Mental health inclusion is very necessary

Inclusivity is a human right for all people, including people living with mental illness. It is also an important part of recovery from mental illness. Inclusion involves feeling accepted, having individual and collective agency to determine participation and the removal of structural and attitudinal barriers to participation.

It is sad that social exclusion of people with mental illness remains unresolved not only in Uganda, but is also a global public health and human rights challenge. Inclusion of people with mental illness in most low and middle-income countries is sparse, which is problematic because explanatory models and consequences of mental illness, and the extent of stigma and social exclusion, differ across cultures. In Uganda, people living with mental illness face widespread social-cultural, economic and political exclusion.

People with mental illness are stigmatised as a consequence of beliefs that they are dangerous, mad or crazy, unpredictable, lack capacity and they experience bullying, physical and sexual violence, confinement and majority of the community members perceive people with mental illness negatively and keep social distance. Stigma, discrimination and social exclusion have deleterious effects on people with mental illness.

Stigmatising attitudes towards people with mental illness are linked to poor well-being and self-esteem.
In January, Mr Frank Olong, a mental health activist at Strides of Hope, a non-governmental organisation, said there are only 33 psychiatrists in Uganda yet the number of people that suffer from mental problems in the country is 11.5 million.

Mr Olong remarked that persons with mental disorders suffer many setbacks with the most common being discrimination due to stigma. As a mental health champion and advocate, I believe promoting inclusion of people with mental illness is a key goal of human rights and global mental health programming to achieve people-centred mental healthcare. Interventions to promote inclusion should aim to minimise the impact of attitudinal, structural and behavioural drivers of exclusion.

There are local cultural strengths that can be harnessed for realising inclusion. Inclusivity can be promoted by emphasising the synergies between human rights and socio-cultural values of acceptance, unity and responsibility.

There is a clear need to increase population awareness of mental health and illness in general and strategies for inclusion in particular. Such mental health education should incorporate the socio-cultural conceptualisations of mental distress and the priorities of people with mental illness and their families, including practical barriers families face when caring for unwell family members (ie time and resource demands).

Lastly, there is an urgent need for the government to prioritise the development of rights-based mental health services that offer an explanation of, and approach to, mental illness that complements socio-cultural practices.

Given that health is just one aspect of inclusion, I am certain that attention is also needed to ensure services and systems across sectors are inclusive and accessible for people with mental illness and their families.

Ms Cherop is a mental health advocate & founder of
The Semicolon Nation. [email protected]