Tackling child and adolescent mental health in Uganda

Candia Umar is a Psychiatric Clinical Officer (PCO) at Arua Regional Referral Hospital in the West Nile region in Uganda.  From being a refugee in South Sudan and studying in the conflict torn country as early as the 1980s, he managed to secure an education which later saw him become a PCO in Uganda where only 1% of the medical doctors and 4% of the nurses were specialised in psychiatry in 2006.

He cares about children’s mental health and worries over the lack of tailored services. He found the THET funded Child and Adolescent Mental Health (CAMH) training, implemented by the East London NHS Foundation Trust and Butabika Hospital partnership to be timely.  Twenty three mental health professionals from 9 regions were trained to assess and treat children with mental health issues. Thirteen health workers have now completed a Diploma, to provide psychological treatments, supervision and training.

The burden of mental health disorders continues to grow in Africa, with one out of every six people suffering from some form of disorder.  Mental Health is unfortunately not prioritised, and is affected by inadequate investment and professionals.  In Uganda, for example there were 1.13 human resources working in mental health per 100,000 of the population^[1].  A decade later, and the figures have not improved, with fewer than 30 psychiatrists serving about 35 million Ugandans. In Uganda where 55% of the population^[2] is under age 17, the burden of mental health issues in children is huge and remains a growing problem.

Butabika hospital which has served the country for decades as the only mental health service provider has been limited by funds.  Uganda spends 0.7% of the budget on mental health compared to the UK’s 10% spending.  It is only lately that other regional referral hospitals came on board with an increase in public awareness.

Uganda is forging forwards with new and revised approaches to mental health provision in the country, the 2014 Mental Health Act being a prime example of this. Existing too is a National Mental, Neurological, and Substance (MNS) abuse Policy and Strategic plan, and the Child and Adolescent MNS abuse Policy Guidelines which the THET funded partnership contributed to.  Children are the most neglected, with few health workers able to identify their disorders.  The Ministry of Health is ready to fill vacancies designated for CAMH if more professionals are trained.

[1] WHO 2006 report

[2] National Census Report

“I am where I need to be right now but I have come a long way.  I studied in conflict torn South Sudan where I was a refugee.  Returning to Uganda in 1986 I opted to take a psychiatric nursing course at the Butabika School of Psychiatric Nursing.

Finding work was hard but my interest in mental health never waned and in 2001, I joined Arua district hospital where I worked for five years.  My quest for knowledge and the absence of psychiatrists in the district saw me enrol for a Psychiatric Clinical Officer (PCO) course at Butabika from where I joined Arua Regional Referral Hospital.

I have seen new and old patients.  I discuss complex patient cases with colleagues and at the end of the month I summarise data and always notice the spike in children’s numbers despite the fact that we have no specific or good services for them.

This and my endless quest for mental health knowledge is what led me to apply for the CAMH training.  It was a striking opportunity.  Before this training I had spent limited time focusing on children’s mental health, and the course helped me to understand in detail how to work with children.  I can give a child all the time that they need, build an understanding and assess them.

It is amazing.  My practice and attitude have changed.  I advise guardians that I need more time to spend with the young patients.  If clients do not turn up, I call to find out how the child is doing.  I even schedule another appointment or help over the phone.  Being good of course comes with more responsibilities because our Arua colleagues are referring children onto the two of us who did the CAMH training. I however, enjoy this.

Challenges, exist.  We have no resources for the children including toys to keep them busy as they wait or during interviews with their guardians.  Often times we fail to follow up with clients in the community.  The bond then breaks before you can achieve set objectives for the children with MNS disorders.  This is a huge setback which drains me emotionally, but I am glad I was chosen to be a pioneer to serve this neglected population.

CAHM has inspired me to become a teacher.  I want to share my skills since we are few.  I will move to the communities and tell them all about children’s mental health issues, since stigma and hatred are outstanding for those affected.”