A total of 730,668 people aged 10 years and above in the Tooro and Rwenzori sub-regions are living with various mental health disorders, according to the 2024 National Housing and Population Census. The sub-regions have a total population of 3,378,840 people.
The census report states that the disorders include psychological distress, bipolar disorder, depression, anxiety, psychosis, and suicidality. This hints at a widespread and growing mental health burden in the sub-regions. Kasese District has the highest number of people affected, 169,711 individuals; followed by Kyegegwa District with 159,281; and Kyenjojo District with 118,219, the report states.
It adds that the three districts alone account for more than half of the total mental health cases in the two sub-regions.
Despite the high demand for care, Fort Portal Regional Referral Hospital is the only specialised facility with a mental health unit serving the sub-regions. However, the facility is understaffed, underfunded, and overwhelmed.
The unit’s principal psychiatrist, Dr Martin Ibanda, says due to the increasing number of admissions, the facility is overwhelmed.
Rising cases
Dr Ibanda explains that the rising numbers have forced some patients to sleep on the floor, while others are discharged earlier than recommended to create space for new admissions.
‘We are handling about 100 patients every day. To serve them better, we established specific clinic days: on Mondays and Fridays, we conduct major ward rounds; Tuesdays are for epilepsy patients; and Wednesdays are dedicated to patients with drug-related mental disorders,’ he says.
He adds that the hospital conducts quarterly outreach programmes in various districts to follow up on patients who have previously visited the facility.
‘We are supposed to have regular outreaches and home visits, but this remains a challenge because we are not well facilitated. We should be visiting patients and their caretakers in their communities to offer support, but limited resources make this difficult,’ Dr Ibanda explains.
The principal psychiatrist emphasises the urgent need for the government to equip lower-level health facilities in districts to manage mental health cases before they reach the regional hospital.
‘District health facilities need to provide mental health services so that patients can first be attended to before coming here. That way, this facility can handle only referred cases. After we discharge patients here, those lower facilities should also provide follow-up care to help reduce congestion at the regional hospital,’ he says.
He adds that drug and substance abuse are the leading cause of mental health disorders in the sub-regions. He says poorly equipped lower health centres are causing overcrowding at the regional referral hospital.
Patients who should be checked at nearby facilities keep coming back because those centres lack mental health services.
Dr Ibanda adds that feeding admitted patients is also a challenge, as limited funding allows the hospital to provide only one meal a day.
Staffing challenges
Dr Ibanda says the mental health unit is supposed to have seven psychiatric clinical officers, but currently, only four are available. Similarly, the facility is expected to have 28 psychiatric nurses, yet only 16 are on staff.
‘The government has not recruited enough professionals in mental health. Even the few available are overstretched. When I go for support supervision, I often find a single psychiatric-trained nurse who is also running the HIV clinic, yet they must still attend to mental health patients,’ he says.
He adds that the regional referral hospital lacks a rehabilitation centre for patients recovering from substance abuse and other mental health conditions.
‘When we treat patients and they regain their senses, especially those with drug abuse issues, we are supposed to rehabilitate them before reintegrating them into the community. Unfortunately, we don’t have a rehabilitation centre. Those who can afford it go to private facilities or to Butabika hospital in Kampala.’
Depression
Dr Ibanda says: ‘Depression accounts for about 32 percent of the patients we attend to. It often goes unnoticed because many patients take time to disclose their condition. In severe cases, depression can lead to attempted suicide. Most of these patients don’t come directly to the mental health unit-they first report to the general ward and are later referred here after being identified.’
Dr Archbald Newton Sebahire Bahizi, the executive director of Fort Portal Regional Referral Hospital, says the hospital recently trained some health workers to begin handling mental health patients.
‘We trained some of the health workers from district health facilities at health centre IV level to start handling such patients and to open up clinic days at their facilities,’ he says.
He emphasises that addressing the growing mental health crisis requires a multi-sectoral approach that goes beyond the health sector alone.
‘To end this vice, we need a multi-sectoral approach. For instance, when police are having community policing meetings, a health worker should be brought on board to talk about these issues – in schools, churches, and other community gatherings,’ Dr Bahizi explains.
Sensitsation
Dr Bahizi notes that sensitisation is key to ending stigma and misconceptions surrounding mental illness.
‘People need to know that a mental health disorder is not witchcraft or a family curse. Our people need to be sensitised so they know where to seek help,’ he says.
He warns that lifestyle choices and substance use are contributing to the problem.
‘People need to shun all possible causes. Today, a lot of things are being produced, and people consume them for relief but in the long run, they affect the body and mind. When it becomes severe, some people end up committing suicide, while others turn violent,’ Dr Bahizi says.
Mr Isaac Mugisa, the executive director of Humura Vulnerable Children and Youth Support Organisation in Fort Portal City, says with funding from NASF, they are implementing a one-year project in Fort Portal aimed at raising awareness about mental health. The project targets about 500 victims through breaking the silence on mental health advocacy.
‘We want to end stigma, restore hope, and strengthen communities. We are holding community dialogues, training teachers, health workers, and youth leaders on how to support mental wellness,’ he says.
Mr Mugisa adds that they are also working on policy advocacy with Fort Portal City to prioritise mental health in planning, ensuring there is a budget to address it, and establishing support groups and referral pathways for affected individuals.
The Kasese District Health Officer, Dr Amon Bwambale, says during the 2024/2025 financial year, the district recorded 642 mental health cases, of which 160 were linked to drug and substance abuse.
Dr Bwambale attributes the rise in mental health cases to poverty, unemployment, negative social influence, alcohol consumption, and substance abuse. He also cites anxiety, depression, manic episodes, epilepsy, and an increase in suicide cases across the district.
‘We need to work together to integrate mental health actions and responses into our health programming. This will help promote people’s mental wellbeing and advocate for policy changes that prioritise mental health,’ he says.
Statistics on mental health in Tooro and Rwenzori sub-regions for people aged 10 years and above [Ubos 2024]
Fort Portal City: Psychological distress 11,298, bipolar disorder 2,865, depression 8,005, anxiety 3,831, psychosis 1,609, suicidality 919.
Bunyangabu District: Psychological distress 18,635, bipolar disorder 7,019, depression 12,144, anxiety 3,994, psychosis 2,218, suicidality 867.
Kabarole District: Psychological distress 17,953, bipolar disorder 5,487, depression 12,015, anxiety 5,213, psychosis 2,529, suicidality 1,264.
Kyejonjo District: Psychological distress 49,684, bipolar disorder 23,324, depression 26,634, anxiety 11,411, psychosis 4,989, suicidality 2,177.
Kyegegwa District: Psychological distress 51,581, bipolar disorder 20,768, depression 31,950, anxiety 19,476, psychosis 9,554, suicidality 1,348.
Kamwenge District: Psychological distress 24,186, bipolar disorder 6,522, depression 14,503, anxiety 7,511, psychosis 4,710, suicidality 1,336.
Kitagwenda District: Psychological distress 15,061, bipolar disorder 6,173, depression 7,637, anxiety 2,327, psychosis 1,424, suicidality 715.
Kasese District: Psychological distress 68,803, bipolar disorder 25,997, depression 42,043, anxiety 18,608, psychosis 10,123, suicidality 4,137.
Bundibugyo District: Psychological distress 25,286, bipolar disorder 11,291, depression 13,309, anxiety 6,886, psychosis 4,394, suicidality 1,856.
Ntoroko District: Psychological distress 6,984, bipolar disorder 2,305, depression 4,829, anxiety 2,197, psychosis 1,089 and suicidality 548.