Mental illness; a condition that requires urgent attention

In Summary

Every month, the psychiatric unit at Mbale Referral Hospital receives more than 200 cases of mental-related cases, with the highest number being teenagers.

It’s a more touching than horrifying experience visiting a psychiatric unit.
When I hit the road last Friday to meet Stanley Itakali, a victim of mental illness, now rehabilitated at Mbale referral mental health unit, I had a grim illusion.
It was surpassed. The unit has genteel architecture and landscape. In the wards, despite a few agitated pacing, strange laughter and heartbreaking screams by the patients, it wasn’t as horrifying as I had imagined.
Standing outside one of the wards, one of the mental users (patient), a woman in her early 20s, stood still, looking at me.

She must have been quite beautiful before the illness struck her. I wanted to take her photo but the doctor told me it was not allowed.
I left. I proceeded to Itakali, who was seated at desk in the waiting room for mental users. He was looking calm and ready for the interview.
Itakali, a teacher by profession, says signs of his mental illness first surfaced in 1988 when he was in Senior Five at Kings College Buddo.
“I could not really tell what went wrong. Though I always had side effects such as drowsiness, poor concentration and irritability,” he says.
The father of five says he was admitted to Mbale Referral Hospital, where he was diagnosed with what the psychiatrist called mental anxiety.

After three months, he was referred to Mulongo hospital, where he was later diagnosed with mental illness.
“Doctors advised me to stay out of school for three years, which I did,” he says.
Itakali, who is now the secretary general on the board of directors, Mental Health Uganda, says even now he gets relapse attacks.
“Mentally unstable people must be close to doctors, because any time relapse attacks occur,” he says, pointing at one of patients, who had turned violent in the ward.
He added that mental patients can create relapse of attacks to themselves by not taking drugs, being nervous, and failure to follow doctors’ instructions.

He explained, however, that drugs are expensive and always out of stock in government mental health units.
Another mental patient who is still under rehabilitation, Sheila Nandutu (not her real name), a 20-year- old, dropped out of school in Senior Six last year. She was struck by the illness in 2010.
“I was fond of sweet foods. I later started developing anxiety and the situation worsened,” she says.
Nandutu now spends most of her time in church and also works part time as a narrator for documentaries with one of the videography studios in Mbale Town.
“She is very good when she is in good mood. When she is distressed, she turns weird,” one of her workmates, says.
But Itakali’s and Nandutu’s stories are just representation of many in Mbale District and eastern region at large.

Unavailability of drugs
The deputy in-charge of the psychiatric unit at Mbale Referral Hospital, Dr David Masaba, says during clinic days they get more than 50- 70 patients.
Clinic days are always on Tuesdays, Wednesdays and Fridays.
“The numbers are increasing each day. Mental illness is becoming a concern that must be addressed before it runs out of hand, otherwise, it will loom to the end,” Dr Masaba, says.
He says the psychiatrists at hospitals are capable of providing treatment to mental patients but the challenge is the unavailability of drugs most of the time.
“When we tell them to go and buy drugs from outside the hospital, they do not buy. Instead they go home and return the next clinic day,” he says, adding that most of mental patients are poor.

The mental health unit in Mbale hospital is the only specialist unit with psychiatrists to handle mental illness in the region.
The unit offers services such as, acute crisis stabilisation, behaviour management, treatment of acute psychiatric symptoms and acute substance abuse detoxification.
They also provide in-patient services such as provision of a safe, least-restrictive environment, prepare the patient for optimal functioning after discharge, among others
In a month, the clinic receives approximately 200 cases. Dr Masaba says the number might be more than that because few are willing to report mental illnesses to hospitals.
The unit has only six psychiatrists, which according to Dr Masaba, is a burden as far as handling an over whelming number of patients.
“We need at least 12 doctors, otherwise it will remain a challenge,” he says.

In the course of an interview, one of patients came to see the doctor. At first I was frightened and intrigued.
“Doctor, they have not given me the drugs,” she said, looking fatigued and worn out.
“That is what goes on here, on a daily basis if we have no drugs,” the doctor said, concerned. The patient walked away in silence.
Dr Masaba said lately they admit more teenagers with mental- related cases at the unit with the number close to at least 20 every month.
He stressed that the government needs to implement structures that demand that each health centre IV has a psychiatrist.
“Mental health has become a national concern,” he says.
Dr Masaba attributes the increasing number of mental cases to rampant use of drugs, alcohol and poor eating lifestyle among Ugandan nowadays.

He adds that due to poverty, most Ugandans are unhappy, something he said can drive one to mental illiness.
The district health officer, Bulambuli District, Mr Muhammed Mulongo says the ministry of Health and government have neglected mental illness as a condition.
“We have structures. We have no man power, no money allocated for mental illness and therefore, sensitisation and other measures cannot be implemented,” he says.
He says if the situation is to be tamed, the government must allocate separate funds for mental health.
However, the area MP for Mbale Municipality, Jack Wamanga, said the creeping mental illness among Ugandans needs to be cured but not prevented.

“The government should create jobs. People are stressed and tired. They do not have what to eat and their reasoning capacity has deteriorated,” says Mr Wamanga.
He says mental illness will over run the country.
“There is no short cut to this. People are getting ill everyday, especially our youth. They have no work yet they have financial challenges,” says, Mr Wamanga.
According to the 2014 National Population and Housing Census, because of poverty, more than four million Ugandans cannot afford two meals a day.

The LC5, Mbale District, Mr Bernard Mujasi, said youth are developing mental illness because of over consumption of drugs and alcohol.
“You find a normal young man today after two weeks, he is mad and when you ask, they say he was a drug addict,” he says.
Mr Mujasi says mental illnesses are sign of backwardness, urging Parliament and government to enact laws on drugs, consumption of alcohol and regulation of processed foods, which bears harmful health complications.

Possible Causes
The founder of family clinic in Uganda, Dr John Khauka, a psychiatrist, who has worked in several medical institutions in Germany, England, Switzerland, says mental illness is a new condition that i s destructive and that the government should channel resources to support its prevention.
“It’s unfortunate that the problem is catching us unware. But it’s not too late, the government should allocate more resources in this area,” he says.

Dr Khauka explained that causes of mental illness include, genetics, poor nutrition, infections, brain defects, parental loss, loss of jobs, consumption of drugs.
But Dr Khauka says the country’s lack of enough technical staff to handle mental illness, especially in the rural areas.
“It’s expensive to treat mental illness, there are few experts,” he said, adding that the few psychiatrists available in the country are situated in Kampala and in administrative positions.
He explained that eating habits today including poor appetite, skipping meals and desire for sweet foods have been a fertile ground for mental illness.
“These sweet foods today affect the human cognition, behaviour and emotions of any individual especially if it’s a kind of addiction,” he says.

Dr Khadijah Nakyisinge, the dean faculty of science at the Islamic University in Uganda and food nutritionist, said when there is malnutrition during child development, either during foetus or early child development (five years below) it will result in cognitive retardation.
“This does not necessary lead to insanity, but there are possibilities, if it goes to extreme, that it will cause insanity,” she says.
Dr Nakyisinge explains that some components in the diet that can affect child cognitive ability like caffeine (central nervous system stimulus) are found in coffee and tea.
Dr Nakyisinge adds that excessive consumption of alcohol and drugs during pregnancy can cause poor cognitive ability in child (low intelligence).

“The brain of those children is usually poor and lacks coordination and the condition may not change even when they are growing but instead worsen. And given other factors,a child may become insane at a certain point in life,” she says.
She said during pregnancy, women should eat nutrients- food components that can found in vitamins and proteins to give the unborn baby good brain development.
She also urged women to visit antenatal care during pregnancy to receive folic acid found in vegetable.

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