KAMPALA, UGANDA - A dramatic suicide attempt caught on video in Uganda's capital has spurred a national conversation about mental illness.
In the footage, a young man jumps from the seventh floor of a downtown shopping complex as onlookers scream in horror. The man survived, but many are now calling for increased attention to the nation's mental health care system.
At Butabika, Uganda's only national referral mental health hospital, there are eight psychiatrists for 842 patients. Nearly always over capacity, the facility offers intensive psychiatric treatment free of charge. One former resident, who wished to remain anonymous, said the care and medication saved her life.
“Two weeks in, it was the first time in my entire life that I ever felt happy," she said. "I didn't realize that before. It was like I woke up. I was still unemployed, I still had no money — to the point where I'm walking for two hours because I have no transport — but I wasn't depressed. I didn't hate myself, I didn't want to commit suicide. I was like, 'Life is great.' ... It's like how you give a blind kid glasses and they see for the first time. I wanted to live. It was amazing.”
Yet most Ugandans, especially in rural settings, lack basic access to effective care. With a population of over 37 million, there are only 32 psychiatrists in the entire country.
Dr. David Basangwa, the executive director at Butabika Hospital, said that the government is improving access in Uganda. This includes refurbishing regional mental health care wards and training around 300 psychiatric clinical officers to work in lower-level health facilities.
However, between stigma and lack of access, many with mental health problems end up self-medicating, Basangwa said.
“Of course, here it's easy for people to get hooked to prescription drugs, because the regulations are there but the enforcement is low," he said. "Same for alcohol. There are laws restricting production and sale, but they are not followed.”
Effective treatment can also clash with cultural norms. Members of the country's small but growing atheist community report being told by their doctors that finding God could help them with depression. And for members of the LGBT community, fears that providers might divulge their sexual orientation to their parents stop many from seeking help.
Dr. Seggane Musisi, a professor of psychiatry, said nobody should forgo treatment for fear of being stigmatized.
“Ethically, in Uganda, you cannot refuse to treat someone due to their sexual orientation," Musisi said. "And there's no law prohibiting the treatment of these people, and there's no law that says they should be charged because of being a different sexual orientation. So they should come for treatment. And we treat many of them. We're not saying a different sexual orientation is a disease. It's not. Nobody is going to be kicked away when they come for treatment.”
Advocates say further initiatives by the government to recruit and incentivize a career in psychiatry are needed.
They stress, however, that addressing social factors that spur mental illness, such as the high rates of unemployment, sexual violence and war-induced trauma, must go hand-in-hand with improving the health of all Ugandans.