Approaches to “mental health” in low-income countries: a case study of Uganda

Publication Date29 Nov 2013
DOIhttps://doi.org/10.1108/MHRJ-07-2013-0025
Pages204-213
AuthorIan Shaw,Hugh Middleton
SubjectHealth & social care,Mental health
Approaches to mental healthin
low-income countries: a case study
of Uganda
Ian Shaw and Hugh Middleton
Ian Shaw is a Professor of
Health Policy and Dr Hugh
Middleton is an Associate
Professor, both are based at
University of Nottingham,
Nottingham, UK.
Abstract
Purpose – The purpose of this paper is to explore the ways in which mental healthdifficulties are
approached in low-income countries, using a case study of Uganda focus down upon the issues.
Design/methodology/approach – The study involved two phases. The first was the collection and
analysis of documentary evidence and interviews with policy makers in Uganda. The second involved
interviews with health staff, traditional healers and the public in the Buganda Kingdom of Uganda. Interviews
were conducted in English or Luganda and translated as necessary. No external sources of funding
to declare.
Findings – There are differing perceptions of mental health and illness in Uganda and there exists culturally
accepted sources of support for distress. This highlights the important role of traditional healers and the
paper argues that they should be recognised for their work in mental health care.
Research limitations/implications – The paper is a small-scale study of one area of Uganda (Buganda
Kingdom), the extent to which it can be generalised is therefore very limited. However, the research is
sufficient to indicate the benefits of traditional healers in mental health care and supports an argument
towards a public mental health model.
Practical implications – The paper argues for a move in priority away from a focus upon a biomedical
model of mental health support towards a public health model and the meaningful engagement of traditional
healers. This would also necessitate a refocus of spending in the wider society.
Originality/value – The paper poses a challenge to the Global Public Health movement and questions the
relevance of expanding biomedical psychiatry in low-income countries. The paper also adds weight to
emerging literature on the value of a public health approach to mental health and illness, especially in the
developing world.
Keywords Africa, Uganda, Traditional healers, Global Mental Health, Public mental health
Paper type Research paper
Introduction
There have been arguments from the turn of this century that low- and middle–income (LMI)
countries have a scarcity of resources for mental health, inequity in access to them and
inefficiencies in their use which have serious consequences for people suffering from mental
ill health. Treatment gaps between poor and rich countries have been estimated by WHO
and others (cf. Khon et al., 2004; WHO, 2004; Saxena et al., 2007) as being as large as
76-85 per cent. In response to such arguments WHO launched its Mental Health Gap Action
Programme (mhGAP) in 2002 (WHO, 2011) and shortly afterwards a “Global Mental Health
(GMH) movement” was also set up (Manning and Patel, 2008). Both aimed for the “scaling up”
of services, particularly in primary care, for mental, neurological and substance use disorders in
LMI countries.
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MENTAL HEALTH REVIEW JOURNAL
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VOL. 18 NO. 4 2013, pp. 204-213, CEmerald Group Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-07-2013-0025

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