Global Mental Health Inside Story: Joseph Atukunda, Kampala, Uganda

picGMHISJosepgprofilepicThis is the seventh interview in the Global Mental Health Inside Stories series. In this series I want to collect and spread information/ideas from people active in mental health from all over the world and specially from low resource settings or fragile countries.
I hope this series contributes to more insight in the challenges and wishes from people active in these settings and adds to a more bottom up movement in global mental health.
Joseph Atukunda answered the 10 interview questions as follows:

Work location and some background information:
I am Joseph Atukunda, an accountant by profession with a higher diploma in accountancy. Located in Uganda working as the National Coordinator and founder of Heartsounds Uganda (Mental Health Champions), a mental health service user led and managed organization. Our head offices are on Ave Maria Road Nsambya, Kampala.
I worked as accountant/administrator of Action Against Hunger ACF (USA) for 3 years and Logistics Coordinator for International Medical Corps IMC Uganda for 5 years.
Started suffering from mental Health problems in 1989 and founded Heartsounds Uganda in 2009.

Brief country profile:
picGMHISJosepUgandaInformation from International Journal of Mental Health Systems, 2010: Uganda is a landlocked country located in East Africa with an approximate geographical area of 236,040 square kilometers, of which about 15.4% is covered by water. As of 2006, the population of Uganda was estimated to be 27.4 million people, of these 48.6% were males and 51.4% females. An estimated 12.3% of the population were living in the urban areas while 87.7% were living in the rural areas. The life expectancy at birth for males was 50.7 and 52.7 for females, while the literacy rate for men was 76% and 61% for women.
English is the official language taught in schools, used in courts of law, most newspapers and radio broadcasts; while Luganda is the most widely used native language. According to the 2002 National Population and Housing Census, the population is predominantly Christian, composed of: Roman Catholics (41.9%), Protestants (35.9%), Muslims (12.1%) and others (10.1%).
Based on World Bank criteria, Uganda is a low-income country. The average per capita income in Uganda is USD 300, with 31% of the population living below the poverty line. This economic situation has implications for mental health in Uganda, given emerging evidence from low-income countries that mental illness and poverty have a dialectical relation, reinforcing and exacerbating each other.
The capital Kampala, where where Heartsounds Uganda operates, counts 1.72 million people.
Mental Health Services are still significantly underfunded (with only 1% of the health expenditure going to mental health), and skewed towards urban areas. Per 100,000 population, there were 1.83 beds in mental hospitals, 1.4 beds in community based psychiatric inpatient units, and 0.42 beds in forensic facilities. The total number of personnel working in mental health facilities is 310 (1.13 per 100,000 population). Only 0.8% of the medical doctors and 4% of the nurses had specialized in psychiatry.

picGMHISJosephLogoHS
Overview of work activities:
Heartsounds Uganda (HSU) is a mental health service user-led Community-Based Organization (CBO), registered with Kampala Capital City Authority. We work towards complementing the mental health system (family and community support among other services), in order to have a holistic approach towards the management of mental illness for successful recovery of those suffering, enabling them re-gain a meaning to life again.
Objectively, HSU works to: Raise awareness to the community on Mental health issues; Defend and advocate for the dignity of service Users (mental health patients and psychiatry survivors); Uphold the UN conventions on Rights and Dignity of Persons with Disabilities (UN CRPD) as far as mental health service users are concerned; Offer complementary support to mental health service users in form of peer support; Protect HSU members from stigma and discrimination; Establish social-networking service center(s).
The organization currently has 105 registered mental health service users. It also has a board of trustees comprised of seven service users, one caretaker and three advisory members who are leaders of mental health organizations.

picGMHISJosephTeamOne of our strategies to achieve the above goals is to create a platform for people who have suffered from mental health problems to meet regularly for peer support and also mix with other people from all walks of life. We are doing this through the Heartsounds Resource Center-internet cafe. This Center is also open to the public who pay a nominal fee to surf the internet and borrow books. This partly helps us maintain the facility. As our service user members mix with the public in the center, stigma is tackled in the process and we raise awareness on mental health at the same time.
Apart from the benefits members derive from the library and the internet cafe, the organization also holds various workshops and trainings for its members. These include workshops on entrepreneurship, mental health relapse and recovery management, management capacity building for board members, self-advocacy training for some of our members, peer support training, focus group discussion training and group facilitation skills. Our members were engaged in carrying out Focus Group Discussions to evaluate work done by the Butabika East London Link in training psychiatric officers at Butabika National Mental Referral Hospital Uganda and other mental health units around the country.

picGMHISJosephMeeting1Heartsounds Uganda got through the Butabika Link a two year funding from the UK Department for International Development (DFID) in order to train our members to become formal peer support workers. So far 26 service users have been trained and are providing mental health peer support to mental health service users within the Kampala Metropolitan Area who are discharged from Butabika Hospital (home visits).
Heartsounds Uganda, the Ugandan National Cultural Centre and the Uganda Film Club have started the Kampala Mental Health Film Club. We show one film on mental health every month viewed by our members, mental health professionals, policy makers, legislators and the public. After the film we carry out a discussion on the insights the films has risen among the viewers.
We also have a Hearing Voices Group; members who hear voices converge every Tuesday of the week in Kampala to discuss and share experiences with the support of a volunteer consultant psychiatrist from National Health Services East London.
Currently, HSU is implementing a one year project on building the capacity of their members on the UN CRPD, advocacy and awareness, through training.
We have secured funding from the Storm Fund in the Netherlands to run a program of Creative Arts for recovery. We have named the Program BEAUTIFUL MINDS.

Heartsounds Uganda as a growing CBO has developed a ‘unified voice’ for service users that is influencing and changing the interests of the service provision, law, policy, rights and community acceptance and inclusion in development programs, among other things.

(note: you can watch a 16 minutes video about Heartsounds Uganda here)

The main challenges personally in work/study/life and for your organization:
picGMHISJosephHeartsoundsofficeDue to lack of enough funding, our offices are housed in my home where I live with my family, and there is a constant fear that a relapsed member could hurt my family. Other members also think I wield a lot of power over them by having the offices in my premises. Again due to limited funding, and because most funders require that administrative costs do not exceed 10% of the total budget, we find ourselves unable to pay our utility bills most of the times.
As we research more about mental health on the Internet by reading books, we have come across some anti-psychiatry stuff that we find difficult to ignore. Like the book Anatomy of An Epidemic by Robert Whitaker. Voicing out our thoughts, after reading such stuff, is putting us at loggerheads with the Service Providers who are meant to be our partners.

The main challenges for the country regarding mental health care:
From the International Journal of Mental Health Systems: Despite the reforms and subsequent improvement of mental health services, Uganda’s mental health system still faces a number of shortcomings. The current Mental Health Act, last revised in 1964, is outdated and offensive. Furthermore, there is a general lack of trained human resources and a scarcity of funding, with no special provisions for mental health funding in the draft mental health policy.

What should be changed in mental health care on a local or national level:
picGMHISJosephFlipChartWe need more funding in the mental health sector, more professionals trained and better medicines.
We need to move more into the direction of Primary Community Health care and move away from institutionalizing patients.
The psychological approach of treating mental Health patients should be given more emphasis and we stop relying mostly on the chemical approach. Medical service providers tend to rely more on the chemical approach as its easier but we need a holistic approach where the psychological needs of the patients are also taken care of. Uganda has very few psychologists on the payroll and Heartsounds Uganda is going to take this on as an Advocacy Issue.

What is the right direction for the global mental health movements:
User involvement and empowerment as experts by experience.

What can ICT, mhealth and e-learning contribute to mental health care:
Most mental health patients are lonely people and most times shy. ICT helps them safely interact with other peers and professionals, that is why Heartsounds Uganda started an internet café where our user members use the café free of charge.

Other thinks you want to share?
I was awarded a Commonwealth Professional fellowship and spent 3 months in Britain hosted by East London NHS, Sept to Dec 2012. You can read about my experiences (after signing up) in this blog post.

We are running a small nice and cosy Guest house at our centre. Those from abroad who are interested in visiting us to see our activities, can stay there at fair prices with meals just £20 a day with wifi internet connection and DSTV.

Links and contact information:
Website: Heartsounds Uganda
Mail address: josephheartsoundsug@gmail.com
Address Heartsounds: Ave Maria Road Nsambya, Kampala, Uganda, Africa

With many thanks to Joseph Atukunda!
Roos Korste, psychologist, international trainer and blogger

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