This is history of psychiatry in Africa and Uganda at large.

1. HISTORY OF PSYCHIATRY

2. • The history of Psychiatric Nursing in England has got four defined
periods. Each of which depend on believes of the people of the day/
period as such the following was applied;
• 1-Demonological period.
• 2- Political period.
• 3-Humanitarian period.
• 4-Scientific period.

3. Demonological period
• During this period, it was believed that mental illness was caused by
demons.
Treatment of patients in Europe involved so many cruel methods such
as beating, plunging the patients into water, smoking them so as to
get the demon out of them, some of the patients were thrown into
water, beating them to death while others were left to steal or beg for
their survival.

4. Political period.
• During the 14th century King Edward passed a law to protect the Insane.
• In 1403 a separate place was set aside to care for the Insane.
• There were no proper Hospitals by then but most of the Institutions were provided by
voluntary organizations eg Monasteries.
• The aim of keeping the insane in one place was to prevent the public from being in trouble.
• The care for the sick was in unfitting places, dirty unventilated, dark and cold while
treatment was in form of chaining, beating and being locked in confined places.
• The insane were exposed in public incase they want the insane to entertain the public.
• Later on in 18th century St Luke Hospital was founded in London. Patients were then
exposed to the public.
• Admission into the hospital was in presence of attendants & visitors who came to see the
patients were granted permission but in the presence of the attendants.
• Both women and men were admitted together and not allowed to move out of those places.

5. Humanitarian period.
• This period took place almost simultaneously in France and England in
1792 and 1793. Dr Phillip Pinnel was granted permission to take off
chains from patients.
• He however freed 50 patients who had been chained for 30 years.
• An English man called William Tuke abolished harshness confinement
and replaced those with sympathy and gentleness. He strengthened
occupation of every things for example gardening for men and sewing
for women.
• In 1803 the first law was passed in England but very little was done in the
institutions, not until 1931 when the mental treatment Act was passed
in Britain that the proper care of the insane started. This regulated the
admission and discharge of the mentally sick.

6. SCIENTIFIC PERIOD.
• During this period Scientific methods of investigating into causes of mental
illness and treatment were implemented.
• This was followed by progress of training Mental Health Nurses and proper
administration of a Mental hospital.
• Treatment available were prefrontal lobotomy (An operation) and Insulin
therapy were a dose of Insulin large enough was given to patient to cause
unconsciousness, some patients improved by this methods. Electro convulsive
therapy (ECT) was first used by Cerletti and Bini in1938 to treat patients.
• It proved to give effective outcome and it is still used up to date. Until mid-
1950s there were few drugs which could be used in treatment of mental illness.
• Bromide Chloralhydrate and Barbiturates were subsequently discovered and
used successfully.

7. Cont’d
• In early 1950s the first tranquilizer drug (Chlorpromazine Largactil)
became available.
• This had an effect of calming the patients without making them
sleep.
• Since then variety of tranquilizers and antidepressants have been
manufactured which has revolutionized the treatment of mental
illness. New and important discoveries were made in the field of
human psychology which is applied in the care and treatment of
mental illness.
• Many psychological methods of treatment like psychotherapy,
behavioral therapy family therapy therapeutic community and
cognitive therapy have come into existence and have beenof great
help in managing mental illness.

8. HISTORY OF PSYCHIATRY IN UGANDA
History of mental health care in Uganda:
• Like in Europe the mentally sick in Uganda were disregarded, ridiculed and
mistreated.
• They were looked at as victims of curse and therefore not fit to belong to
human society.
• Traditional healers provided treatment but it was a try and error.
• Sometimes patients (mad men and women) as they were called, were beaten
and left roaming from village to village without anyone’s concern.
• The need to introduce mental health services in Uganda was realized in 1920
when the district health commissioner noticed an increase in the number of
mentally sick and ordered them to be cared for in Hoima in the prison.

9. Cont’d
• The patients were admitted and locked up in the asylum.
• The asylum was poorly ventilated and was never cleaned.
• The patients were looked after by the prison warders who would never talk to
them and only briefly saw them during meal time when a container of food
would briefly be slipped in through a small space created when the door was
slightly opened.
• The patients were separated from the prisoners but were given custodial care.
• There was no psychiatric treatment of any kind and the main reason for
confinement was to protect the public and their property from the destructive
“Lunatics”.
• It is said that modern psychiatric treatment in Uganda started in 1920 in Hoima
prisons because of the bad background.

10. Cont’d
• Government and medical practitioners at the time thought it proper to remove
the mentally sick from the prison environment and look after them as sick
persons in the hospital like environment.
• Kampala was preferred so it was agreed that the hospital is built for the care of
the mentally ill.
• A site on Mulago Hill 100 meters away from the hospital was identified.
• It had to be that far because of the fear of disturbance from the mentally sick.
• In 1934 a ward was constructed and completed now the current Queens
Hostel in UIAHMS.
• Between 1936 and 1937 at least 40 patients had been admitted at old
Mulago. They were being looked after by Nursing Attendants (including by
Grannie).
• They were untrained but learnt to handle patients on job.

11. Cont’d
• In 1938 the mental treatment ordinance was passed.
• This opened way for introduction of proper psychiatric services.
• The treatment of the mentally sick had to change to adapt to the
modern scientific methods; this ordinance later became an act
of parliament.
• In 1940 the first 40 patients from Homia prison were transferred
to Mulago hospital.
• This increased the numbers and the space became small.
• The ward became overcrowded and difficult to be managed.

12. Expansion of the Mental Health Services
• Because the ward was close to the road both patients and by-
passers suffered embarrassment as patients would smear
themselves with excrete, undress publically or sometimes throw
excrete at the road users.
• A solution to the situation had to be sought. So it was decided that
a large hospital be built.
• Because Butabika was so strategically in Kampala and far away fro
the population setting with so much abundant land, 600 acres of
land was allocated for the purpose.
• This was to become a National Referral Mental Hospital to admit
patients from all over the country.

13. Butabika NMRH
• In 1954 Butabika hospital was built with 2 wards each accommodating 50
patients.
• One kitchen and one office block were also constructed.
• The female ward was constructed a good distance from the male ward.
• Strong men and women were recruited to manage the patients.
• Between 1954 and 1958 a number of European medical and nursing staffs
arrived from abroad and the hospital began to operate efficiently.

14. • In early 1959 with the provision of adequate supplies of modern
drugs and equipment, the discharging rate of patients improved
drastically.
• In 1956 the training of Nursing Attendants began in the wards by
ward sisters and male in-charges. Most of whom were Europeans.
• Butabika hospital turned out to be the largest and the most efficient
mental hospital in the sub-Saharan region

15. Cont’d
• The criminal unit called Broad More and formerly known as Kirinya unit was
opened in 1959 with one male admission ward, two convalescent wards, a
female ward, administrative ward, sick ward, a kitchen and occupational
therapy.
• It had its own full administration.
• The Mental Treatment Act which replaced the Mental Treatment Ordinance
was passed in parliament in 1964.
• This made it possible for the magistrates to follow patients at the hospital
and sign temporary detention orders.
• It remained in place until 2018

16. Services Offered
• It catered for both civil and forensic cases.
• The latter were criminal psychotics who could not be contained by
just the prison services.
• The location at Butabika Hospital was considered because it was more
spacious than Mulago hospital where patients would often be a
nuisance to passers-by in the densely populated Mulago city suburb.

17. Specialized care
• In the early years of provision of professional mental health services,
expatriate psychiatric workers manned the mental health facilities
right from Hoima, Mulago and Butabika hospitals.
• The first indigenous mental health workers learnt on the job as far
back as 1956.
• Some were sent abroad for specialized training in psychiatry.
• Notable among the indigenous psychiatrists included Professor
Bbosa, Dr. Kitumba. Dr. Muhangi, Dr. Fred Kigozi, and Prof. Seggane
Musisi.

18. Cont’d
• In the early 1960’s a Nursing Training School was opened at Butabika hospital
to train enrolled mental health nurses.
• In the subsequent years more advanced courses were included in the
training program.
• The Medical School, at Mulago Hospital, also began a course in psychiatry.
• The mental health personnel were trained to handle what the general public
commonly referred to as the “mad people” who had been confined to
mental asylums.
• Mental health services have since then been synonymously associated with
the mad person.

19. Mental Health Training in Uganda
• Butabika Psychiatric Nursing Training School was opened in 1960 with an
initial 60 Enrolled Psychiatric student Nurses by nurse tutor Hope Wood.
• The first African principal nurse tutor was Mr. Vincent B. Wankiri from 1960 –
1970, they were training pupil nurses only.
• In 1967 an extension course for already enrolled psychiatric nurses was
introduced. The first direct entrants were recruited in 1970.
• In 1967, an Extension Course in Mental Health Nursing for already Enrolled
Psychiatric Nurses was introduced to enable them upgrade to Registered
Psychiatric Nurses.
• The introduction of additional programmes increased the enrollment from 60
to over 100 students in 1980s and has continued to rise up.

20. Training Cont’d
• PCO programme was started up in 1979 by Prof Bbosa.
• This was aimed at bridging the gap between the psychiatrists and
nurses.

21. Roles of PCOs
• Assess, treat and manage patients.
• Conduct health education to patients
• Impart knowledge and skills to students and staff
• Participate in planning, budgeting, coordinating, monitoring and
evaluating clinical work.
• Manage and account for allocated resources

22. Roles Cont’d
• Conduct health education to patients
• Initiate and participate in research activities
• Promote and observe the professional codes of conduct and ethics.
• Participate in continuous professional Developments activities
• Preparing and submitting Reports
• Perform other duties as may be assigned from time to time