67 Mental Health

Dave Baillie

Unipolar affective disorder goes towards 1/3 of global mental health burden. Schizophrenia 1/10

85% of global suicide occurs in Low and Middle Income Countries.

Big relationship between mental health, physical health, poverty. Schizophrenia shortens life span in UK by 15 years.

Uganda has around 1 psychiatrist for every million citizens.

Account for 12% of mental health burden, but 1% of funding. Most of that funding goes towards institutions rather than community.

It makes economic sense to use antipsychotics in LOMI (trials in Uganda)

It’s a bit unclear how long patients gain benefit from antipsychotics. The first gen antipsychotics are still just as effective in LOMI.

mhGAP Intervention Guide - online tool from WHO, useful to have. []

Problems:

• Is depression the same in all settings
• Who should determine how we approch this

67.1 Uganda Mental Disorders

• Eddalu = Violent Madness
• Ensimbu = Epilepsy
• Pbusiro = Learning Difficulties
• Kantaloose = Anxiety/Dizzy

Traditional healers are way way more available than psychiatrists. They have their own explanatory models of disease.

Around 80% patients will use both traditional and medical models.

Very institutional care provided at the one mental health hospital.

There’s a lot of hidden depression in the community.

HIV adds to mental health - depression, psychosis, dementia