By Francis Lubega
Mental health is a crucial aspect of overall health, and it affects millions of people worldwide, including those in Uganda.
Recovery from mental health is a journey filled with challenges and setbacks. However, with the proper support and care, individuals can overcome their struggles and regain their mental well-being. The story of Justin Ambayo Guma is a testament to this. Mr. Ambayo,72, is a family man with a wife and four children: four boys and three girls. They live in Kabale, in Entebbe. He is unemployed even as he continues with his mental health recovery.
Ambayo’s adult life began when he joined the Air Force at 19 during President Idi Amin Dada’s regime. He underwent training in Russia and returned to Uganda hoping for a better life. “I thought that getting a chance to enroll in the Air Force Army at 19 would make my future bright,” he says.
However, things took a turn for the worse after the regime change. He lost his job in 1999 and struggled with stress and depression, which eventually led him to become an alcoholic and violent towards his family.
“Very many colleagues of mine ran out of the country seeking refuge in Sudan, currently South Sudan, where most of them died. It was such a terrible experience for us who were serving the government by then because of the way we were thrown out during the change of government,” he says.
Supportive Environment
Despite his struggles, Ambayo never gave up hope. With his family’s support, he enrolled in a secondary school and worked as a laboratory attendant. He even found work as a radio operator in a refugee camp in western Uganda, but his drinking problem persisted. His family intervened in 2019 and took him to Care First Recovery Homes, a rehabilitation center, where he was treated for three months. The family paid two million Ugandan shillings monthly for his therapy and medication to regain his mental health. Today, he lives a happy and fulfilling life with his wife and seven children.
Ambayo says that by having a supportive environment, good feeding, and caring people around him, he has managed to maintain his mental health and well-being after recovery. “The recovery journey starts with the individual accepting that he is sick and needs help. Medication and therapy can only work if the victim accepts that they are sick and need help.”
Journey to recovery
Kyalimpa Amos, 39, from Kabarole District, Western Uganda, too, has faced his fair share of mental health challenges. He currently lives in Kisaasi, Kampala, in a rental with his wife and two children: a boy and a girl.
Kyalimpa’s life deteriorated after losing a job due to the COVID-19 pandemic in 2020. He was working in a boutique by then. To cope with stress, Kyalimpa turned to alcohol and drugs like marijuana and khat (Mairungi in the local dialect). He became an addict and violent, forcing his wife to run with the kids back to the parents’ home for some time.
“All I cared about was how to get some marijuana and alcohol for the day, and that required me like at least three thousand shillings a day. Whenever I tried and didn’t get that money, I would go along the road begging from people that I would see in the range of my age, lying to them that I had been working on a construction site and I was not paid for the day, so I am so hungry, and I need something to eat. I never cared about family anymore.”
Kyalimpa’s journey to recovery began when his brother, who had been working abroad for a while, intervened and took him to a rehabilitation center. Due to his worse condition, doctors advised a full year of treatment, during which Amos says therapy played a crucial role in his healing process.
“The therapist told me that I was the only person that would get myself out of trouble by first taking it at heart and believing by having the desire to heal and that I would be a responsible person again once all was done,” he shares.
After completing his treatment in 2022, Kyalimpa returned home and moved to Kampala with his family. “After rehabilitation, I knew that the only thing that would make me not relapse was to be responsible towards my family and ambitious.” He now works as a porter and has since found solace in his faith. He regularly attends church and maintains his mental well-being by associating with sober people and eating well, he says.
His story serves as a testament to the importance of seeking help and support in overcoming mental health challenges and the power of therapy and faith in facilitating recovery.
Rehabilitation centers
One of the rehabilitation centers helping people recover from mental health is the Care First Recovery Homes. Dr. Paul Onwe Esheya, the founder and chief executive officer, says the center has 21 in-patients, while a minimum of 20 outpatients are served daily.
The leading causes of mental illness, according to Dr. Esheya, are stress, joblessness, alcoholism, and substance abuse. He explained that everyone has a percentage of insanity, with an average person having around 5%. However, once this percentage rises even slightly, the difference becomes noticeable to those around them.
Dr. Esheya and his team of psychiatrists, psychologists, and addiction specialists offer a holistic package to patients. The treatment process begins with detoxification and continues with psychotherapy, helping patients develop life skills such as knitting, making soap, and other activities. Additionally, the facility assists in spiritual awakening, acknowledging the importance of addressing the whole person for full recovery.
Despite the progress made, significant challenges remain. “Many patients resist accepting that they are sick; some even sue in court. Furthermore, guardians who cannot afford the treatment costs of 2 million Ugandan shillings per month pose another obstacle to providing necessary care,” he complains.
Dr. Esheya says the government has contributed to the fight against mental illness by giving licenses to private rehabilitation centers, providing a call center for mental health issues, and funding the public health sector to deal with mental health. However, the call centers have not been successful in remote parts of the country due to poor telephone connectivity.
Butabika National Referral Hospital, located in Uganda, is one of the leading mental health facilities in the country. Initially designed with 550 beds, the hospital has since expanded to accommodate 650 beds due to increased government funding. However, the number of patients surpasses the available bed capacity, with approximately 1100 to 1200 patients currently admitted.
In an interview, Dr. Juliet Nakku, the executive director of Butabika Hospital, explained that various factors contribute to the prevalence of mental illness, including genetic issues, alcohol and drug abuse, cancer, epilepsy, and psychological trauma. Additionally, malnutrition plays a significant role in exacerbating mental health issues. The youth population is disproportionately affected by mental health problems, with exposure to substances like drugs being a major contributing factor, she noted, adding: “There has been a significant increase in the number of mental health patients since the COVID-19 pandemic, with the hospital reaching a peak of 1000 patients.”
A recent study conducted by the Ministry of Health in collaboration with Makerere University School of Public Health found alarming rates of mental health issues in various regions of Uganda. Specifically, 30% of individuals interviewed had diagnosable anxiety, 18% suffered from depression, and 30% of young children aged 11-17 exhibited emotional problems that negatively impacted their academic performance.
Mental health Call centers
The government has taken several initiatives to address the growing mental health crisis. First, mental health care has been integrated into the Ministry of Health’s policy framework, recognizing its importance in public health care. Additionally, it has established 13 regional referral hospitals to improve access to mental services across the country and trained in-service workers under the World Health Organization’s program, aiming to enhance the capacity of mental health professionals.
The mental health call center has also been widely acclaimed for its effectiveness in supporting those in need. The call center serves as a lifeline for individuals experiencing mental health issues, offering them access to professional help and resources 24 hours a day. This service is particularly crucial in Uganda, where there is a shortage of mental health professionals and limited access to mental health facilities, especially in rural areas. The call center helps bridge this gap by connecting individuals with trained counselors who can provide immediate support and guidance. The system has an interactive voice response (IVR), live calls, and voicemails. Users interact with automated IVR 24 hours nonstop daily. It contains mental health information in English and Luganda audio format. Callers get Navigation instructions and choose from a menu of topics in a self-service manner by pressing the corresponding keys on their phones. For example, to select the language, it prompts the caller: “Thank you for calling Butabika Hospital. Please choose your preferred language. For English, press 1, Bw’oba oyagala kuwuliriza mu Luganda, yoga 2”.
From the IVR, callers can choose to speak directly with an agent, for example, to seek more clarification on information in the IVR or ask for information that the IVR does not cover. If it is during office hours, the system connects the caller to the agent. The staff does not sit in a physical call center; they are accessible via dedicated mobile phones.
All their phones are dialed concurrently, and whoever picks first responds to the caller. Outside working hours, the system instructs the callers to leave a voice mail, and the call agents return the calls the next day. This is only possible from a softphone on a computer within the hospital since the caller’s number is hidden on the agent’s mobile phones for privacy reasons.
From August to December 2022, 456 calls from 236 unique numbers (an average of four calls per day) were made to the system, reaching at least the IVR (automated) component. Of these, 99(21.7%) calls were made during out-of-office hours for the call agents, so they went to voice mail and were called back within the following days.
Of the remaining 357 calls made during office hours, 80(22.4%) calls stopped at the IVR, while 231(64.7%) spoke to a live agent. Furthermore, the call agents never answered the 22(6.2%) calls. On average, live calls were responded to within 11(SD 7) seconds, and their average length was 3.5(SD 2.8) minutes. Callers came from different parts of the country, but most were from the central region. They included caregivers seeking advice about relatives who were showing symptoms of mental illness or those who were already undergoing care.
Mental health patients who were relatively stable were seeking advice about medication or return dates, and others, such as clinicians from other health facilities, journalists, and government officials, wanted more information about the call center system or the mental health care services offered at Butabika Hospital.
One of the call center’s key strengths is its ability to reach a broad audience by providing a toll-free helpline—0800211306—Dr. Nakku says the call center has made it accessible to people from all walks of life, regardless of geographical location or socioeconomic status. This has been particularly beneficial for individuals living in remote areas, who may otherwise have limited access to mental health services.
Another vital aspect of the call center is its focus on promoting mental health awareness and addressing associated stigma. Through its educational campaigns and outreach programs, the call center has raised awareness of mental health issues and encouraged individuals to seek help without fear of judgment or discrimination.
Limitations
One of the primary limitations of mental health call centers is their coverage. While these centers are available throughout, they may not reach everyone, especially in areas with poor telephone and internet connectivity.
Another limitation of the mental health call center initiative is a shortage of qualified mental health professionals to meet the demand for mental health services. This is exacerbated by low public funding for mental health support and treatment. There are also systemic issues contributing to mental health problems in Uganda, which remain unaddressed. For example, poverty can lead to chronic stress, which can have a significant impact on mental health. Additionally, access to adequate healthcare services is hindered by poverty.
Another systemic issue contributing to mental health problems in Uganda is gender inequality. Gender-based violence and discrimination can have a profound impact on mental health, particularly for women and girls. Limited access to education and economic opportunities can also contribute to feelings of hopelessness and despair.
Thus, without addressing the social and economic determinants of mental health health problems in Uganda, the responses discussed above remain limited. Therefore, inadequate state support can exacerbate the effects of systemic issues on mental health.
