Make mental health services affordable

“Mental health is not a luxury, but a necessity. It is not a choice, but a right. It is not a matter of charity, but of justice,” said Dr Tedros Adhanom Ghebreyesus, the Director General of the World Health Organisation.

As part of the Nation Media Group (NMG) Uganda mental health awareness campaigns, the Daily Monitor and NTV Uganda had a news story shining light on the workplace mental health crisis. One of the issues that struck me the most from the story was the high cost of seeking mental healthcare services. 

Even though mental health is a growing concern, it remains one of the most underfunded and neglected areas in healthcare, particularly in Uganda. Last year, the acting assistant Commissioner of Mental Health and Control of Substance Abuse at the Ministry of Health, Dr Hafsa Lukwata, revealed that mental health takes up less than one percent of the total budget allocated to her ministry.

Much as we are encouraging people to seek help, including going for therapy, most Ugandans are unable to afford such services because their incomes cannot allow them. Recent reports by the International Association for Suicide Prevention, and the World Health Organisation, highlight both the severity of the mental health crisis in Uganda and the substantial financial barriers that prevent many from accessing necessary care. 

A report released by the Bank of Uganda in 2022 indicated that of the 22.8 million working Ugandans, only one percent earn more than Shs1 million, while 49.2 percent earn less than Shs150,000 per month. An earlier survey, funded by the same institution indicated that at least 17.2 million (70 percent) Ugandans out of the 24.6 million adult population, rely on family and friends, meagre personal savings, and borrowing as a coping mechanism to survive. 

Yet, the Daily Monitor story reported that some therapy sessions in Kampala City range between Shs100,000 and Shs150,000 per hour. Medications for conditions such as depression and anxiety add to this burden, with one pill costing as high as Shs3,000 for a patient who needs two prescriptions daily for treatment that may stretch for months, depending on the severity of the condition. These economic challenges and expenses make continuous mental health treatment unsustainable for more than two-thirds of Ugandan workers, forcing many to abandon mental health services and suffer in silence.

These consequences have significant implications for employers alike. Unaddressed mental health conditions lead to decreased productivity, higher absenteeism, and increased turnover rates. The Daily Monitor story, produced in partnership with The Bill and Melinda Gates Foundation, highlighted stress, anxiety, and depression as rampant among employees yet stigma associated with mental health conditions often prevents them from seeking help, in addition to high costs.

This situation results in a vicious cycle where untreated mental health conditions are exacerbated, leading to more severe consequences both for individuals and the organisation. That’s why we need to normalise conversations around investing in mental health services the way we are creating awareness, not just as a moral obligation but as a sound economic strategy.

In a promising development, the US government has committed $1 million (about Shs3.7 billion) aimed at improving mental health services in Uganda. As announced by the Embassy at the beginning of this month, this investment includes funding for training community members to be mental health providers, thereby developing affordable community-based mental health services, and supporting awareness campaigns.
By increasing the number of trained mental health providers at community level, the initiative aims to lower the cost of services through greater availability and competition.

Community-based services promise to provide more affordable care options, particularly for those in rural areas who face additional barriers such as travel costs.  The Mental Health Integration three-year project, funded through USAID/Local Works and implemented by StrongMinds, a local partner, is critical in reducing the cost barrier to mental healthcare.

Whereas awareness campaigns are vital in reducing stigma and encouraging more people to seek help, driving demand for more affordable services will go a long way in addressing this issue. Partnerships between employers and mental health service providers such as StrongMinds, Mental Health Uganda and Butabika hospital, among others, to negotiate lower rates for available services, are crucial.

Beyond conducting workplace surveys, employers can play a key role by also incorporating mental health benefits into their health insurance plans, for those who have them, subsidising therapy sessions, and offering on-site mental health services.  

Further, let’s empower workplace managers to recognise signs of mental distress, foster open communication about mental health, and implement policies that support mental well-being as we navigate through associated costs. 

This comprehensive approach is crucial and avails a sustainable mental health infrastructure that is both accessible and affordable.

Johnson Mayamba, [email protected]