Source: The Conversation – Africa – By Lydia Namatende-Sakwa, Associate Research Scientist, African Population and Health Research Center
“Me who is a poor person, do I have the luxury to have depression? No, it is only you who is rich that has the luxury to have depression.”
This statement, shared by a research participant in Kampala, the Ugandan capital, captures a persistent misconception: that depression belongs to wealthy people or those whose lives are comfortable enough to permit emotional vulnerability.
It is an example of how socio-cultural beliefs can become a barrier to recognising mental health problems and seeking support.
In 2025, Uganda’s Ministry of Education and Sports issued a set of mental health and psychosocial support policy guidelines and resources for schools. These included a training manual, teachers’ handbook and wellbeing guide. They provide practical information on recognising distress, psychosocial support, referral and wellbeing in education settings.
The next challenge is to put the guidelines into practice.
Our team of researchers at the African Health and Population Research Center did a study to provide evidence that would help schools in Uganda follow the guidelines. We looked at what people understand by mental health, what learners and staff need, school capacity and what needs to happen first to put the guidelines into action.
The study engaged 200 learners, teachers, parents, community representatives, policy actors and development partners across four districts: Kampala, Jinja, Gulu and Mbarara. Kampala is the capital city; Jinja is a mixed rural-urban context. Gulu is an area affected by conflict and displacement. Mbarara is an education and economic hub with urban and rural schools.
We found socio-cultural and gender norms strongly influenced whose distress was recognised, how it was explained and whether seeking help was considered acceptable. Mental health at school was linked to issues like literacy, spirituality, poverty, family instability, displacement, disability and trauma.
Learner distress reflected overlapping academic, family, economic, social and institutional pressures. The responses at school must take all these into account. School mental health programmes must address both emotional wellbeing and structural pressures such as poverty, stigma and exclusion.
Listening to Ugandans
Our four study sites were chosen to reflect a range of environments, with different resources and socio-cultural influences.
We held dialogues at each site with learners aged 13-18, parents, teachers, government representatives, youth-led organisations, religious and community leaders, NGOs and researchers. Special interest groups (including refugees, LGBTQ organisations and people with disabilities) were also included.
The dialogues explored understandings of mental health, learner and staff needs, school capacity and future priorities.
What’s influencing mental health
The study participants described student mental health as a growing concern. They mentioned depression, anxiety, stress, low self-esteem, fear, social withdrawal, substance use, bullying-related distress, trauma, anger, academic pressure and poor emotional regulation.
Participants described these as interconnected problems.
The drivers of distress among students were identified as:
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academic pressure
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family and home background, including absent parents, domestic violence and neglect
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poverty that resulted in lower self-esteem and greater exclusion from peer groups
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bullying, teasing, humiliation and harsh discipline
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substance use and addiction, especially among boys and urban learners.
Boys and girls were seen as vulnerable to different pressures.
Barriers to getting help
Participants in all sites said mental illness carried a stigma. It was seen as morally wrong, caused by supernatural forces, or “a disease for the rich”.
Another perception was that boys and men couldn’t seek help for fear of looking weak.
Learners also felt they could not trust adults with their problems. They feared that teachers might judge them or reveal their personal stories publicly. Learners experiencing anxiety or distress thought they might be labelled lazy or badly behaved, or accused of “faking it” or “seeking attention”.
The danger is that withdrawal, poor concentration, anger or declining performance might then be treated as deliberate disobedience.
Mental health difficulties were sometimes attributed to witchcraft, curses or demonic possession. Religious and cultural systems can offer hope, belonging and support, but problems arise when they become the only explanation for distress. As one Kampala teacher warned,
Some people will pray until somebody dies.
Learners reported being told, “You have to be strong … a guy who does not cry.” Such expectations encourage boys to hide stress and may lead to withdrawal, anger or risky behaviour rather than seeking support.
Girls face pressures linked to harassment, poverty, reproductive-health stigma and social judgment, often while being expected to remain silent. Female educators also face gendered scrutiny, including questions such as, “Where are their husbands and why are they not interested in staying with them?”
Counselling can itself carry stigma. People reported fear and shame associated with getting professional help.
Changing systems to change norms
Teachers should recognise that a child’s behaviour may arise from bullying, poverty, bereavement or family conflict. Schools should ask not only “What is wrong?” but also “What may have happened?”
School mental health programmes should respect cultural beliefs without delaying appropriate help.
Girls should be protected from harassment and enabled to report problems confidentially. Schools should promote a broader understanding of masculinity in which recognising emotions and seeking help are seen as responsible behaviours.
Schools need private support spaces, clear confidentiality procedures and counselling that is normalised. Learners must be able to seek help before problems escalate.
Socio-cultural and gender norms are reinforced through everyday practices and cannot be changed through awareness messages alone. Uganda’s response must combine norm change with system change. Schools need culturally grounded mental health literacy, safe environments, respectful discipline, confidential support, gender-transformative programming, trained staff and links to health and community services.
The key question is whether schools can recognise distress without judgment and respond with dignity, protection and appropriate care.
– ‘Lazy, weak, bewitched’ – how stigma stops Uganda’s children from getting help, and what schools can do about it
– https://theconversation.com/lazy-weak-bewitched-how-stigma-stops-ugandas-children-from-getting-help-and-what-schools-can-do-about-it-292539