Mental Health Policy Overview in Uganda

Uganda has a draft mental health policy and an out-dated mental health law, but no separate Mental Health Strategic Plan. The small proportion of health financing which goes directly towards mental health is oriented towards the National Mental Hospital and Regional Referral Hospitals with mental health units; while mental health also benefits indirectly from the general PHC funding to a limited extent.

There is no mental health social insurance scheme although the majority of the population has free access to psychotropic medication. No human rights review body exists to review human rights issues in the mental health facilities and mental health workers have not received specific training in this area.

Approximately 1.13 human resources work in mental health per 100,000 population. Rates are particularly low for clinical psychologists, social workers and occupational therapists, according to results from an assessment using the world health organization’s assessment instrument for mental health systems (WHO-AIMS) conducted in Uganda in  2006.

The assessment report adds that user associations exist in Uganda but do not receive financial support from Government. Some of these associations have been involved in developing and implementing policies.

In terms of the network of mental health facilities, there is one National Mental Hospital (with 1.83 beds per 100,000 population), 27 community based psychiatric inpatient units (with 1.4 beds per 100,000 population), 1 day treatment facility (with 0.64 user per 100,000 population), and no community residential facilities.

Public education and awareness campaigns are overseen by the mental health division. There are links with other relevant sectors, but no legislative or financial support for people with mental disorders. Finally, primary health care staff receive minimal training in mental health.

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It is clear that there is a need to finalize the mental health policy, develop a strategic plan for mental health and to direct more efforts towards strengthening the integration of mental health into Primary Health Care.

Number of human resources in mental health care

The total number of human resources working in mental health facilities or private practice per 100,000 population was 1.13. The breakdown according to profession was as follows: 0.08 psychiatrists; 0.04 other medical doctors; 0.78 nurses; 0.01 psychologists; 0.01 social workers; 0.01 occupational therapists; and 0.2 psychiatric clinical officers; other health care workers (auxiliary staff, non-doctor PHC workers, health assistants etc) exclusive.

Five Percent (5%) of the psychiatrists worked for only government administered facilities, 5% for only NGOs/for profit mental health facilities/private practice; while 90% worked for both sectors. Accurate data on distribution of the other professionals was unavailable.

All the professionals worked for both in and outpatient facilities. Fourteen (14) psychiatrists worked in community based psychiatric inpatient units and 8 in the mental hospital. Eight (8) other medical doctors, who are not specialized in psychiatry, worked in the mental hospital.

As for the nurses, 62 worked in community based psychiatric inpatient units, while 153 worked in the mental hospital. Three (3) of the psychosocial staff worked in the community based psychiatric inpatient facilities and the other 3 in the mental hospital.

Only 1% of the medical doctors and 4% of the nurses were specialized in psychiatry.

In terms of staffing in the mental health facilities, there were 0.04 psychiatrists per bed in community based psychiatric inpatient units in comparison to 0.02 psychiatrists per bed in mental hospitals. As for nurses, there were 0.16 nurses per bed in community based psychiatric inpatient units as compared to 0.31 nurses per bed in the mental hospital. Accurate data for other mental health staff is unavailable.

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. The limited number of mental health staff signifies the need for people to embrace online psychiatry.

The authors of the assessment report say that although there have been important developments in Uganda’s mental health policy and services, there remains a number of shortcomings, especially in terms of resources and service delivery.

There is an urgent need for more research on the current burden of mental disorders and the functioning of mental health programs and services in Uganda.