Law enforcement responses to mental illness in rural Uganda: A qualitative study of practices, challenges, and opportunities for training

Abstract

For many people with serious mental disorders, the carceral system often serves as the first point of contact in a mental health crises, yet little is known about how law enforcement personnel in low resource settings, for example, in rural Uganda, recognize and respond to such crises. We conducted 84 in-depth qualitative interviews with individuals representing five groups involved in law enforcement in rural Uganda: Local Council I Chairpersons, Local Council 1 Secretary for Defense, Prisons Officers, Local Defense Personnel, and Criminal Investigation Directorate (CID) officers. Participants were recruited through purposive and snowball sampling across two districts in eastern Uganda. Data were analyzed using the framework method. Participants described a common trajectory. Mental health problems were identified through visible behaviors or alerts from family or neighbors. Officers tried to de-escalate crises before arranging referral, whether informal (i.e., through local leaders) or formal (e.g., health care or criminal justice facilities). They identified numerous barriers, including the need to transport patients long distances, lack of availability of medications, and stigma. Many expressed compassion for people with mental illness, but several described behavioral enactments of stigma, including community vigilantism. They proposed concrete interventions, including brief role-tailored training, structured family involvement, checklists, and supporting basic needs.The Ugandan law enforcement apparatus is commonly called upon to address mental health crises but lack standardized guidance or resources. Psychoeducation and brief role-based training could potentially improve safety and continuity of care.