Fixing Uganda’s mental healthcare

You are an addictionologist and drug addiction is on the rise in Uganda. Why is it so?

A number of factors would be at play in the rising prevalence of substance misuse and addiction and these would include poverty, inadequate coping strategies, family dynamics, influence from peers and idols who portray substance use as ‘cool’, self-medication etc.

Drug addiction is a complex phenomenal. Contrary to many widespread perceptions, addiction is actually a very complex psychological and physiologically process that manifest in any behaviour where one finds temporally relief and pleasure, craves it and continues to engage in despite suffering negative and sometimes harmful consequences – and is unable to give up.We usually see this in series of behaviours including gambling, alcohol, sex, shopping, internet, drugs and alcohol, food, pornography, video games.

To date we know a lot more than previously as a result of improved research and more interest in the subject but the concept of addiction causes remains complex and rather controversial to some extent. Some experts consider addiction as a disease of the brain while others disagree referring it purely behavioural. Others argue that addiction is rooted in childhood trauma.

Studies indicate a clear and distinct correlation between child trauma and drug and alcohol addiction. Like many mammals, humans are born into a world where they expect to be nurtured, loved and supported, understood, seen and heard. In psychology we refer to this concept as ‘attachment’. Once this is disrupted, children tend to develop a deficient sense of themselves resulting in a host of problematic behaviours in response with substance misuse, addiction, mental illness amongst them. Furthermore the traumatic incidents experienced during childhood very easily can, and often do, wind up following them into maturity creating a variety of long term health issues that may cause them to self-medicate through excessive drinking or drug abuse.

All these positions are persuasive but one common denominator that is uncontested for us clinicians is that it is a ritualised compulsive comfort seeking set of behaviour that one engages in to address emotional pain.While addiction can develop as a result of continued recreational or habitual practices, it is often a form of pain relief- a distraction from distress- a means to achieve a sense of power and control, companionship. One can rightly argue that addiction is simply a coping strategy adopted in absence of better or healthier alternatives. Addiction therefore is not the primary problem. It’s often an attempt by an individual to solve the problem. Most addictions are usually attempts to regulate our internal emotional distress.

What in your view is the best treatment for addiction?

There’s no such thing as best treatment or rather a one size fits all approach. It all depends on a number of factors and variables but experience tells us that addressing the core aspects of distress, trauma putting in consideration issues such as financial, social and physical wellbeing will likely improve outcome of the treatment chosen.

Issues of violation of human rights have previously come up as regards controversial treatments for mental complications and Butabika has previously been taken to court over isolation of patients. Others are against electro-convulsive treatment(ECT). What are your views about this kind of treatment?

There’s no doubt issues of human rights have to be addressed and there are positive signs that recommendations from reviews are being implemented. I am however not well versed with the details of the court case but on a broader perspective, seclusion of patients demonstrating high risk to themselves or others is an acceptable practice in risk management. As for ECT, it is safe and effective, if well managed and administered for treatment of treatment resistant depression, schizophrenia, manic depression of course taking into account potential side effects.

Uganda still uses legal frameworks that were drafted more than 30 years ago to administer mental health but parliament is now reviewing a new mental health bill. As a stakeholder in this sector, what key issues would you want this piece of legislation to address?

It is an encouraging development and the review has long been overdue. I am passionate about issues relating to Human Rights and protection of the vulnerable groups. I am also a keen advocate for community based treatment as well as integration of psychiatric services within our primary care structures.

Finally what would you recommend to government as most urgent if they are to fix the mental health sub sector as figures show about 30% of Ugandans suffer from a mental health issue?

Government needs to prioritise mental health as much as it does for physical conditions; especially since the interface and reciprocal relationship between the two is often underestimated despite overwhelming evidence linking them.The highly fragmented healthcare system where mental health challenges are treated and addressed separately from physical needs greatly undermines the complex functioning human body system and how it interacts with each other. Integrating mental health care within existing primary care therefore would be another viable option in helping closing the treatment gap.

Any final remarks?

It’s to parents. They should teach young ones about the risks and threats associated with substance misuse and addiction. Be honest about the short term pleasures that potentially can result in distractive behaviours. Scaring them off may not achieve desired deterrence. Do your best to prevent young people from brutal and terrible experiences both at home and at school. Incidents such as bullying, physical, sexual and emotional abuse may later in life trigger addiction. Monitor your child’s social networks and peers.

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