Mental health activists have called on the government to consider community-based health care interventions as opposed to putting every mental health patient on drug therapy.
With the burden of mental disorders continuing to grow, Mental Health Uganda (MHU) a non government organisation for people with and survivors of mental health says the government needs to consider a streamlined community-based services programme for persons with psychosocial disabilities.
The executive director of MHU, Derrick Mbuga Kizza, says drugs and injections are not the only therapy for mental health treatment and management. According to Mbuga, while the new Mental Health Act 2014 pushes for community mental health care, it doesn’t provide a clear framework on how it will be realized.
“The law is putting a lot of emphasis on treatment which is wrong. I have seen persons with mental disabilities who run to the hospital thinking it is a safe haven and it becomes hell or get more agitated after drugs,” Mbuga said.
“I am not saying that people should get off the drugs but to disabilities like depression, drug abuse and alcohol that are not severe and need community intervention, we should not be quick to put people on drugs.”
He added that prevention in mental health using community interventions will go a long way in trying to fix the huge sums of money allocated to purchase psychiatric drugs that are often expensive. Mbuga made the remarks at the closure of a national conference on mental health held at Imperial Royale last week under the theme: “Prevention in Mental Health: A call for community-based services”.
In December 2018, President Museveni signed into law the Mental Health Bill, 2014, thus repealing the Mental Treatment Act of 1964. Mental disorders come with different presentations in form of depression, bipolar affective disorder, schizophrenia, dementia and intellectual disabilities, among others.
According to the World Health Organisation (WHO), depression is the commonest mental disorder and one of the main causes of disability worldwide. Globally, an estimated 300 million people mainly women, are affected by depression. Mbuga said MHU was part of the NGOs consulted by parliament during the drafting of the bill but the output shows otherwise.
“We explained community mental health care to MPs but the challenge is that whatever you sell to parliament, there’s no guarantee that it will be implemented. You have an MP who tells you that as long as you have provided drugs, you have fixed mental health. Then, you have a lot of time to sensitise such a person.”
Speaking to The Observer on Monday, the chairperson of parliament's Health Committee, Dr Michael Iga Bukenya, confirmed meeting MHU officials but slammed their argument.
“Those are activists looking for money from donors to survive. So, they don’t know that we can’t write everything in a law? I think their concerns are out of ignorance and don’t know how laws operate,” Bukenya, also Bukuya County MP said.
He added: “Do they want a law to look like a textbook of over 1,000 pages? Those are activists and I have no more comment on that. I am not the one who made the law but the ministry of Health. You should talk to the ministry of Health and they tell you how they are going to implement the law.”
Yesterday, the in charge of the mental health section at the Health ministry, Dr Hafsa Lukwata, agreed with Mbuga that the Act lacks details on community-based health care for mental disorders.
“It’s true this aspect is not well contextualized in the law but this is a concept that is not popular here. We want to borrow some concepts from developed countries that are implementing it,” Dr Lukwata said.
“We are working with NGOs that are trying to do something but putting it down in the law is another thing. That one will not happen very easily.”
She explained that at the time of drafting the bill, much priority was given to hospitals and drugs in a bid to improve access to specialised care for persons with mental illnesses.
Unfortunately, now that a law has been enacted, she said the ministry will see how to link people and health facilities with communities before and after treatment.
“We are going to sit down and review what is happening elsewhere so that we can write something and pilot it in our communities. It’s not only Uganda in learning mode but the entire region yet no success has been made,” she said.
In the meantime, the ministry will also soon write regulations to guide who whoever wants to provide community health care to persons with mental disorders.