Mental Health: The Untold Effect of COVID-19 on Uganda's Population

COVID-19 is exacerbating the immense mental toll on a number of Ugandans as the country struggles through the second lockdown.

Behavioral and public health scientists have warned that unless addressed, mental health facilities in the country could see more Ugandans seeking treatment for disorders like depression, insomnia and depression.  

The Ministry of Health's Assistant Commissioner for Mental Health, Hafsa Lukwata says right from the beginning they realised the importance of mental health and psychosocial support during COVID-19.  

Lukwata says while the COVID-19 has been here for a year, for many it can be quite depressing for one who tests positive of the virus. She says some of the disorders will depend on how one initially reacts. 

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According to the WHO, before the pandemic hit, one billion people lived with a mental health problem. During the pandemic, critical mental health services were halted in 93 percent of countries worldwide, according to the WHO, while demand for mental health support kept increasing.   

The Impact Of COVID-restrictions and mental health 

Dr. Wilson Winstons Muhwezi, an Associate Professor of Behavioral Sciences and Mental Health Makerere University’s School of Medicine says one of the unhealthy things that are indicative of a mentally disturbed population is the level of defiance against COVID-19 restriction.

“What we see for example temptation to violate what has been prescribed for purposes of preventing COVID-19. For example, high levels of defiance. That is not normal. That certainly to us in the metal health fraternity is indicative of people who are extremely depressed by day today challenges of survival and in spite of what is prescribed to deal with the problem, they go out of the way to tray and scavenge for existence” said Muhwezi

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The level of defiance against the COVID-19 restriction have been evident in Kampala city and its suburbs. Police and the army have been photographed while battering individuals who have insisted leaving their homes even when the president sent the country into second lockdown. Kampala residents have come many excuses including faking illness to break the lockdown rules.

According to Professor Muhwezi, there are a number of people in the country who are likely to experience psychosocial challenges related to the COVID-19 public restrictions.

“Some populations are much more at risk of breaking down mentally compared to others. For example, we know that our people who are predisposed to mental illness are much more likely to break down,” said Muhwezi. He said that there who have always been seen at mental health units but with restriction on life. "We are much more likely to see our patients breaking down more that they would ordinarily do. But we also note that the poor and vulnerable are more likely to break down,” he explained

Twaweza Uganda’s Sauti Za Wanainchi survey in Kampala found that seven out ten 10 residents worried about running short of food during lockdown measures in May-June 2020. 

“In May-June 2020, during lockdown measures, seven out of ten citizens (70%) reported having worried about running out of food at least once in the previous month due to a lack of money or other resources. A little under half (43%) reported having had such worries five or more times over the same period. A majority of citizens (58%) reported that over this period they have eaten less than they thought they should, including half (50%) who have done so three or more times” reads part of the findings    

Before the COVID-19, the Ministry of Health had observed that mental and behavioral disorders are common, affecting more than 25% of all people at some time during their lives. Behavioral and mental health experts say COVID-19 is worsening the situation. They say those that test positive of the virus, fall sick of COVID-19 or their immediate family members were likely to suffer from psychiatric disorders, including anxiety, depression or insomnia.

“We know that adolescents and youth have got severe levels of distress in this COVID-19 time. Young people should be in school. They are not in school. They are at home. Ordinarily this is a population that should be fraternizing and interacting in a school setting,” Professor Muhwezi observed.

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According to the Twaweza, across Uganda, eight out of ten citizens (79%) say teen pregnancy has become a bigger problem during the Coronavirus pandemic, and half say physical (51%), emotional (51%) and sexual (46%) violence has got worse. Citizens also mention an increase in problems related to alcohol consumption (58%) and drug abuse (49%).

Treatment For COVID-19 and mental health 

Dr. Gloria Seruwagi, a public health specialist with a background in social and behavioural sciences says the poor are at a higher risk given the high cost of treating a person diagnosed with severe form of COVID-19. “The private sector has stepped in to support. But it's expensive and many families can't afford it. Development partners and civil society are also trying to support, but scope is limited.” She said

“Most Ugandans feel trapped. The second lockdown essentially means that people cannot rely on the other support systems and social networks that would have helped them cope in the absence of accessible, responsive and affordable healthcare.”  She added

Feelings of depression, stress and anxiety

Uganda Counseling Association President, Elizabeth Okell0 says it appears like the COVID-19 task force and the president did downplay the psychosocial effects of COVID-19.  She says some of the restrictions on burial may not have been well-thought-out.

“I put myself in the shoes on one who has had multiple losses and you have to go through that, you get into a period of extreme sadness because of the loss that is going on. You are locked down, multiple losses, you can’t go across the districts to bury, you are attending burials on zoom if you are privileged enough. So that pro-longed sadness is very critical,” said Okello.

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According to Okello, It is hard for many people to believe that their loved one has succumbed to COVID-19 since they were unable to witness or interact with them in their end-of-life hours.

She says restricting burial traditions or rituals exacerbates the already complicated grief and its long-term effects.

Vincent, Mujuni, a Communications, Partnerships, and Advocacy Manager with a Mental Health Organistion- StrongMinds Uganda the emerging metal health issues come when there is very little or  no mental health awareness in communities in most parts of the country. 

“ We have seen that a lot of people in our society have lost loved ones, the loss of loved ones, the loss of essential property. There are many people have been working and this time has drained them to almost zero. They have loaned out and sold out all the have just to remain coping. The loss of those things that mean and make value for you always leads you in that state where you are vulnerable,” said Mujuni whose organization mainly targets women with mobile phone-based counseling services

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According to Professor Muhwezi and others, Mental health is an active state of mind which enables a person to use their abilities in coordination with the common human tenets of society. However, despite its importance, it is often the least prioritized amongst health conditions. In 2019, the World Health Organisation said in low- and medium-income countries like Uganda where disease, ignorance, and poverty are common, a demand for a steadfast mental healthcare can seem a luxury.