The assumption that mental health services are reasonably well-organised and that the health unit staff at both micro and macro levels know their roles in the integrated health care delivery has proved wrong as only a limited number appreciate this policy requirement to that effect.

This was the conclusion of the first ever major mental health systems study for Uganda that was conducted under the Research Programme Consortium entitled "The Mental Health and Poverty Project: Mental health policy development and implementation in four African countries" using funds from the UK's Department for International Development.

According to the Ugandan report of the study, the relatively low appreciation of the existence of a national mental health policy and national mental health programme, and ignorance of the mental health legislation calls for urgent action.

This, it was noted, "is not only to review these documents in a wide consultative form with representatives of all expected stakeholders in the country but also to disseminate them even in the current status, while waiting for the review process."

The study notes that widespread stigma towards mental disorders and the prevalent cultural attitudes towards the causes of mental illness which in turn affect the health-seeking behaviour will have to be tackled as soon as possible for improved access to modern mental health care.

Similarly, the study concluded that "the lack of knowledge on mental health among the general health workers should be a major source of concern for policy makers at the ministry of health headquarters, which calls for urgent rectification through massive and purposeful in-service training."

Its authors say the study, published this year, comes at a time when there is growing recognition that mental health is an important public health and development issue in Uganda.

Nonetheless, mental health was found to be a complex term that is not well understood by the majority of the people. The study findings note that in the community, "mental illness is greatly linked to supernatural causes even when the cause is an obvious physical one."However, the urban dwellers were found to have more modern scientific understanding of mental illness, attributing it to biological, psychological and social causes.

And the lowest point of the study was the finding that a negative attitude and low interest in mental health still prevail among general health workers, including the Primary Health Care doctors although some of them received orientation in mental health during their training.

To this, the study authors suggested a number of possible areas of action among which are the finalisation of the mental health policy and development of the Mental Health Strategic plan, improvement of interaction and training in mental health issues for primary health care workers, and strengthening of community based mental health services by training Primary Health Workers to promote integration.

Other measures include the strengthening of multi sectoral collaboration, developing training on mental health and human rights, reviewing of mental health legislation to bring it up to date with current international standards, a primary health care training programme on mental health, spread in all regions in the country and review and strengthen staffing for mental health.