Brain Gain in Uganda: A Case Study of Peer Working as an Adjunct to Statutory Mental Health Care in a Low-Income Country

Cerdic Hall, David Baillie, David Basangwa, and Joseph Atukunda

The Rationale for Involving Peer Support Workers in Mental Health

People with mental health problems are more likely to experience violence, abuse, stigma and discrimination, restricted political and civil rights, reduced participation in society as well as a lack of access to health, education and employment (Funk et al. 2010). In all resource settings, people living with mental illness are at risk of remaining in and drifting towards poverty, in a negative cycle (Lund et al. 2011). These challenges have been described in Uganda, in a context of high psychosocial burden for the population plus reduced opportunities and discrimination against people with mental illness (Ndyanabangi et al. 2004).

C. Hall

Primary Care, Camden and Islington NHS Foundation Trust, London, UK

D. Baillie

East London NHS Foundation Trust, London, UK D. Basangwa

Ministry of Health, Kampala, Uganda J. Atukunda

Heartsounds Mental Health Champions, Kampala, Uganda © The Author(s) 2017

R.G. White et al. (eds.), The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health, DOI 10.1057/978-1-137-39510-8_30

Uganda, with a population of 37.5 million and one of the highest birth rates in the world, is considered a low-income country: an estimated 24.5% live under the poverty line (World Bank 2014). Over two million people live in the rapidly expanding capital, Kampala. Epidemiological studies have found high rates of mental health problems, with 21—24% suffering from depression (Bolton et al. 2004) and 30.3% suffering from mental illness generally. There are 25 psychiatrists in Uganda, 7 of whom are based at Butabika Hospital, the 450-bedded national referral and teaching hospital located on the edge of Lake Victoria on the eastern outskirts of the capital, Kampala. This was built in 1954 as a 970-bedded asylum, to replace former more custodial asylums at Hoima (1920) and Old Mulago (1930). Butabika took referrals from all over the country until a policy of decentralization in the late 1990s led to the strengthening of regional mental health services, with Mental Health Units being built in 12 major towns in 2004. These are run mainly by Psychiatric Clinical Officers, although three have a psychiatrist.

A number of different studies have described indigenous classifications of mental illness (Orley 1970; Ovuga et al. 1999; Abbo 2011; Okello 2006). Explanatory models for mental health problems cite clan issues, including ancestral spirits and witchcraft, as well as physical illness and substance misuse (Abbo 2011). These attributions may contribute to discrimination and also to families feeling shame and hiding family members with mental illness (Ndyanabangi et al. 2004), both of which reduce educational or vocational development (Ndyanabangi et al. 2004; BasicNeeds 2007).

National Health Service (NHS) International links are partnerships between health institutions in the UK and counterpart health institutions in LMICs. There has been a long history of overseas volunteering by UK-based health professionals, and over the past 25 years, the Tropical Health and Education Trust (THET) has supported and built a partnership approach that aims to harness knowledge and technical expertise to strengthen health systems through the training of healthcare workers in low-income settings (THET 2014a). This approach has been endorsed as a method of supporting development of overseas partners, and potential benefits to UK institutions have been highlighted, particularly improved skill and knowledge to serve diverse communities (Crisp 2007). UK Department of Health guidance advocates that links should embrace a principle of mutual benefit and ensure primacy for and ownership by the low- income countries being partnered (Crisp 2007). BELL, formalized in 2005, is a partnership between Butabika Hospital and East London NHS Foundation Trust (ELFT), a large London-based NHS Trust[1] providing mental health services to some of England’s most diverse and impoverished populations.

  • [1] ‘Trusts’ in the UK context are divisions of the National Health Service that provide health care to aspecified geographical area or in a particular medical speciality.
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