer or HIV! WHO more conservatively attributes 14% of the global burden of disease to mental, neurological and substance use disorders.  In low income countries, most sufferers have no access to treatment. Yet, there are treatments available and preventive ways of managing stressors that all of us will deal with at one point of our lives if we all skill-up rather than hide, deny or minimize.

Stress is a part of our lives and we all handle it in different ways.  Some of us are resilient and manage by pulling up our sleeves and getting on with it, while others will break down and lose all sense of control. The majority of us will stand somewhere in between these two extremes – often using most of our energy in impression management than in looking for viable solutions.  Illness of the mind is similar to illness of the body: it needs to be taken seriously at individual and national policy-making levels.

In its aim to reach its Comprehensive mental health action plan, 2013-2020, WHO Mental Health Gap Action Program stresses four main goals:

1. Strengthen effective leadership and governance for mental health.
2. Provide comprehensive, integrated and responsive mental health and social care services in community-based settings.
3. Implement strategies for promotion and prevention in mental health.
4. Strengthen information systems, evidence and research for mental health.

On the Global calendar of health promotion days, October 10 is World Mental Health Day and October 1 – 7 is Mental Awareness week.  Uganda dedicated the entire month to mental health. There were sporadic activities in different arenas, from different perspectives, and at different levels of involvement in support of mental health and mental health awareness.  It is difficult to estimate the effect or reach of any of these inputs.  In this The Medical Concierge Group Ltd in conjunction with a psychiatrist and two psychologists carried out a small survey between 19th September and 24th October 2018 to understand mental illness in Uganda. This was done in an effort to find out how to contribute to some of the WHO mhGAP objectives, mainly the last three and these will inform their effort for the coming year.

Among 158 survey respondents, we found, inter alia, the following:

• The majority of respondents (83%) were from Kampala and Wakiso areas. One reason for this may be that mental health awareness is lower in small towns and rural areas.  A further survey could perhaps focus on communities outside urban areas.
• 94% were between 19-39 years. This comprises the largest section of the population of Uganda, but the survey was conducted in a technically sophisticated way and may have been biased in its reach.
• 70% of respondents think of mental illness as depression, anxiety and stress, while 26% think of it and mania and psychosis.

• 84% responded that they, or someone they know, have what they believe was or is mental illness.
• 30% said it was anxiety or stress, 14% bipolar disorder and 12% substance abuse. This confirms the WHO finding that mental and substance abuse are among the most prevalent disorders.
• 60% sought medical treatment, while 32% did not.
• Of those who did not get treatment, stigma, unavailability and lack of information were the main deterrents.
• 96% would see a psychiatrist, psychologist or counsellor if the service was available and affordable or free of charge.

These statistics confirm the need for a comprehensive, systematic, easily available and affordable approach to treatment and mental services.

How does this inform our objectives for the coming year October 2018- October 2019?

1. We need to find out about mental health awareness and disorders among older people and children; more information is required about the mental health care needs in rural areas.
2. A directory of mental health practitioners should be developed for accessibility
3. Development of an outreach team and platform to people with mental health issues who are unable to visit a mental health practitioner or institution
4. Data collection and research in order to improve our understanding of the problem and offer appropriate services efficiently and cheaply.
5. Continued work with destimatization and mental health awareness.

Other findings from the survey:

• More than half of the respondents had signs of depression two weeks prior to taking the survey.
• More than half of the respondents hadn’t suffered from sleeplessness two weeks prior to taking the survey.
• More than half of the respondents hadn’t experienced signs of sleep disorder two weeks prior to taking the survey.
• 65% of the respondents have taken a drink containing alcohol.
• 41% of those that take alcohol have more than two drinks on a typical day.

The participants of this survey were mostly young, tech savvy urbanites. This may have stacked the deck in a particular direction.  This group is likely to use the internet to inform itself on mental illness and may hence not represent the rest of the population.

However, it is important to note that the youth make up about 75% of the Uganda population. From the survey, respondents admitted to having had symptoms of depression two weeks prior to taking the survey and 96% would entertain mental health treatment from a psychiatrist, psychologist or counsellor, if made accessible, free or affordable. This is a clear indication of what we need to do to combat mental illness.

Although stigma remains a deterrent, mental illness is no longer regarded as just psychosis or schizophrenia.  The respondents appear to view mental health as much larger than these disorders.  This points to the need of better primary and secondary interventions, so as not to swamp the tertiary level of treatment.

Data collection is paramount to establish a data base of the numbers of sufferers, psychosocial interventions in place and the effects of these. There is a need to put systems in place that can inform on the performance of current interventions.  Some of these concerns will be our focus for the coming year.

Survey Credit :  Lead author- Elizabeth Kibuka Musoke (Senior Clinical Psychologist)