East London NHS Foundation Trust and Sheffield Health and Social Care Trust linked with Butabika Hospital, Kampala, Uganda to contribute to improving the mental health of Ugandans through enhancing the skills and competencies of the Psychiatric Clinical Officers (PCOs), both in rural and urban areas in Uganda, with a focus on promoting skilled management of aggression and violence in in-patient care.

Mental Health in Uganda

Uganda is a low-income country with an estimated population of 32 million.  It spends only 0.7% of the total health budget on mental health compared to 10% of the health budget in the UK (WHO Mental Health Atlas, 2005). Mental health problems are increasing, with depression at 12-68%, anxiety disorders at 20-62% and alcohol dependency at 14% in the general population (Mental Health Policy, 2007).

Butabika Hospital is the only national referral psychiatric hospital in Uganda, caring for hundreds of patients from all over the country, with numbers as high as 1200 on some occasions. 60% of the patients at the hospital suffer from acute conditions.

The overall goal of the link is to build capacity of mental health professionals in practicing safer management of aggression and violence in Ugandan psychiatric hospitals, resulting in safer in-patient care and safer work environments for mental health staff.

Making a difference

The Psychiatric Clinical Officers (PCOs), who lie between the nurses and the doctors in Uganda, have greatly benefitted and still continue to reap the benefits of this ongoing link. Mr. Mathias Nampogo, the Chairman of the Uganda National Association of Psychiatric Clinical Officers, acknowledges that there is now a greater synergy among the members in Kampala, Jinja, Mbale and Soroti districts. This renewed sense of team work has led to improved attitudes and better management of aggressive and violent cases, thus an overall improvement of in-patient care. In Jinja district for example, a user group has been formed (Schizophrenia Fellowship) and PCO’s now encourage the patients in sustainable livelihood activities.

During exchange visit trainings and workshops a lot has been learned and shared in cognitive psychotherapy, alcohol and substance abuse, post traumatic stress disorder and psychotherapeutic skills.

Rebecca Wandeka, a PCO at Butabika, spent 4 weeks on the exchange programme and was amazed at the differences between Uganda and the UK. ‘The patients in the UK have rights!’ she exclaimed. ‘Rights to choose the type of treatment for example a tablet over an injection.' This was such a contrast from what she was used to in Uganda where a patient is rarely given an option.  Rebecca has learnt how to spend more time listening and talking to the more aggressive patients.

This health link has been able to address the difficulty the hospital faced in terms of frequent assaults by patients on staff and other patients. Further still, other health centres across the country have also gained a better understanding in the management of aggression and potential aggression of mental health patients.

IHLFS Team, British Council Uganda