Mental ill-health is a global concern, with depression being the second leading cause of years lived with disability. It is estimated that at least 1 in every 4 Ugandans has some form of mental disorder.
Mental illness can begin at any age, from childhood through later adult years, though most cases begin earlier in life.
Mental disorders affect one’s productivity and functionality, hence making it difficult for affected persons to fulfill their different responsibilities in society.
The increased morbidity caused by mental disorders greatly affects the quality of life of the sufferer. Mental disorders are defined as disorders that affect one’s mood, emotions, thinking and behaviors. The commonest of these include depression, anxiety, alcohol and substance use disorders, bipolar affective disorder and psychoses.
There are no distinct causes of mental health disorders, but it is believed that mental illness can be due to genetic or environmental causes or a combination of these.
A mental illness develops as a result of interaction of biological, psychological and social factors as illustrated in fig.1 below. Common environmental factors include; adverse events such as loss of dear ones, physical illnesses, trauma of all kinds, work related stress, marital discord and broken families and alcohol and substance use.
When the World Health Organization declared the COVID-19 outbreak a global pandemic in March 2020, the government responded by putting several measures in place to curb its spread and also ensure preparedness to handle any cases. Among these was imposing a total lockdown and also setting up auxiliary treatment centers for COVID-19 cases. This is when mental health facilities were also turned into COVID-19 wards.
“When the country went into lock down, the Ministry of Health directed regional referral hospitals with exception to Mbarara, Gulu and Fort Portal to give away the mental health units to treatment of Covid-19. This meant that people with mental health problems could not be admitted anymore.”
However, even with the cases going down as shown by recent statistics from the Ministry of Health, there seems to be no indication that they will reopen the facilities to mental health patients anytime soon.
This has left mental health activists worried, and they are now calling on the government to consider re-opening of mental health clinics at regional and referral hospitals across the country.
Last month, there was a case that broke out where a student named Mark Mudoola aged 19 years died at Butabika Referral Psychiatric Hospital in Luzira. He was a Senior Six (S6) student of St. Mary’s College Kitende died of a “following head injury a blunt trauma.” And thi ha brought a lot of panic in the country.
The issue of human rights abuses of persons with mental disabilities within psychiatric facilities is not new in Uganda. Acts of seclusion and restraints, forced medication, denial of the right to informed consent and participation in their own treatment, forced institutionalization, even by family, sexual violence, torture, inhuman and degrading treatment by the agents of Butabika Hospital, police and the community have always existed in Uganda. This abusive and invasive manner of treatment deepens societal stereotypes against persons living with mental disabilities.
The actions leading to this death amount to a violation of well laid out rights in international, regional and national legal frameworks ratified and enacted by Uganda.
According to Article 15 of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) obligates State Parties to stop all acts of torture, cruel and degrading treatment and ill-treatment against persons with disabilities. Specifically, the Special Rapporteur on torture has equally highlighted seclusion, restraints and forced medication in psychiatric facilities as acts of torture.
Mr. Mudoola’s case reflects why the CRPD specifically highlights denial of legal capacity and restraints as a human rights issue. Mr. Mudoola had already indicated his unwillingness to be admitted. However, the people at the hospital went ahead to forcefully restrain him during admission. If the CRPD standards had been followed, he would still be alive today.
Besides the UNCRPD, the Constitution of the Republic of Uganda 1995, the Persons with Disabilities Act 2020 and the Mental Health Act 2019, all guarantee the rights of all persons with mental disabilities’ freedom from torture, cruel, inhumane and degrading treatment and the right to life.
Speaking to the media on Friday at Mental Health Uganda offices in mengo, Daniel Lubanga the Programs Manager said that uthe Uganda police should thoroughly investigate the matter as it is criminal and unacceptable, and make the findings public as this death is not an isolated event.
He also added calling the Members of that coalition have on many occasions reported on various human rights abuses that they have experienced in Butabika and other psychiatric facilities, yet these are not investigated, followed up or accounted for.
“It is very important that the government of Uganda, through the police, makes an example of this case in order to restore confidence in Butabika Hospital as well as the other mental health hospitals across the country. It is also important that accountability is upheld to pass a strong message that “the lives of persons with psychosocial and/or intellectual/ or mental disabilities matter”.
Mr. Lubanga also said that Butabika Hospital Administration should bring to the public officers responsible for Mudoola’s death to account within a month. And that the Ministry of health should open up an inquiry into the complaints against Butabika Hospital with a view to instill a human rights based approach to service delivery.
According, Benon Kabale the executive director at the mental Heart recovery initiative said that they are taking steps to educate the public through creating public awareness on mental health and human rights that really need to be respected by all persons within the community to the institutional level.
He also urged the Ugandan government to come in and support civil society organizations because we realize that the police lacks information in mental health care, and they would like to create more knowledge and understanding of the persons with mental health issues and disabilities to ensure that all people in the community are safe and as well with institutional Butabika.
“We have witnessed a number of violations within hospital settings and community, torture among others simple because all those people with mental health disabilities are stigmatized in the community shouldn’t be the case because these are also people, and they need to respected,” said Benon Kabale.
He also added saying the government to ensure that it puts in place serious measures to enable within the community to access good and quality medical care and also from the local council level they need to ensure that the administrative powers are protected such that person’s rights are promoted and respected fully within the community.