Dynamics of covid-19 and mental health treatment

BY Irene Abalo Otto

When Uganda’s health care systems began experiencing a surge in covid-19 cases from June, 2020, some regional referral hospital mental health units were converted into Covid Treatment Units, CTU.

“We resorted to the mental health unit because of the nature of how it had been constructed. It could easily be zoned (to prevent infections spreading to other patients in the hospital). Sooner or later, we realised we had run into trouble with mental patients. We did not have where to put them. We tried putting them in other ordinary wards but the other patients were complaining. We were lucky that we had Kyabakoza Health Centre II, which was constructed but not yet used and it has a fence,” Dr. Nathan Onyachi, the Masaka Regional Referral Hospital Director explained on Sunday. The district allowed the hospital to temporarily use the health centre as their mental health unit.  

In June, Arua Regional Referral Hospital shifted their mental health unit to the Ear, Nose and Throat admission room after the unit was turned into a CTU. Twenty mentally ill patients on admission were relocated. 

“Two of the mentally ill patients were found mixed with covid patients in the red zone. After four months when they shifted to EAT, some patients started escaping to go back to their old mental health unit which had covid patients. Up to now, the hospital is struggling to keep the mentally ill in their new location,” Mr Stephen Candia, a journalist in Arua who also attended covid task force meetings where reports would be presented on emerging issues told Daily Monitor. The management of the hospital declined to speak to Daily Monitor on the current situation. 

Other referral facilities have had to adapt and change their method of operation to avert such challenges.  

Masaka hospital realised that after shifting their Mental Health Unit to Kyabakoza Health Centre II, a new nearby facility, they needed to adopt consellign of relatives to manage their patients from home rather than admit them at the health facility. 

“Covid units have zero patients for the first time. We are keeping our fingers crossed. We do not want to get excited. We hope that it means the disease is going down. If we spend some time without receiving covid patients, we shall consider returning the mental health unit probably by the end of February,” Dr Onyachi said adding that;

“Fortunately, our mental health staff found innovative ways of avoiding admission of mental health patients. They started giving longer acting medicines that could keep them at home and somehow they have coped. Probably the worst thing they have done is to detain a patient a day or twenty four hours and then let them go home. It is also a good thing for them (staff). They did not think they could do it but they have done it,”

At Lira Regional Referral Hospital, service models also changed during the covid period by venturing more into community outreach than waiting for patients to come to the hospital. This was intended to reduce crowds at the facility to prevent the spread of covid-19 that would exacerbate the situation of the mental health patients.

“We are now doing community outreaches to have mental health patients access care. Our team of professionals go out to the patients in areas that we have mapped. There are just a few people (with mental health illnesses) coming to the health facility,” Dr Steven Oboo, the Director Lira Regional Referral Hospital said on Thursday last week.

Mental health medics say the lockdown measures instituted by the government made some patients miss out on their medications.

“They missed out on their medication. When they locked down, most health facilities had not yet delivered the medicines. They were still preparing to replenish, then the lockdown came and the facilities were still waiting for their supplies. Somehow, there were these relapses. Once there is a relapse, people sometimes have to be admitted to first normalize and calm them down, The medicines became available after the lockdown,” Dr Hasifa Nkwata, the Commissioner in charge of mental Health at the Ministry of Health told Daily Monitor last week.

This forced the patients to seek care from other facilities before options could be found for space within the existing space in the hospitals to accommodate mental health patients.  This affected the conventional set up of care for mental health patients.

“Initially, when we had just started (covid lockdown) everything was okay. However, when the lockdown ended, other services somehow continued but the mental health services suffered because there was nowhere they could be. Our units were being used as the Covid Treatment Units,”

Since the phased lifting of the lockdown began on June 4, Butabika Hospital received a high number of patients.
Dr Juliet Nakku, the deputy executive director of Butabika National Referral Mental Hospital, told Daily Monitor in July 2020 that between July12 and July 18, the hospital received about 1,050 cases needing admission, yet previously they received between 800 and 900 patients per week.
Butabika Hospital has a bed capacity of 550.  

“We do not know exactly what is causing the surge, but we suspect it could be due to two reasons. One is the fact that mental health services are not being accessed in other parts of the country.” Dr Nakku told Daily Monitor in July.

But currently, the referral facilities are adapting to the change in service delivery.

“For the referrals, it is not true that people were being referred officially to Butabika. Only that when services were not available, those who were taking care of those patients had to get other alternatives and that is how we saw the people getting into Butabika hospital. Whoever would fail to find proper care, they were shifting to Butabika,” said Dr. Nkwata.

There is no clear statistic to show the current number of patients seeking mental health care are both regional and national levels. But the commissioner mental health said fewer patients are on admission at referral facilities. Most patients are being attended to at the out-patient department, treated and they go back home.

Arua Regional Referral Hospital, Fort Portal Regional Referral Hospital, Gulu Regional Referral Hospital, Hoima Regional Referral Hospital, Jinja Regional Referral Hospital, Kabale Regional Referral Hospital, Old Mulago Hospital, Lira Regional Referral Hospital, Masaka Regional Referral Hospital, Mbale Regional Referral Hospital, Mbarara Regional Referral Hospital, Moroto Regional Referral Hospital, Mubende Regional Referral Hospital, Soroti Regional Referral Hospital.

The pandemic shifted most attention from other sicknesses at various health facilities to prevention or treatment of covid-19. Some mental health patients are on long term treatment and require refills after a specific period of time.

“She has to take medicine every day. She cannot skip. They are treating her for mental health. She used to speak to herself. I have come to pick medicine for my mother. She was admitted here for many years but when she was discharged, I took the responsibility upon myself to get her medication from here,” Ms Namudu Lillian, a 20 year old daughter of a mentally ill mother of seven from Mukono district. Ms Namuddu is a Midwifery student at Muyenga in Kampala. Namuddu was speaking to Daily Monitor from Butabika Hospital on December 2, 2020. She has grown up seeing her mother struggle with mental illness for about fifteen years after her mother’s marriage went soar. The marriage eventually broke and her father remarried. Her mother remains single.

“She wants to speak only to me. The rest of the time she is there quiet. She just sleeps in the bed. She tells me that she wants to come back here (at Butabika hospital). She says there is freedom. When she had just come back (home) from here, she used to demand us to care for her. She wants you to bath her, feed her. She never wanted to bath alone. It reached a moment when we left her to care for herself. The bad thing is that she is weak. So she stays in bed most of the time,” said Ms Namuddu.

Information obtained from medics at Butabika National Mental Hospital details that the number of out-patients visiting the unit were mainly re-attendances which does not indicate an increase in the number of admissions at the government facility from June to October 2020. 

The medics spoke anonymously because they do not have authority to speak to the media. The main mental disorders for which people seek mental health care include; epilepsy, bipolar, schizophrenia, depression and dementia.

In 2019, Butabika hospital received about 12,855 patients seeking treatment for epilepsy, 11,354 for bipolar, 10,344 for schizophrenia and 2,437 for depression. Daily Monitor is yet to get the figures for 2020 from the hospital due to bureaucratic requirements for access to the statistics.