Margaret was engulfed by depression and overwhelmed by stigma. With little motivation for life as she struggled to adjust to living with HIV while pregnant, she contemplated death. “I could lock myself in the house every day. I wanted to kill my child and kill myself because I thought I was no longer useful in this life and I didn’t want my child to suffer as I did,” she says.
In her village in northern Uganda, a community-based counselling group is helping people living with HIV by providing psychosocial therapy to better cope with and overcome mental health conditions. Adjusting to living with a chronic infectious disease can be difficult. People living with HIV face a greater risk of developing mental disorders, with depression and anxiety among the most common comorbidities they face. Margaret credits the counselling group for her survival.
Operating in Uganda’s northern districts of Gulu, Kitgum and Pader, the community-based counselling group known as the Social-Emotional & Economic Empowerment of Depressed HIV Persons through Knowledge of Group Support Psychotherapy (SEEK-GSP) not only helps patients through the difficult psychological crisis, it also provides economic support for self-sufficiency.
Group support therapy
Sessions are carried out through group support therapy, which entails bringing people facing the same mental health challenges together to share experiences, encourage and support each other to tackle and defeat the challenges. Under the SEEK-GSP programme patients go through eight sessions that include psychotherapy, problem-solving and providing business skills to improve livelihood.
“One of the advantages of GSP [group support psychotherapy] is that it does not require ongoing intervention by expert mental health practitioners. Instead, we trained existing primary health care workers in rural centres to deliver GSP sessions to affected people,” says Etheldreda Nakimuli-Mpungu, a consultant psychiatrist and principle investigator with the SEEK-GSP project.
Since 2010, more than 200 community health workers and village health team members have been trained under the SEEK-GSP programme to recognize and treat depression. They provide psychosocial support to people in villages through group support psychotherapy and to date have treated depression in more than 5000 people living with HIV/AIDS.
“I have more confidence in life,” Margaret says. “I know that if I continue to take my medication correctly, I can live a normal life with HIV and do all my chores without fear.”
Dr Hafsa Lukwata, the head of the Mental Health Programme at the Ministry of Health, says that the government is working to improve mental health care in the country, including through training of nonmedical staff on mental health care, boost public education initiatives and advocate for increased global funding for mental health care, including among people living with HIV/AIDS. In recent times, the heightened socio-economic depression from health emergencies including COVID-19 pandemic and response measures has further necessitated multisectoral action to improve mental health.
“We plan to strengthen the links between the Ministry of Health and technical and social partners, including NGOs, the education sector and civil society to support health innovations in Uganda such as the SEEK-GSP programme,” says Dr Yonas Tegegn Woldemariam, the World Health Organization (WHO) Representative in Uganda.
Dr Yonas explains that WHO plans to work with various advocacy platforms, including the Uganda ParliamentaryForum on Mental Health to help implement mental health-promotive laws, promote GSP and other innovations in all countries and encourage multi-sectoral commitment to mental health.
Investment in mental health remains very low in Africa. On average, African Ministries of Health allocate about 90 US cents per capita on mental health, up from 10 US cents in 2016. However, this is often allocated to large psychiatric institutions in the major cities with only about 15% getting to the primary and the community health levels, which are closer to the majority of people in need of mental health services
This year’s World Mental Health Day theme is Mental health care for all: let’s make it a reality— a call to government leaders to make quality mental health care for all a reality.
For the SEEK-GSP programme in Uganda, the next step is to expand operations nationwide. “In future we want to train a thousand lay health workers in each of Uganda’s five geographical regions. This will enable us to treat up to two thousand people a year,” says Dr Nakimuli-Mpungu.
She points out that the project has the potential to fill the gap in the treatment of depression, especially among people living with HIV/AIDS, reduce HIV transmission and protect families from hunger as well as enable more children to stay in school.