1. State of Mental health in Uganda
Samuel Maling
Mbarara University of Science and Technology

2. About Uganda Total Population (2014 Census) 34,856,813
Population aged < 15 years
50%
Population aged <18
67%
Population > 60 years 4%

3. 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

4. Infrastructure improvement
Mental wards in Regional Hospital: Before
Now

5. History and milestones of mental health development
1996
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
Drafting committee for new mental health policy established
and process commenced
2010
Drafting committee for new mental health legislation established and Process commenced to review Mental Health Act

6. Mental Health Financing

7. Inequity within a limited resource setting
Mental health expenditure towards mental hospital
Health expenditure towards mental health

8. Human resources for mental Health

9. Mental Health workers in Uganda

10. Regional Referral Hospitals in Uganda

11. Human resources for mental health in Uganda (Per 100,000 population)
The distribution of human resources between the urban and rural areas was disproportionate. The
density of psychiatrists in or around the largest city was 11 times greater than the density of
psychiatrists in the entire country. The density of nurses was 13.4 times greater in the largest city
than the entire country.

12. Provision of Mental Health Services in Uganda
Informal Sector
Formal Sector . .
Hoúse holds/ Villages
Barriers to uptake of formal mental health services
Health centre II
Health Centre III
Health Centre IV/Hospital
Traditional healers
& Faith healers
Barriers to development of formal mental health services
Regional referral Hospitals
Barriers to integration/ collaboration
National referral Hospitals
C. Abbo PhD Public Defense Seminar at KI
23/04/2017

13. 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

14. Uganda is a traumatized Nation

15. Political transition in Uganda
Mutesa II
Obote I
Idi Amin
Obote II
Tito Okello
Museveni
1966 Crises
Overthrow
1979
Coup
1985
Overthrow
1986
Coup
1971

16. NRA LRA Rebel Movements in (U) UPA Cattle Rustlers HSM FOBA UFM ADF
UNRF II
UNRF I
HSM
UPA
NRA
FOBA
UFM
ADF
UNLA

17. 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%

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

19. Collaborators: from 2005 GTZ
Mental Health services in the refugee Camps
Mbarara University/Hospital
Red cross
GTZ
UNHCR

20. 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

21. Mental disorders seen in refugee camps in SW Uganda (2011)
Number %
Depression
291
33.5
Anxiety 7 .8
PTSD 83
9.6
Bipolar Disorder 22
2.5
Schizophrenia 15
1.7
Psycotic diorder
Epilepsy
434
49.9
Mental retardation 2 .2
Total
869
100.0

22. Depression in Uganda

23. 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%

24. Mental Illness in HIV

25. Psychiatric disorders in patients attending HIV Clinic at Mulago
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
Non-affective psychosis
No diagnosis

26. Mental Health in Children

27. 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)

28. 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

29. Mental health in the elderly in Uganda

30. 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.