Our reflections on the State of Uganda Population Report 2025

Uganda is a young country. More than seven out of every ten Ugandans are below the age of 30, and we often hear this described as one of our greatest opportunities. We talk about the demographic dividend, the future workforce, the next generation of leaders, entrepreneurs and innovators, and the contribution that young people can make to Uganda's social and economic development. But there is a question we do not ask often enough: what happens when a young country is not doing enough to protect the mental health of its young people? If young people are expected to carry much of Uganda's future, then their mental health cannot be treated as a secondary issue.

The State of Uganda Population Report 2025 gives us reason to stop and ask that question more seriously. The report describes mental health as a “silent emergency” and estimates that 22.9% of children and 24.2% of adults are affected by mental health conditions. Yet fewer than one in ten people who need mental health care receive appropriate support, while reported cases in health facilities have increased significantly between 2021 and 2024. These figures are important because they show us the scale of the challenge, but they are also easy to read as statistics and move on. Behind every percentage is a person: a student struggling to concentrate in class, a young person withdrawing from friends, someone dealing with conflict or violence at home, a parent who knows that something is wrong but does not know where to turn, or a teacher who notices a change in a student's behaviour but does not have the confidence or support to respond. The numbers tell us how big the problem is; they do not always tell us what it feels like to live with it.

We have become very comfortable talking about Uganda's young population as an opportunity. We talk about the demographic dividend as though it is guaranteed simply because we have millions of young people. It is not. A demographic dividend depends on whether young people are healthy, educated, skilled, economically engaged and able to participate meaningfully in society. Mental health sits right in the middle of that equation. A young person who is struggling with depression, anxiety, trauma, substance use or other mental health challenges may find it harder to learn, remain engaged in school, build relationships, find and sustain employment, or participate fully in their community. This is why youth mental health cannot sit at the edge of Uganda's development agenda. It is part of whether that agenda succeeds.

This is also why we need to change the way we talk about youth mental health in Uganda. It is not simply a health-sector issue that can be addressed by adding more services to hospitals and health centres. It is an education issue because mental health affects how young people learn and participate in school. It is an employment issue because economic uncertainty, unemployment and exclusion can affect mental wellbeing, while poor mental health can make it harder for young people to enter and remain in the labour market. It is a family and community issue because young people's mental health is shaped by the relationships and environments around them. And it is a development issue because the health and wellbeing of Uganda's young population will influence the country's ability to realise the demographic opportunity we talk about so often.

Young people do not experience their mental health in hospitals. They experience it in classrooms, at home, among friends, online, in their communities and while trying to figure out what their future looks like. A student struggling with anxiety may spend six hours a day at school. A young person experiencing depression may continue attending classes every morning while privately struggling to cope. Another may be dealing with bullying, violence, family conflict, substance use, academic pressure or uncertainty about what comes after school. These experiences do not wait until a young person reaches a health facility before they begin to affect their lives. Yet too often, our response begins only when things have become severe enough to enter the health system. By that point, we may have already missed many opportunities to recognise distress, provide early support, reduce stigma and connect a young person to appropriate care.

This does not mean that Uganda does not need better mental health services. We absolutely do. We need more mental health professionals, stronger integration of mental health into primary healthcare, better financing, stronger referral systems and greater access to appropriate treatment and care. The recommendations emerging from the population report are therefore important and should be taken seriously. But alongside strengthening the formal health system, we need to ask a different question: what can we do before a young person reaches a crisis? How do we make it easier for a young person to recognise that they are struggling, talk to someone they trust, receive appropriate first-line support and reach professional care when it is needed?

This is where schools matter. Schools are one of the few places where we can reach large numbers of young people consistently and early. Teachers are often among the first adults to notice that something has changed. They see when a student withdraws from friends, stops participating, begins missing classes, struggles academically or behaves differently. They may not know what is happening, and they should not be expected to diagnose or treat mental illness. But with the right skills, confidence and systems around them, teachers can become an important bridge between a young person who is struggling and the support they need. A teacher does not need to be a therapist to know that something is wrong, respond appropriately and help a student find the next point of support.

This distinction is very important because strengthening school-based mental health support should never mean turning teachers into mental health professionals or expecting schools to become hospitals. It means creating schools where mental health is understood, where distress can be recognised earlier, where students can safely ask for help and where there are clear pathways to appropriate support. A teacher should know what to do when a student says they are not okay. A student should not have to navigate the mental health system alone. A referral should not simply mean giving someone a phone number and hoping they follow up. And a school should not have to start from zero every time a mental health concern emerges. These are not separate activities; together they form a system of support.

At Twogere, this is the space we have chosen to work in. Our argument has never been that schools can replace mental health services. It is that schools can become an important part of the support system around young people if we equip the people already there, establish clear referral pathways and create meaningful opportunities for students to participate in building healthier school environments. This means investing in teachers with practical skills to recognise, respond and refer, rather than relying only on awareness sessions. It means supporting student mental health champions who can help make conversations about mental health less frightening and less stigmatised. It means strengthening connections between schools, families, communities and health services, and making sure that when a young person is referred for help, there is a system that can follow that referral and understand what happens next.

It also means taking young people seriously as part of the solution. Too many mental health programmes are still designed for young people rather than with them. We conduct consultations, ask young people what they think and then go back to our organisations and design the programme ourselves. We call that participation, but sometimes it is simply consultation dressed up as participation. Young people have knowledge that institutions do not have. They know what it feels like to navigate their schools, families, friendships, social media and communities. They know where support works and where it breaks down. Their lived experience should not be treated as a nice addition to a programme or something we bring in at the end to make the programme look more inclusive. It should inform how the programme is designed from the beginning.

There is another shift we need to make in how we think about the response. We need to stop measuring our mental health work only by what we deliver. How many teachers were trained? How many students attended an awareness session? How many schools received materials? These numbers are useful for understanding reach, but they do not tell us whether the system is actually working. The harder questions are whether teachers feel more confident when a student is struggling, whether students are more willing to seek help, whether schools are identifying concerns earlier, whether referrals are actually being completed, whether young people experience their schools as safer and more supportive environments, and whether those who need professional care are actually reaching it. If we are serious about closing Uganda's youth mental health support gap, these are the questions we need to start asking and measuring.

The population report gives Uganda an important opportunity to rethink the way we respond. We know that Uganda is young. We know that mental health needs are substantial. We know that a large proportion of people who need support are not receiving it. And we know that the consequences extend far beyond the health sector. The question now is what we do with that knowledge. We can continue to build a system that waits for young people to become unwell enough to seek help, or we can build one that moves closer to where young people already are and provides support earlier. This does not require choosing between community-based support, school-based systems and professional mental health services. We need all three, connected to each other.

At Twogere, we believe the second approach is the more sustainable one. We need schools that know how to respond, teachers who feel equipped rather than helpless, students who know where to turn, referral systems that actually connect people to care, families and communities that can recognise distress without shame, and health services that are connected to these systems rather than operating separately from them. We also need to recognise that building these systems will take more than individual projects or short-term training. It requires investment, policy support, institutional ownership, evidence and sustained attention. Most importantly, it requires us to stop treating mental health as something we will deal with after we have solved the “real” development problems.

Mental health is one of the real development problems. If Uganda's young people are our greatest opportunity, then their mental health cannot be an afterthought. We cannot continue to celebrate the size of our young population while failing to invest in the conditions that allow young people to thrive. A demographic dividend is not created simply by having millions of young people; it is created by creating the conditions in which those young people can learn, participate, work, contribute and live healthy lives.

The State of Uganda Population Report has given us an important warning. For us at Twogere, it is also a call to action: we need to build mental health support around young people, not wait for young people to find their way into the mental health system. That means starting where young people already are, strengthening the adults and systems around them, listening to young people themselves, and ensuring that when someone needs more specialised care, there is somewhere meaningful for them to go.

Uganda is a young country. The question is not whether young people will shape its future. They will. The question is whether we are willing to build a future in which their mental health is treated as fundamental to that future, rather than as an issue we remember only when there is a crisis.