https://www.listennotes.com/e/8ea1edc647fa4daeb83b3220a1d53734

Foreign Hi, I'm Natalie Bitatire and I'm here with my dad, Patrick Bittere, and this is our podcast. Today we are talking about mental health. What are your thoughts on mental health and the situation here in Uganda?

Hello everybody. And it's a pleasure to be here with my daughter Natalie. And she has put me to task today to talk about mental health, an area that I am not as comfortable talking about, but it's very close to my heart because it's a fast growing problem in the country. And this beautiful country of ours, Uganda, has got such a young population and they embrace nearly anything and everything. They embrace alcohol, they embrace whatever is fashionable, they embrace social media. And some of these things come with consequences. Today you find that our health infrastructure simply can't cope. Now we have a. Generally, you could say we have a community based health system in the country, but it doesn't address mental health. And mental health comes with a stigma. And that stigma that's attached to mental health affects members of the family that have this issue and not just the individual. So it's something we shy away from and we keep under the rug, which is wrong. We've got to deal with it, we've got to talk about it, especially because it's becoming such a big problem. We really have got to focus and that's why I'm glad that you have brought this to my attention. It is something that is close to my heart and I feel we have to raise the level of awareness and the sensitivity that it requires. So it's a journey. I don't think it's going to be something we can accomplish in one shot. It's a real task for the government and I've tried to engage them at different levels and I found yes, it's a problem. We all want to deal with it, but they are overwhelmed. There are too many other problems. We've got malaria, we've had Covid came and eclipsed everything else. We had so many other diseases in the country that were taking the limited resources that we had. So unfortunately, mental health gets very little attention. We need to do a lot more.

I totally agree. I also think that there's a very different perspective because it's something young people have had to deal with more, even from my generation. It's something that we talk about more, we understand better, we can look out for each other more. So we're just more aware about it. But in your generation it was just not something that's ever discussed or it's like a problem on the side. So do you think your generation can do more? Or as a private sector, what can we do to improve this? Because we can't just leave the burdens to the government or to Butabica. It's just not reasonable in this day and age. In other countries they have apps, they have therapists, they have different kinds of community organizations to tackle these problems so that people can go there in an open way and get the help that they need.

When you say in my generation, I feel like you're talking about the age, a different age, like the ice age or the dinosaurs. No, my generation is not very far from yours. I've seen this happen in the last 50 years. I mean, I may be just over 50 or 60, but you're actually aware when you're about 30 about what's happening around you. That's when life starts for you. And I've seen the transition. The population was so small compared to where we are. It was growing, but not at the rate at which it's growing. And we were not scared. The thing that differentiates Africa from the rest of the world is our rate of growth and the young people, because Uganda is uniquely right at the top of this pile. We have such a fast growing population, such a young population. And like I said, they embrace everything. They've got so much energy, it's their hormones, their drive. And because the of our climate, we accept anything, we've been fair, we don't get extreme conditions. And that has brought about a laissez faire attitude. People are laid back and anything goes. Try this, try that, whatever drink, you just try everything. In the process, you get corrupted. So this generation that you're talking about has been dealt an unfair hand. I feel they have been hit by so much so quickly, they just can't deal with it. And there's the dilemma. Can the government come in? Because all over the world, especially in the developed world, there's a social infrastructure, a safety network that is there to hold support. These people here, they just fall through the cracks. The family system can't do anything about it. The medical services can't do anything about it. The health system is simply too weak and spread too thin. So we have a real problem. In fact, I could say we are bordering on a crisis with men. And unless we do something now to plug it, it's going to get worse. The young people are affected in so many ways and Covid came and exacerbated everything. People don't realize the effect of being locked down. Our schools, almost uniquely in the world have been Locked for the last two years. They only open this week. That two year hiatus is quite something. People need to be prepared psychologically, not just students, even the teachers. The society needed some kind of adjustment. Hey, school is coming. The government has tried with its limited resources and everybody is keen to get back. But the consequences of this lockdown will be felt for a long time. I don't want to go in the area of how many girls got pregnant. That's a discussion for another day. And that's not for it to be. But mental health is a critical issue. It needs to be addressed and we've got to do more. Look at the number of people in the hospitals. The National Hospital in Uganda, Butabika. It was designed with 500 beds. It has 1000 people at any given time. They just don't have enough beds. People are dumped there, the family dumps their relative there and they wash their hands and they think that's sort of the problem. Now some people get some attention, whether it's medicine or other therapeutic or counseling and then they are ready to go home. But nobody wants to take them out of there. So the place is congested and that's not good. We've got to do things differently if we're going to have an impact. And one thing is to start by doing what you're doing, raising awareness. We must be conscious about this. This is a problem. It's an illness like any other illness. It's got to be treated. We've got to sympathize with them, we've got to put resources there and we've got to try and get these people out of these hospitals, out of these institutions and look after them in a family environment, look after them at home, stabilize them and learn to live with them, learn to cope, learn to help them cope with living outside. There's too many people are breaking down. The number of suicides is going to keep going up. And it's just a sad story.

It really is. When I say your generation, I mean the first time someone committed suicide, when I was younger, I remember one of our aunties explaining to me in Uganda, it's such a bad thing. You even beat the body. How could this person kill themselves and do that? And the church also doesn't like bless you or do a proper funeral because it's such a taboo subject. Right. But now that I've understood more about suicide and mental health and the kind of state the person is in by the time they do that, it just, it horrified me that that's the attitude and like you said the stigma is the big problem, but also the lack of information. Like, I know a lot of Uganda has more rehabs and a lot more substance abuse now, but I've seen a lot of discussions of psychologists and even on Twitter, Africans talking about it because we don't have access to mental health. And like health care or therapists or understanding how to process things, people turn to substances. And substance abuse is a symptom of a mental health issue. It's not that you started drinking and that's what's caused your depression or that's what's corrupted you, but you've turned to that because it numbs you out or because it makes you have confidence when you have anxiety or it does something different for you. And now we're seeing so much more with alcoholism and substance abuse. Even drugs like hard drugs in Uganda, which is so scary. But people don't really have anywhere to turn or know how to talk about it, and they only have each other. And you end up getting involved in these groups and doing these kinds of things together. So, like you're saying instead of just dumping kids in rehab or pretending there's no problem, which so many parents do, because I understand it's such a difficult topic. I don't know where this taboo came from or how it was perceived when you guys were younger, but also because you didn't have to go through it the way young people do now, it's a whole different dynamic. So how would you advise parents or employers or other people who are older who don't understand it clearly, but have someone in their life struggling? Because I bet there's a lot of people who see a problem with their child or their friend or their niece or nephew, but they don't really know how to even approach it.

Now when you talk about the older generation in our days, when I was young, like I told you, I became alive to my environment. When I was about 13, 14, we were about 12 million, 10 million Ugandans in this country. The health infrastructure was there. There was one hospital, Malag hospital, main hospital, a few religious hospitals. Butabica was the main hospital until today. They are the same hospitals that are there. They're the major hospitals. Yes, Many rehab centers have come up small clinics, but we have 45 million people. In the next 25 years, we're going to be 100 million people. The infrastructure simply cannot cope with this rate of growth. So that was the first variable you've got to get a grip of. The second was in those days, simply because the health infrastructure was weak. Even in those days, it was weak. Education had just come, Christianity had come. We had to have our own traditional way of managing, putting checks and balances in place. My understanding is the taboo that came with it with mental health, with running mud, was necessary to deter people from going down that road. That's how I felt that if you commit suicide, we shall cane your body. We shall bring your body down, cane it, and we shall not pray for you, we shall put you away. That was to deter people from feeling that moment of weakness when you're on the edge. I just can't take it anymore. I want to give up. In life, no, if you give up, you're going to hell. We're going to bless your body, we're going to cane your body to deter you, to keep still on the side of fight, deal with the problems, deal with the challenges. We had many issues, health issues. People didn't understand. There was so much malaria, measles. Children were dying. People were frustrated. Child infant mortality was very high. A mother would lose her child and she feels she's given up and she wants to commit suicide. So to get them to stay strong, they put checks and measures. Those are the kind of methods they use. Of course, they are antiquated. They were draconian. They don't belong. In this day now, people committing suicide is a bad thing by any standards, and it's bad for the society. It means something's wrong, something's not being addressed. Now, I got to realize this more and more when I watched a movie, I think it was by Russell Crowe, A Beautiful Mind. And I realized so many people have mental breakdowns and people don't really understand. Now, that was a very beautiful movie and it's a classic. Those who have not watched it, please watch it because it takes you down this rabbit hole. You really think this man must know what he's doing. A brilliant mind, a scientist, but actually he had a mental breakdown and then his wife and family having to accept it. We have got to accept those who have a mental breakdown. We've got to accept it as a disease, like any illness that anybody gets. They need care, they need love, they need attention, they need help. We've got to give them as much help as possible. Now, I have come across so many young people and they think their problem is, like you said, it's because of alcohol. So we dismiss them. He's an alcoholic. But they don't realize the underlying reasons are what caused it. The frustration, the unemployment, the high aspirations. Especially now with social media. People Want to live another life. It's living a dual life. In that life, you're on Instagram and in social media and you tell people you're a celeb and you're getting along well. The reality is it's not like that. So these people really have got the odds stacked against them and they need help. And the sooner we, especially in the private sector, start addressing this, talking about this, dealing with it as parents, as communities, as a country, it's only going to get worse unless we start doing it now. So I'm really happy that you brought this subject. We may not have all the answers, but we've got to support all the organizations, especially in the private sector. We can't leave this to the government. The government has got way too much. The government has got a role to play and they must up their game, and where we can partner with them, we shall. But the private sector has got to come up and do a lot more. Those with the skills, those who can study psychology and psychiatry and doctors, the people who can specialize in this area. And we remove the stigma that's attached to mental health care so that people can deal with it factually, scientifically, and manage it. It won't go away, but let's manage it.

I agree. That would be great. It does take time, though, and I think we're fighting a lot of culture and religion and tradition. So I wonder time we have, it's.

The resources, other resources that we might not have, but time we have, we just have to begin early. We have splendored a lot of time. We have suppressed the subject, but the sooner we bring it to the surface and deal with it, the better.

So how do you think we should be dealing with mental health in the workplace?

That's an interesting question, because it exists in the workplace and often it is suppressed, especially in the workplace. It happens. Send the person home. That's how we've dealt with it. And that's not acceptable. But also it can be disruptive, especially if it's not measured and put in place. Now, we have different levels. Maybe level one. We can work with you and see how we adjust the environment for you so that we help you to stabilize. And if it's about pressure, reduce the pressure on you, move you in an area where it's a bit more relaxing. And if the cohort of people, the team that's working with you is what's causing you the pressure, we can change some of those things. But at the end of the day, we've got to interact with the person and see how to do it. And then when we can't deal with it in the workplace, then it's got to go external. Now many people think medicines help it, they solve the problem. And there are all kinds of medicines from citrulline and things that will calm you down. Xanax, the pharmacy industry, big pharma has made a fortune sending all kinds of drugs. And these drugs, most of them unfortunately are opioids, they addictive and without them then you're beholden to them. So the risk of going down the medicine is something we try to avoid and only go there when you have to go. It's clinical, you're now a clinical case, then you need the medicine. So we'd rather have counseling in house counseling and encourage people, companies especially to have in house counseling and bring in people to talk about these subjects so that people have got a problem, have somebody they can share it with. Some of you have watched the TV series Billionaire I think billions, Billions good. And where they have an in house counselor because they are under so much work pressure, there's a full time high tech person very well trained to manage all of their problems. Now we can't afford to do that in our environment. But a big company like Coca Cola, you can't have so many people. Uganda breweries mtn so many people. And you don't have anybody who does counseling within the company. We've got to begin there. Now the counseling sessions should be private, the records shall be private and it shouldn't affect the human resource reports when you go in the sessions. However, an environment that is conducive must be created and raising awareness that this is something we've got to talk about because it can happen to anybody. It's your child, it's your sister, your brother, your relative that's affected. So deal with it, help them. And that's the best way to do it in the workplace. Now in Uganda, the workplace is a small population. The bigger forces out there because we are seen mainly as farmers. The population that's involved in outdoor activity is so much bigger. And probably that's the reason why Covid didn't hit us so hard. I don't know. But touch wood, just keep the COVID pandemic pandemic away. But because most of us spend time outside, there are different triggers that cause this. And we've got to be mindful of what triggered this person to go into this, to have an episode even when they are recovering. What causes a relapse. Now those studies have not Been done in depth. The research has got to be done. A lot more research has got to be done and eventually we should get there. One thing I do know, not just about mental health, about any society from experience, is when a society has a low level of trust, when a society has a low level of discipline, you get all kinds of challenges coming through it. So discipline is important. Discipline from the family structure of some kind. It will help when people know what they've got to do and they develop a routine, a discipline.

And.

And that's why going to school was so important. This period we went through, this hiatus I talk about, of two years of not going to school disrupted everybody's life, not just the students, but also with the parents and the teachers. So people need that structure and it's got to be maintained. And that's why governments build infrastructure. Things like stadium sports centers where people go and they venture. They watch football, they play basketball, they play table tennis, they do all kinds of things. And the government has to invest in these things because they are outlets. Now when all these things suddenly close down, even bars and nightclubs, they're outlets. But these in Uganda were closed for two years. So it's just put us in a position where there's so much pressure built in there, painted up pressure that's got to find a way of releasing it easily so that life goes on. People feel there's a normalcy to what they are doing. And that pattern, that rhythm is so important. I know people get up early and then they got lost. They don't know what to do when they've gotten up so early. You're up at six and there's zero to do. And then you go around the whole day looking for what to do. And that day is gone. And then the next day the same routine. That is frustrating. Eventually it gets to you without doing anything. So people have got to find a rhythm, find what to do. They need employment, they need school. They need something that occupies them, that gives them purpose, gives them meaning, gives them dignity. All these things tie in to keep that sense of balance.

That's true. It's good advice and it's something that we have to be more aware of and not just take it passively as the day comes. It's one of the things I talk to some of the women I coach in her with. It's about how you plan your mindset or change your mindset so that you speak to yourself in a compassionate way. You make sure that you have routines and goals and something you're working towards and how you adjust that attitude can really affect how you prosper and how you move forward. Also something people usually suggest is exercise. It's one of the things that you said, certainly with discipline, which is helpful. These are all useful pointers. And I think the more people educate themselves, because by the time you're having episodes and there's a trigger, you're already doing quite badly. It's a good thing to notice about, but it's always like built up over time. So you need to be aware of how. What kind of inner monologue you're having in your mind and how you're seeing the world, your perspective and your attitude, because it's easy to go down that negative one. And that's how you start to have different kinds of episodes where you're having breakdowns and you can't even walk anymore. So it's also something we encourage with the managers, the different companies, to have compassion and to have that rapport so that people feel comfortable to tell you when they have a problem. Don't wait till it's so bad that it's out of hand. You don't know what to do. Your family is calling your work because you can't get out of bed, or you've been missing for days, or you show up at work in a state where things are not making sense. So it's good to be aware and not wait for that crisis when you speak up or when you seek help and understand that it's help that you need and it's not your fault. Like you said, it's an illness. So we should treat it like a medical disease. Like if you had had a physical injury. Are there any resources or people you suggest or how did you learn about this? Things that you can share so people can also investigate and educate themselves more?

Yes, actually, there are several companies that are doing wonderful work. Many of them are small, but they do incredible work. I got involved with one company called U Belong. It was founded by an Australian. He's a priest, he's a PhD. His PhD is in psychology. And he's been on the commission in Australia for several years, guiding on mental health in Australia. So he chose to come out to Uganda because he saw Uganda as a hotspot and he felt too little was being done. So he began this organization called you'd Belong. It's a small team, but he does incredible work. His time, his commitment with a very limited resource. And his focus is he breaks it, I think, into three stages. He focuses on getting people out of institutionalized mental Health care. So he goes to Botabica and he looks for those who have got some treatment or who are at level, at a level where they need to be taken out of there because keeping them in there at times makes things worse. So those are the ones he targets. He tries to bring them back into their family environment, but you can't just bring them and dump them in their family. So he trains the people in their family first so that they can receive their son or their daughter back. And he trains them on how to handle them and then he gives them support, even medical support, with a doctor. He's got a team, one brilliant doctor, Brian, I think Mutumba, who he works with, who prescribes the medicines and they manage the medicines and they taper you off these medicines slowly with time, or step them up when you need them. And they stay in touch and they have this database that they keep in touch with thousands of people. Now, it began with a small community and they've just been growing. So their problem is mobilizing resources to bring more and more people out of there. Because some people go there at level one and within three months they're at level four or level five of mental care because it just keeps getting worse in that environment. So those who come in at that level should come in for a couple of days and they should be taken out, but the family doesn't want them back. So you've got to have an organization like you belong that has got enough trained workers to prepare the person to come back home, prepare the home where they're going to come, and then give them monitoring and evaluation to give them the support, ongoing support. That way they are getting more and more people out. Then you build a community based health care system so you're looking after them in the community rather than in the institutions. Otherwise everybody has a slight problem, put them in a mentor institution and dump them there. A mentor institution is not our prison. They have not committed an offense. We need to deal with them with sympathy and scientifically. And that's what he does. So joining this organization to me was so insightful. I learnt a lot. I must admit. I'd never been to Gotabika before. Then I went to Gotawica. I was blown away. I was moved almost to tears. But I said, I must get involved in this. I'm now a director, advising them on their board. And our challenge, our biggest challenge is raising funds. Whoever you write to, most people ignore. Oh, no, no. Mental health is not something you want to deal with. It's not fashionable it's not sexy. It's something people don't want to deal with. So occasionally I get some support and I need to say thanks to some of the banks, especially the financial institutions have been generous and given us some money. But most of the money we raise is international. We have to go to international communities for a problem in Uganda to deal with our brothers and sisters. We need to raise awareness here so that people can contribute even small amounts eventually. Some of these organizations that are doing this wonderful work because it could be your child tomorrow, don't wait for it to be your child. Let's try and see what we are doing to help our communities deal with our local problems. The first world has got enough issues. When I see, when I compare. There's so much information today on the Internet online and there's so many books out there. People just have to read. Reading is becoming harder for so many of the younger people. But there's so much information about mental health care and studies have been done for so long and we've got to avoid pumping people with medicines if we can. Medicines play a crucial role at the right time. But if we can manage the environment so that we don't, we manage those triggers that cause that this disruption in their people's lives. That's what we've got to do. You mentioned the word prosperity. This inequalities of income is not helping. Where people live a false life on social media and they want to have that prosperity and yet the real world is really hard for them. Now we've got to address that. That comes from financial literacy, culture, discipline. Discipline is key. I can't emphasize enough, but we'll talk about that in another show.

Yep, that's a big problem, especially for young people who see the best day of everyone on Instagram comparing it to their worst day and they don't understand why some people's lives are like that and theirs are not. That discrepancy is too big. It's very sad. Something I, I encourage for that I do this to even my own siblings use Instagram for a good thing as well. I follow so many therapists on Instagram just having helpful quotes or they explain different things or help you to understand yourself is so helpful. Such a newsfeed is not just celebrities and people looking good and having holidays. You're learning things, you're processing. You're understanding stuff better for yourself as well. So I would also encourage that the.

Internet is one of the most powerful tools that has been discovered in the last 50 years. It is so Useful if you use it well. But also it's the biggest weapon of mass destruction that has come up in the last 15 years. It will destroy more lives maybe than any other tool that has come up. Because since Nagasaki, the bombing that happened then, I don't think we've had something so big that is devastating. I'm not saying that we should run away from the Internet. We should learn to harness it. And the young generation especially, have got it the other way around. They live in a virtual world and then come back to reality and they just can't deal with it. They're completely incompatible. So I must warn the young people out there, please use Internet wisely. I warn the parents, too. You've got to make a difference. That tool is so powerful, and that tool is in everybody's hand today. On a mobile phone, that device can change, make or break people's future entirely. You've got to learn to harness it. And that requires, as I said, discipline. People must be compliant. The state has a role to play. But the state can't do everything. It's a family unit. At the end of the day, that will matter most.

Remember we watched that documentary on Netflix, what was it called that showed how social media.

The impact of social media.

Yeah, the impacts of social media. I need to remember the name of this.

Scary.

It was really scary, Right, The Social dilemma. That's what it was called, something like that. Because it shows how those companies just want us to be addicted to the phones, and that's their business. It's not their fault. But it's irresponsible because. Because they are pushing younger and younger people to just be on your phone all the time, seeing things, watching things, and not checking how it's affecting you. And you're right, it's a huge problem, like a bomb, because suicide rates all over the world have gone up from ages as young as 11 because of the pressure of social media. So it's a big, big challenge. At least be empowered and know these are the things I can do. Parents can put child locks. They can put. Most phones these days have settings you can put such your kids can't see certain things or can only use social media for a few hours a day. And as kids get older, even young people. Be selective in what you follow and be careful about what's triggering you and affecting you and remove the negative things so that you're more in control of what you're doing and how much you're using.

I sympathize with these young people. I tell you why what chance do they have against the brightest people in the world? These companies, Facebook, Instagram, TikTok, they've collected so much money, they recruit the brightest people in the world in Germany, in China, in India, and they put them in Silicon Valley in some of those places. And then they start playing with algorithms and all kinds of tools to play on your mind. Now you think, I've got enough discipline, I can stand against them. You don't stand a chance against these people. They've got you from the beginning to the end. They know all the filters you put there, all the tricks you're trying to do. They know how to get past you. They will play on you. So you've got to be very, very mindful when you go on the Internet, go there for the business you want to do and get off. Once you start this habit of scrolling, you go down a rabbit hole and you never get up. And you think, I've got it. I can control it. Even with the adults, it's really dangerous. So how do we go against it now? Maybe because this will probably go on the Internet, they'll pick you up and say, that guy is working against us. You've got to watch out. And they start tweaking some of the things, the content that I get. But I think it's our responsibility to manage the content that people receive. Garbage in, garbage up.

Yep, definitely. You do what you can. You try. I have no notifications. I try to manage what's in my feed.

At least you won't.

Yeah.

I remember President Obama saying that the biggest threat to his daughters was going to be the Internet. Whatever they say and do, that's what he was most scared of. And that's something that the Secret Service cannot protect his children from because they're out there. Whatever you say will be out there. And you can see the story. It's beginning to play out. He said this long time ago, but it's a fact and it affects everybody.

It's scary. We just have to do what we can and be supportive to each other.