Fixing Uganda’s mental healthcare

Haruna Nyanzi Bujirita is an Addictionologist and consultant in Child and Adolescents Mental Health. He is also CEO of MetroHealth International that’s setting up the country’s first private mental hospital in Ttula-Kawempe in Kampala. He spoke to The Independent’s FLAVIA NASSAKA about addiction and why mental health is still an ignored segment in Uganda’s healthcare.

Metro Health International (MHI) is new in Uganda and joins a sub sector of mental health which is somewhat an ignored segment when it comes to both allocation of government resources and being attractive to private health providers. What attracted you and what services exactly are you offering?

In Uganda, challenges in psychiatric treatment are enormous, ranging from limited human resource and capital, infrastructural and logistical limitations, to treatment and quality of care, huge stigma and related barriers. The only specialized and publicly available service is Butabika Hospital yet it’s unable to adequately cope and handle the demand and related needs.

The conditions constitute an unmatched disease and disability burden amidst indications placing Uganda at high prevalence of mental or substance abuse disorders, and with a considerable percentage of those affected also suffering co-morbid physical and chronic conditions. Evidence for instance, suggests that majority of HIV/AIDS patients in every clinical setting suffer from co-occurring affective disorder such as depression and anxiety. Similar statistics show that these mental health conditions are more than twice likely to occur with other chronic conditions such as diabetes.

Metro Health offers an opportunity to work alongside government and others to support address these challenges through a dedicated integrated service that combines Primary care, Mental Health and Addiction treatment programs under one roof – offering a full continuum of well-coordinated prevention, in-depth evaluations and evidence based treatments for a broad range of physical, psychiatric and addiction disorders for all ages. Our approach,which includes combining patient care, research and education within the same setting, is informed by the abysmal lack of coordination in patient care, with a centralised approach involving the merger of general psychiatry and substance abuse with comprehensive primary care.

When is the hospital expected to fully start operation?

We are expecting to complete all construction in 12 to 18 months. It’s a five storey complex and the whole project will cost about $4.5million. We now require about $2.5million to complete.The plan is to have a state of the art fully fledged laboratory, diagnostics and imaging center to compliment primary care services.

We have about 30 psychiatrists to cater for a population of 40 million and a few psychiatric nurses and psychologists. Are you coming in with your own staff?

Our model recognises the limited skilled personnel and it’s the reason we have developed education and training as a key component of our services.

We also have been involved in a range of successful pilot projects in Middle East and parts of Africa focused on addressing challenges of limited skilled work force in mental health through a task shifting psychosocial intervention scheme involving training lay health or community workers in delivering screening, psycho-education and brief behavioral interventions of common mental health disorders under supervision of a skilled clinician. This approach which has proved effective has been widely proposed as a strategy for expanding access to mental health care.

Very little research has been done on mental health in Uganda and many cases are never treated at the psychiatric hospital. What strategy do you intend to use to reach out to patients and make them or their caregivers realise they are sick and therefore need treatment considering the fact that in some societies traditional beliefs are still very entrenched?

The issue of limited resources and funding impacts greatly on any sector and it therefore comes as no surprise that some of these challenges exist. While our MHI model takes into account an outreach strategy, your question points to a wider theme involving the reciprocal relationship between physical and mental health amidst a wider healthcare systems that remains highly fragmented with the delivery of mental health services largely kept separate, uncoordinated and often with no linkages with the broader healthcare delivery system where majority of physical ailments are managed and treated.

This very fragmented approach to managing ailments not only deprives patients of better treatment outcomes but also places additional burden and pressure on a system that is already experiencing considerable stresses in managing the complex intercept between these conditions.The strategyrecommended by WHO is integrating mental health care into primary care and is the most viable way of closing the treatment gap and ensuring the people get the care they need.

In regard to a society with entrenched traditional beliefs associated with mental illness – that calls for fight against stigma. Stigma is a huge hurdle that is partly responsible for driving mental illness, substance abuse and addiction underground and preventing many from seeking necessary treatment. Similarly sufferers require considerable compassion if they are to overcome their challenges. Stigma prevents any sort of such engagement and therapeutic environment since in many instances they feel castigated.