Integrating mental health into primary care in Uganda

In the realm of global health, integrating mental health into primary care has emerged as a critical strategy to address the growing burden of mental illnesses.

The World Health Organization (WHO) has underscored the necessity of this integration, proposing a model to enhance mental health services through primary healthcare systems. However, despite these recommendations, many countries, especially those with limited resources like Uganda, face significant challenges in implementing these strategies effectively.

The government’s approach of building a structured referral system from village-level Health Centers to National Referral Hospitals demonstrates a keen awareness of the need for a comprehensive mental health strategy. Yet, the reality on the ground reveals a stark contrast between the policy aspirations and the actual implementation.

One of the central issues lies in the underutilization of mental health services, particularly in rural areas where healthcare infrastructure and resources are sparse.

While the decentralization strategy was designed to bring services (mental health inclusive) closer to communities, many rural health facilities remain ill-equipped and inadequately staffed to handle mental health cases effectively. For instance, a 2023 report by the Makerere university school of public health noted that Uganda still grapples with a significant mental health treatment gap of 85 per cent, leaving only 15 per cent of those in need with access to care.

Studies show that depression and generalized anxiety disorders in Uganda, are prevalent at 5.3 per cent and 4.1 per cent respectively. Uganda ranks among the top five countries globally with the highest depression prevalence.

Poverty, unemployment, HIV infection, disasters, and adverse environmental conditions are some of the factors that increase the risk and consequence of mental health conditions in Uganda.

Primary healthcare facilities often refer individuals to higher-level tertiary care, and mental health stigma persists, with limited awareness among the general population. This disparity exacerbates the problem, leaving a significant portion of the population without access to necessary mental health care.

The WHO’s model for integrating mental health into primary health care advocates for several key components: promoting self-care, building informal community care services, developing community mental health services, expanding mental health services in general hospitals, and limiting reliance on psychiatric hospitals.

For Uganda, adopting these principles requires not just a commitment to policy but also tangible improvements in training, resource allocation, and systemic support.

A critical area for intervention is the training of healthcare providers. The current gaps in mental health training for primary healthcare providers limit their ability to effectively identify and manage mental health conditions. Periodic in- service training is essential to equip these providers with updated knowledge and skills, enabling them to offer better care and support to patients with mental health issues.

Moreover, enhancing the overall support system for healthcare workers is vital. This includes providing adequate medical supplies, improving outreach processes, and ensuring that referral systems are functioning smoothly. Empowering primary healthcare providers to manage and treat mental health problems within their facilities can reduce the burden on higher-level institutions and improve the accessibility of care.

Another pressing issue is the uneven distribution of health workers across facilities. Many rural areas suffer from a shortage of healthcare professionals, resulting in high workloads and compromised quality of care.

Increasing the distribution of health workers and ensuring that facilities are adequately staffed can significantly improve the delivery of mental health services. Addressing these disparities is crucial for making mental health care more accessible and effective.

The WHO model emphasizes the importance of community and informal support systems. Fostering self-care and community-based mental health initiatives can play a transformative role.

Building informal community care services and strengthening community mental health services can bridge the gap between formal healthcare settings and the general population. By promoting mental health awareness and reducing stigma, communities can better support individuals facing mental health challenges and encourage them to seek help.

For Uganda to realize its goal of integrating mental health into primary health care, there must be a systemic transformation. The government’s mental health program aims to address various facets of mental health care, including policy development, community education, and integrating mental health into general health services.

The writer is a journalist and a public health professional