On October 10, Uganda joined the rest of the world in commemorating World Mental Health day whose theme was ‘Depression: A Global Crisis.’
According to international surveys conducted by the World Health Organization, between 30-40% of the global population experiences a diagnosable mental disorder in their lifetime.
Experts believe that the prevalence of mental illness will increase worldwide in the next two decades, with clinical depression topping the list of most common disorders.
While recognizing the interaction of individual genetics and psychological influences, experts believe that factors such as economic hardships, political and social violence and cultural disruption are the cause of this rise in prevalence of mental illness.
In Uganda, the experience of People With and Survivors of Mental Illness (PWSMIs) has been one of inadequate mental health care as well as social stigma and exclusion.
A lack of a community- based treatment plan in our mental health care has created a revolving door phenomenon at our mental health facilities in which individuals with severe illness are discharged on getting better, but (for lack of follow-up etc) fail to reintegrate back into family, work/school and community life, experience relapse and become homeless on our streets where authorities apprehend them and involuntarily commit them to the mental health facility only for the cycle to start all over again.
Alarmist news reports continue to perpetuate the stereotype of a criminally violent lunatic, but in fact, from experiencing beatings to workplace discrimination, PWSMIs are more likely to be victims rather than perpetrators of both physical and structural violence.
Both public service and private sector employment forms still require applicants to indicate if they have ever experienced mental illness, and in practice, those that do are never employed, and this amounts to discrimination.
Medical insurance schemes in Uganda deliberately don’t offer cover for mental disorders so that those who seek treatment in private settings have to contend with high costs of treatment and medication given the chronic nature of mental illness.
The Mental Treatment Act of 1964 is now obsolete and its offensive language reflects the prejudices and scant understanding of mental health prevalent at the time it was written. The custodial care practices it provides for have been discarded in Uganda and the world over because they don’t meet minimum human rights standards in health care and more so they are at variance with guarantees of fundamental rights and freedoms for all persons.
Yet the Act maintains a place in our law books as a telling symbol of institutionalized social stigma and exclusion. Yet not all is gloom and doom. There have been commendable efforts by the government at deinstitutionalizing mental health care and integrating it into primary health care. A small but growing Mental Health User Support Groups (MHUSG) movement is taking root in Uganda.
MHUSGs provide platforms for safe self-disclosures, information sharing, building social support, advocacy on rights and freedoms of PWSMIs and economic empowerment. The latter is of especial importance because not only does it enable PWSMIs meet their basic needs but through it they can (re) gain a valued place in their family and community as well.
Globally, individuals such as Nobel for Economics Laureate Professor John Nash, award-winning actress Catherine Zeta-Jones and English soccer star David Beckham have spoken publicly about their experience with mental illness. Their frank disclosures coupled with their accomplishments in academia, film and sport have helped people across the globe rethink their attitudes towards PWSMIs and mental health in general.
As with other life’s adversities, experience with mental illness can be educative and a source of personal growth and can uniquely equip individuals with skills and knowledge to help others. In a sense this reflects the resilience of the human spirit - the ability to “bounce back” from an otherwise debilitating experience such as mental illness.
Dramatic improvements in both medical and psychotherapeutic interventions for mental illness in the last thirty years have now made it possible for PWSMIs to be cured or improve so much that they can enjoy normal life.
Even then, there is still need for government to increase funding for the mental health sector to develop community based treatment approaches, make new legislation and policies on mental health that are in conformity with modern practices in mental health care as well as partnering with civil society in education and awareness campaigns that disseminate accurate information, while countering misconceptions on mental health issues.
The writer is a psychologist and advocate for Mental Health.