Breaking stigmas, promoting wellness: Phil's initiatives for mental health support and physical wellbeing in Uganda.
Phil provided workshops for hospital staff and medical students in Uganda about the benefits of physical activity and healthy eating for people living with mental illness, and he plans to create a gym at the main psychiatric hospital to improve patient wellbeing and help address cultural stigmas around mental illness.
In the West, people with severe mental illness (such as schizophrenia and bipolar) have shorter life expectancy of 15 to 20 years. In developing countries, people with mental illness die up to 30 years earlier. The main cause is not the mental disease itself but preventable physical illnesses that are linked to weight gain, often as a result of the medication taken, and poor diet and a lack of exercise.
Mental illness in Uganda is often considered a curse and attracts stigma among sufferers and their families. Sufferers are often sent to witchdoctors for treatment and excluded from family activities. In Uganda’s capital city of Kampala, the Butabika National Referral Hospital provides care to many patients with limited staff and facilities. Patients typically spend hours sitting around on the grass, and there is only one occupational therapist to help provide activities for hundreds of patients. Psychiatrists often prescribe medications which promote weight gain. Cardiovascular disease and diabetes are becoming increasingly common among patients and the broader population, with increasing urbanization and greater availability of processed food and drinks such as hamburgers and soft drinks.
Together with Simon Rosenbaum (UNSW) and other partners, Phil designs and implements lifestyle interventions to improve the physical and mental health of those with severe mental illness. It is a relatively cheap intervention that was first trialled at Bondi Junction Community Health Centre in South Eastern Sydney. Seeking to apply this model in the developing world, he and his team piloted a course around lifestyle intervention for students at Gulu University in Uganda. The course was taught to third year medical students over 2.5 days, addressing topics such as holistic health care and the need to implement interventions to address the rising incidence of non-communicable diseases such as diabetes and heart disease. The ultimate aim was to get the next generation of health workers to think differently about mental illness, and to promote the use physical activity and diet programs in treatment. They received positive feedback and are now looking to refine course content and include material across the medical course using online delivery.
Phil also collaborated with local colleagues in Kampala to deliver similar material to staff and students at Butabika. Phil, Simon Rosenbaum and Justin Richards taught a course to staff there and students from Makerere University about the rise of non-communicable diseases in the country, NCD’s role in the early death of the mentally ill, and how physical activity and diet can help. The hospital executive director, Dr David Bansangwa, supports installing outdoor gym equipment for patients to use, and with Phil’s help, plans to build a permanent gym indoors. Phil will collaborate with exercise physiologists trained at UNSW Medicine to develop activity programs for patients in the gym. Phil is also working to support a program where patients can be assisted to grow their own produce on hospital grounds to improve the quantity and quality of food they eat.
Phil’s work in Uganda is increasing knowledge among health workers and students about how best to treat mental illness. Physical activity and diet can improve the well-being of patients and extend their lives. With improved well-being comes greater confidence and capacity to be a functioning member of society. Patients can return to work and contribute to family life.
This work is also helping to reduce the stigma around mental illness in Uganda. His work is changing the attitudes of current health staff and the students who will be the next generation of health workers. The courses and gym projects at Butabika are encouraging local government to allocate more money towards mental health treatment.
Associate Professor Phil Ward is a clinical neuroscientist and Postgraduate Coordinator for the School of Psychiatry at UNSW. He heads the Schizophrenia Research Unit based at Liverpool Hospital, and has overseen the evaluation of lifestyle intervention services in the division of mental health in south eastern Sydney. Phil believes that simple lifestyle interventions can have a big impact and are very feasible in a lowresource environment like Uganda. He is determined to ensure that high rates of obesity and physical inactivity do not develop in Africa as they have in Western countries.