The following brief will present two recommendations for GLI’s Mental Health Facilitator program. Recommendations were conceptualized after analyzing statistical information collected on Lake Bunyonyi June-July 2022.
Prepared by: Sarah Wooldridge,
Community Development and Public Health Intern Summer 2022
Colorado State University, MPPA
Summary →
Researchers executed interviews and focus groups with locals to learn about village services, perceptions, and belief systems surrounding mental health. Researchers discovered that a majority of the study participants have a narrow understanding of mental health diagnoses, expressed uncertainty about accessing support for mental health issues, and disagreed on best practices for treating mental health issues.
The last evaluation of this program was published in 2016. Since then, Uganda has undergone massive political change and resistance, legislative change, taken in millions of refugees, and muscled through a global pandemic. Although the results of this study are similar to the results of the last evaluation, this brief suggests emphasis on community characteristics related to information and training as opposed to tangible barriers which were suggested in the previous evaluation. An additional difference from the two studies concerns stigma around mental health disorders. The first evaluation cited stigma as a barrier to MHF program implementation and effectiveness. However, participants from this study did not routinely discuss stigma.
Mental health disorders impact communities broadly and at all levels. Mental health needs must be addressed to create a thriving community and support overall health and well-being. “Overall and with moderate level of certainty, the prevalence of any mental disorder in Uganda was 22.9%.” (Opio, JN). Acute symptoms of mental health issues are more prevalent in low resourced, rural areas such as Lake Bunyonyi. These areas also require the most attention from NGOs as they are often disregarded by their own government. The MHF program is a critical service on Lake Bunyonyi. It must be evaluated regularly to ensure it performs to its greatest potential in order to expand the reach of mental health services and support to all rural Ugandans of Lake Bunyonyi.
This brief will proceed with two recommendations for the MHF program and conclude with acknowledgment of other actors which impact the success of the MHF program. Additional actors cited require systematic coordination with governing bodies to facilitate economic growth or financial assistance on Lake Bunyonyi.
Introduction
The Global Livingston Institute (GLI) is a United States based non-profit organization and has been in operation since 2009. GLI’s mission is “to educate students and community leaders to innovative approaches to international development and empower awareness, collaboration, conversation, and personal growth.” (GLI, n.d.) GLI achieves this mission by facilitating international development in rural communities in Rwanda and Uganda. GLI has been facilitating research, education, and immersion experiences since its conception. GLI takes on a variety of projects that help build economic and overall community capacity in these countries. This brief will focus on work that is currently being done in rural Ugandan communities which live on Lake Bunyonyi. More specifically, this brief will address program improvements, evaluation, and future considerations for GLI’s Mental Health Facilitator (MHF) program. The MHF program deploys local GLI staff and community members into local rural villages to administer a Train the Trainer1 model for mental health preparedness and response. The last Train the Trainer facilitation occurred in July 2020. Mental health needs in these areas are vast and low resourced. GLI provided this background information to support efforts made by current and future researchers for the MHF program:
In low-income countries with high rates of poverty, communicable disease, and maternal and child mortality, the importance of mental health is often disregarded (Lund, 2018). In Uganda, and sub-Saharan Africa at large, the need for mental health services is frequently overlooked or deprioritized given other issues such as HIV, which garner a higher level of attention through large scale events; annual music festivals in Uganda, focused around HIV/AIDS, reach mass international audiences, increase knowledge on the issue, and decrease stigma (Van Leeuwen et. al, 2018). A negative stigma associated with mental health issues stems from both a lacking availability of mental health services and low willingness of affected individuals to seek such services (Gellert, 2017). Cultural beliefs about mental illness being related to ‘witchcraft’, or similar causes, de-motivates individuals to seek formalized mental health services, and why 80% of patients interviewed in Uganda’s mental hospitals have previously sought treatment from traditional healers (Van Leeuwen et. al, 2016 ; Molodynski & Cusack, 2017).
As part of its mandate, the Mental Health section of the Ugandan Ministry of Health repealed the Mental Treatment Act of 1964 to the Mental Health Act of 2014, calling for a “population free of mental, neurological and substance abuse disorders” (Uganda Ministry of Health, 2019). In 2018, Uganda Parliament preliminarily passed the Mental Health Act, which brings hope for the country, broadening the definition of “Mental Health Conditions” to include depression, bipolar disorder, anxiety disorders, schizophrenia, and addictive behavior due to alcohol/substance abuse among several others (Bukuwa, 2019).
A lack of strong mental health information systems and the presence of social stigma lead to a significant deficiency in the reporting of mental health disorders (Petersen, et. al., 2017; Ritchie & Roser, 2018). The actual number of Ugandans suffering from mental disorders is closer to 35%, and could be higher considering potential gaps in reporting (Molodynski & Cussak (2017). Uganda is said to rank “among the top six countries with the highest cases of mental illness in Africa” (UG Mirror, 2018). The two most common mental disorders, depression and anxiety, combine to represent 13.6% of the total number of years lived with disability (YLD) in Uganda (World Health Organization, 2017). Although as it stands, Uganda spends 9.8% of its gross domestic product on health care, but only 1% of this is allotted for mental health, and no substantial change in this area is outlined in the 2018 Mental Health Act (Molodynski & Cusack, 2017 ; Bukuwa, 2019).
Due to a limited number of mental health professionals, coupled with a lack of resources, 90% of individuals with mental illnesses do not receive any treatment (Molodynski & Cusack, 2017). Butabika Hospital is the only operating national mental hospital in Uganda, located in the capital city of Kampala. There are 28 inpatient psychiatric units throughout Uganda, 60% of which are located in Kampala, while 87.7% of Uganda’s population lives in rural communities (Shah et. al., 2017). Quick dissemination of the 2018 Mental Health Act throughout Uganda is crucial, as most district level health plans still fail to even mention mental health (Mugisha, et. al., 2017). Decentralized, community-based care has proved to be a highly effective model in rural areas of Uganda (Shah, et. al., 2017). The utilization of community health workers allows for a larger population to be reached than traditional methods, and means that treatment can be adapted to fit existing community beliefs and needs (Shah, et. al., 2017).
To improve the MHF program and better deploy resources to local communities which live on Lake Bunyonyi, researchers conducted an extensive amount of qualitative research, travelling to and interviewing community members which might inform problem solving for mental health challenges on Lake Bunyonyi. The interviewees were carefully chosen from various groups of stakeholders in an effort to provide perspective variety and allow for comparison between the groups. The groups of people targeted for interviews were secondary school students, health care workers, traditional healers, religious leaders or practitioners, those who have been trained through the MHF program, and local leaders. Field work was conducted directly with locals. Interviews were recorded and sometimes required translation assistance. All interviews and recordings were conducted with verbal consent from the individuals participating, later transcribed, and then analyzed and coded for recurring themes. Incentives were not offered to participants. This brief will follow with two recommendations for GLI’s MHF program. All demographic data can be found in the Appendix.
