Illustration by Minority Africa, used with permission.

This story was written by Hellen Kabahukya, and originally published by Minority Africa on September 06, 2024. An abridged version is republished below as part of a content-sharing agreement.

It’s a Thursday morning, and I decided to be vulnerable over the phone. For the first time, I tried teletherapy. Unlike the traditional way of doing therapy in my past, where I met with a therapist in person, I chose to go the anonymous way.

Mental Health Uganda (MHU) was the recommended option. Panic engulfed me as I dialed the toll-free number. As the phone rang, I listened to a caller tune that relaxed me from the panic I was feeling. The phone rang for about 30 seconds before a gentleman answered it. The question in my mind was, how does this even work?

Upon picking up the call, the man identified himself as David and asked that I introduce myself. He assured me that the call was confidential and that none of my information would be shared outside of our phone call. He went on to tell me that the session usually lasts 45 minutes to an hour at most.

For the first time in a long time, I told someone the things I’ve kept to myself. We explored my grief, relationships, and dealing with everyday demands. I did most of the talking while David quietly listened.

“Would you like to talk about the issues surrounding your father’s death and how that left you feeling?” David asked.

Something about his voice reassured me that I could be open, and I found myself speaking of issues that had long been buried in my head.

I am a face reader, so I am always conscious of people’s facial reactions when I speak. With the counsellor on the phone, I wasn’t worried about judgment, and he often asked where he needed clarification, which reassured me that he was listening.

In the end, he gave me recommendations and some insights to reflect on in preparation for our next discussion the following week.

Teletherapy and Mental Health Uganda

Teletherapy is a new treatment in Uganda that only gained traction during the COVID-19 period.

A number of organisations, including Mental Health Uganda, offer this service. The organisation has been offering mental health services for close to 27 years.

“We developed the idea in 2018, but we fully implemented it in 2021 during the COVID-19 lockdown when we realised that many people needed support but could not physically meet,” Geraldine Kauma, the communications officer for Mental Health Uganda, explains.

Nanteza Teopista is a 26-year-old woman living with HIV/AIDs. When she was diagnosed with the disease, the first thing she was enrolled in was counselling, but she still battled with suicidal ideas.

For two years, she has been in and out of therapy. Teopista meets her therapist once a month, and sometimes, when it’s overwhelming, she schedules an online appointment.

“I honestly prefer using online therapy when dealing with a new person. I feel it’s safer and anonymous, but with the therapist I have had for the last two years, I prefer we meet physically; I feel she’s able to read me better when she’s seeing me,” Teopista explains.

The state of mental health issues in Uganda

Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community.

Mental disorders vary and present differently. They include depression and anxiety, bipolar, personality disorders, schizophrenia, and other neurological and developmental disorders like autism.

“Unless diagnosed, many people end up living out their lives with mental health challenges, and the stigma surrounding mental disorders prevents many from seeking the much-needed help,” explains Dr Hafsa Lukwata, the acting commissioner for mental health and control of substance abuse at the Ministry of Health.

In Uganda, mental health issues extend far beyond statistics, impacting individuals, families, and communities in profound ways. The prevalence of mental health conditions surpasses the global average, with a significant portion of the population experiencing these challenges between the critical ages of 11 and 24.

Eighty-seven percent of Uganda’s population lives in rural areas, and there are 28 in-patient psychiatric units throughout the country — and only one mental referral hospital. Over 60 percent of the units are near the capital, Kampala. Thus, those living in rural areas have little access to mental healthcare.

According to reports by Ugandan mental health professionals, 35 percent of Ugandans have a mental illness, and 15 percent of Ugandans require treatment.

“The most common mental disorder you find in Uganda is depression and anxiety. These are treatable, but the challenge is most Ugandans don’t believe in seeking help,” Moses Mpanga, a clinical psychologist and founder of MIND Nest Uganda (MNU), explains.

Unfortunately, the existing stigma surrounding mental health exacerbates the situation, leaving those affected isolated, ashamed, and often reluctant to seek the help they need.

“Apart from severe symptoms that may present a patient as a danger to themselves or those around them, and in this case, we look at suicidal ideation and thoughts, schizophrenia. Oftentimes, patients require therapy or outpatient treatment methods,” Dr Lukwata elaborates.

Not a silver bullet

The practice of tele-counseling is still in its infancy in Uganda. It allows individuals to receive therapy and counselling services from licensed professionals via video conferencing, phone calls, or online messaging.

“Teletherapy provides a convenient and accessible alternative to traditional in-person therapy, especially for those who may have barriers to accessing physical therapy, such as geographic distance, physical limitations, or scheduling conflicts,” explains Lorna Nakabuye, founder of Kampala Counselling Services.

According to Afsan Mirza, a private mental health counsellor, the people she has counselled over the phone prefer it to physical meetups because they get to do it without the fear of anyone finding out and stigmatising them for it.

Many counsellors also noted that women are more into physical therapy and prefer to have a close relationship with their therapist, while men prefer to remain anonymous and hence prefer tele-counselling.

While tele-counseling has a good chance of being another milestone to open up access to mental health treatment, the cost is still a challenge for many Ugandans who need the service.

“The cost of access to therapy is between USh 50,000 (USD 13.44) to USh 300,000 (USD 80.65), and this is a session of a maximum of an hour, depending on where you receive the service. That is very expensive for anyone who has to see a professional twice a week or more,” Teopista explains.

This also excludes many people who are unable to afford therapy in general. Organisations that offer the service free of charge still have to incur the costs from the providers, making it costly to provide. One organisation, which sought anonymity, noted that the cost of attending to one client over the phone was the same as treating four people in person.

Furthermore, only 63.8 percent of Ugandans have access to phones, with much of that population living in urban areas. This means that many Ugandans have no access to phone technology and thus may struggle to access such services.

Teletherapy always seemed useless to me; after all, why pay to call a therapist if you can just call your best friend? Also, being an emotional person, I always preferred in-person therapy. The only difference is that, just like with my best friend, I would censor myself to avoid sharing information that would get me judged.

However, with teletherapy, that was the least of my fears; even my name was fake — it was like writing an anonymous Reddit story, and at the end of the day, I still received the same attention and care as I would with an in-person therapist.