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From Stress to Strength: Supporting Mental Health In Unprecedented Times

1 June 2022


Country Spotlight

Uganda is a low-income country with a population of 38 million. Uganda spends 9.8% of gross domestic product on healthcare, or US$146 annually per person. Less than 1% of this goes into mental healthcare, compared with 10% in the UK (World Health Organization, 2016).

The Gulu Sheffield Mental Health Partnership was established in 2012, with the main aim of improving the quality of mental health service delivery in Gulu. The partnership is between Sheffield Health and Social Care NHS Foundation Trust and Gulu Regional Referral Hospital which is one of the 14 regional referral hospitals in Uganda.

The partnership has been working together to deliver mental health awareness training, RESPECT training (an ethical approach to manage violent and aggressive patients) and suicide awareness and prevention training at Gulu Regional Referral Hospital, among other activities. The trainings and projects implemented through the partnership have created awareness and minimized stigma, while improving mental health care in Gulu district.

However, on March 21st, 2020, Uganda reported its first case of COVID-19 and suddenly everything changed. People started living in fear, lockdowns were imposed, face masks had to be worn everywhere, and hand-washing and social distancing became mandatory. Communal and social lives, as well as practices like shaking hands, visiting family and friends, and sharing, were discouraged. This affected people’s daily lives and their mental health.

Mental health service users in the Gulu were heavily affected; some no longer wanted to attend the hospital for drug refills due to the fear of getting infected, coupled with high transport cost as public transport was banned. There was a big drop in the number of patients coming to the hospital for review and drug refills. Instead, there was an increase in the number new patients breaking down mentally due to the high levels of stress experienced following disruption to their routine.

Through the Gulu Sheffield Mental Health Partnership, we were able to send announcements to radio stations in Gulu district to encourage the public to continue coming to the hospital to access mental health care.

While the pandemic affected everybody either directly or indirectly, psychologically it affected health workers heavily. As other sectors were being closed and workers asked to go home, health workers were instead pushed to the frontline, facing a disease that very little was known about and for which there was no cure.

In October 2020, due to the urgent need for Mental Health and Psychosocial support, Gulu Sheffield Mental Health partnership allocated the unspent Suicide Awareness and Prevention training fund to train 43 health workers from various health facilities within Gulu in the treatment of COVID-19 patients. The positive feedback, comments and recommendation from the trainees motivated us to keep supporting each other mentally and psychosocially.

As the number of COVID-19 patients increased, the regional referral hospital became overwhelmed and the government offered for some patients to undergo home-based isolation and care. This meant that more health workers needed to be trained to link with the Village Health Teams to follow up with and care for patients.

Our response: Mental Health and Psychosocial Support Training in Gulu Regional referral Hospital

In May 2021, the Gulu Sheffield Mental Health Partnership secured a grant through THET’s COVID-19 Response Fund for a six month mental health and psychosocial support training project. Through the project, a total of 180 health workers were trained to support the increasing number of COVID-19 patients.

One of the trainees had this to say:

“I went through a lot of stress when the first cased of COVID-19 was report in Uganda in March 2020. I had fear that I would get infected and infect my family, and also fear of death. When the COVID-19 cases started rising in Uganda in May 2020, I requested to go on 21 days leave which was granted. At home my landlord wasn’t comfortable, she told my wife that they don’t feel safe to stay in the same environment with a health worker as they may get infected, after some days she approached me and informed me that she would like to renovate the house I’m in. Indirectly she wanted me and my family to leave, I had no choice except to move to my unfinished building in a village about 7 kilometers away from my work station. My 21 days of leave expired at a time when the cases were just increasing more and more but I had to go back for work with a lot of stress.

But after attending two days of training in mental health and psychosocial support, I got a big psychological relief, strength and life skills to continue with my work as I was trained on how to cope up with stress, how to offer Psychological First Aid interventions, how to identify people who need additional support, promotion of safety, access to basic needs, and linking infected individuals to health care.

The project was timely as it came before the second wave of COVID-19 in Uganda. However, responding to public health emergencies such as COVID-19 requires offering mental health and psychosocial support to the responders before deployment, during the response and also after the response.

– Opiyo Nicholas, Covid Project Lead, Gulu Sheffield Mental Health Partnership


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