Drivers for nutrition care to clients with mental illnesses attending Ugandan regional referral mental health units

Abstract

Background: The narrow approach of managing mental illnesses with drugs has made mental health to remain a global public health problem with deaths occurring as earlier as 32 years less than the rest of the population. Health care professionals in the mental health sector need to be knowledgeable and proficient in nutrition as it applies to health promotion, prevention and treatment of mental conditions. Due to the devastating medical, social, and economic effects malnutrition brings to the clients, their family and country as a whole, nutrition interventions deserve a place in the care of clients with mental illnesses. However, there is limited information on how nutrition care is being applied to promote the health of clients living with mental illnesses in Uganda. Objective: The study examined health workers’ perceptions of nutrition care; the nutrition supports offered and finally surveyed the dietary practices of people living with mental illnesses attending selected Ugandan Regional Referral mental health units. Methods: This descriptive cross sectional study was conducted amongst 83 mental health beneficiaries and 19 healthcare workers. A purposeful sampling technique was employed to identify study participants in four Regional Referral mental units. Qualitative and quantitative methods of data collection such as; observation, key informant interviews, focus group discussions, and audio-visual materials were used in addition to check lists and food frequency questionnaires. Results: Health workers exhibited utmost positive perceptions towards integrating nutrition in mental health care as nearly all participants acknowledged its importance. However, the lack of technical, financial, and material support frustrated this attitude. Foods provided by hospitals lacked dietary diversity and were therefore of negligible value in promoting patients’ recovery. In addition, nutrition assessment was never carried out in Regional Referral mental units. Only a few lucky clients received nutrition education. In most of the times, food selection was governed by the desires of the clients. Patient’s priorities and preferences determined food selection for any given meal from family members. As a result, diets of people with mental illnesses were mostly characterized by high fat consumption, with starch based staples and low fruit and vegetable consumption. Conclusion: This study revealed that the drivers to nutrition care delivery to PLWMI were positive health workers’ perceptions, adequate nutrition knowledge among health workers and presence of material and financial support. However, although health workers had positive perceptions, their nutrition knowledge was poor. Inadequate nutrition refresher training, lack of technical, financial, and material support were identified as the factors that inhibited successful implementation nutrition activities in mental units in the study area. Recommendations: Enhancing mental health focused on-job nutrition training, mentorship and coaching for health workers serving in mental units; increasing the nutrition budget for mental health facilities and hiring clinical nutritionists in each mental department would improve nutrition management of clients with mental illnesses.