Mental illness presents as a major burden to societies with substantial distress to affected individuals, families, communities and resulting in high social, human and economic costs (Wait Harding 2006, Dewa et al 2007)
The prevalence of mental illnesses in the Ugandan population is estimated at 35% compared to 13% worldwide prevalence with 3% prevalence of severe mental illness (Demyttenaere 2004). Many low income countries like Uganda lack the adequate human and financial resources to provide specialized mental health care for people affected by severe mental illness (Kigozi et al 2010). Specialized mental health services are mainly located in urban areas not easily accessible to many people who, worse still lack information about mental health. Challenges in accessing formal treatment include: long distance from health facilities, frequent medication stock outs, family negligence and shortages in human resource, preference of traditional healers and spiritual healers as first contact in attempt to seek for healing. This has always caused delay in the process of recovery.
In 2010, Uganda had only about 1.13 health personnel per 100,000 with all cadres included: like psychiatrists, psychologists, social workers, resource occupational therapists, nurses and other medical workers (Kigozi et al 2010). The current situation shows that it has even lowered to 1.02 per 100,000 indicated as follows: 0.08 psychiatrists, 0.2 psychiatry clinical officers, 0.01 psychologists, 0.78 nurses, 0.04 other medical doctors, 0.01 occupational therapists and social workers. This is by all standards far below the average ratios of many nations (Kigozi et al 2010). In addition, the mental health sector receives only 1% of the health sector budget finance and much of this finance goes to the national referral mental health hospital of Butabika, making it almost impossible to handle most mental health challenges and eventually building up a gap in service delivery and affecting the delivery of community mental health services.
It may therefore be helpful to explore the integration of Peer Support Workers (PSWs), who are defined as people with a lived experience in mental health and have accepted to openly share their experiences for the benefit of others who are still stricken under the power of self-stigma and poverty. They are to be integrated in the government health sector to bridge the gap in human resource (staffing shortages through co-production in these low income countries and to tap or benchmark their enriched experience as a tool for recovery). It is this experience of PSWs that shall empower and inspire those service users who are still reserved about their mental health status to realize that recovery is possible and can become productive.
Community mental health services are not well established in Uganda due to the lack of qualified staff. This is a contributing factor to the gap in knowledge about mental health in the communities.