BUTABIKA: On March 21, 2017, Beatrice Namukobe was admitted to Butabika Hospital for the mentally ill on recommendation by the police after she allegedly killed a five-year-old boy.
She escaped from her asylum and in a repeat of the crime; she allegedly killed another three-year-old girl using a knife. Unfortunately for her this time, a mob waylaid her and lynched her.
When she killed the first child, the police believed she had a mental problem and referred her to Butabika for treatment.
Namukobe represents a growing case of mentally ill persons in Uganda; some so obvious and visible but majority of cases are subtle with patients scattered in workplaces, in families or schools like time bombs waiting to explode.
Like Namukobe, there are many patients with mental problems that are ignored, some are taken to treatment centres like Butabika Hospital, but when they escape, it ends there.
Dr Caroline Birungi, a Psychiatrist and lecturer in the department of Psychiatry at Makerere, says mental illness which is the condition that disrupts a person’s thinking, feelings, mood, ability to relate to others and daily functioning is becoming a common problem in Uganda.
Dr Birungi says that 35% of Ugandans – about 11.5 million people – suffer from some form of mental illness, with depression being one of the most common.
“But barely half of these people seek medical attention from health centers in a country where people only associate mental illness with advanced and manic psychosis,” said Dr Birungi.
“However, even in the most seemingly obvious cases of the disorder, police and other institutions of health do not seem to have the capacity to detect patients,” she adds.
She explained that mental illness in Uganda affects over one-third of the population but that less than half of these individuals seek intervention because of the lack of mental health services, including providers of care, such as nurses; psychotropic medicines; psycho-social interventions; and psychotherapies, misinterpretation of symptoms.
She said the country’s mental health services are still significantly underfunded (with only 1% of the health expenditure going to mental health), and skewed towards urban areas and the total personnel working in mental health facilities are 310 (1.13 per 100,000 population) with only 0.8% of the medical doctors and 4% of the nurses had specialized in psychiatry.
A WHO report March 2017 ranks Uganda among top six countries in Africa with the highest cases of mental disorder and the report adds 1.7 million or (4.6%) Ugandans suffer from depressive disorders and 1.07 0r (2.8%) Ugandans suffer from anxiety disorders.
The report estimates that by 2020, mental disorders will be the second most diagnosed and recognised illness second only to cardiovascular diseases.
In the case of Namukobe, it is said she confessed killing her first victim and told the police she would repeat the act if she is released.
Although she was referred to Butabika for diagnosis and treatment, she later fulfilled her ‘promise’ before she got killed by a mob, itself a possible case of a ‘collective mental disorder’.
“Most of the common causes of mental illnesses are genetic passed on from a parent/s to the child. They are also caused by one’s personality and people who are at risk of suffering from mental disorders because of their personality are the kind that cannot stand disappointments, are short tempered and are difficult to deal with,” Dr Sheila Ndyanabangi, the head of control of substance abuse at the Ministry of Health says.
These illnesses are in form of mood disturbances, brain infections or injuries, epilepsy, schizophrenia and psychotrauma. “In our environment, factors like rampant infections in form of malaria, HIV/AIDS are sufficient contributors,” Dr Birungi says.
“Injury to the brain as a result of accidents can be an offset of mental illnesses. Drug abuse in form of alcohol, marijuana, cocaine among others also leads to these disorders,” she added.
Dr Muhammad Mulongo, the DHO Bulambuli says the worst hit areas with mental illnesses in the country are northern Uganda and West Nile because they experienced war for a long time and that in a research conducted in 2004 among people living in camps in the northern Uganda, 30 per cent of IDPs had symptoms of moderate severe depression because of alcohol, drug abuse and stress.
“And People with HIV/AIDS are at a higher risk for mental health disorders, they actually have an increased risk for developing mood, anxiety, and cognitive disorders,” said Dr Mulongo.
He added that people living with HIV are twice as likely to have depression compared to those who are not infected with HIV and that some forms of stress can contribute to mental health problems for people living with HIV, including: having trouble getting the services you need, experiencing a loss of social support, resulting in isolation, experiencing a loss of employment or worries about whether you will be able to perform your work as you did before, having to tell others you are HIV-positive, managing HIV medicines, going through changes in your physical appearance or abilities due to HIV/AIDS, dealing with loss, including the loss of relationships or even death and facing the stigma and discrimination associated with HIV/AIDS.