The Cost of Not Investing in Mental Health

Uganda spends a lot of time talking about what it needs to invest in to secure its future. We talk about roads, electricity, technology, agriculture, education, skills and jobs. We talk about Uganda's young population and the opportunity it presents. We talk about building a stronger economy and creating the human capital needed to drive that growth. But there is one investment we still struggle to treat with the same seriousness: mental health.

The question is not simply whether Uganda can afford to invest in mental health. The more difficult question is whether Uganda can afford not to.

For a long time, mental health has largely been framed as a cost. We ask how much it will take to train more professionals, expand services, provide medicines, strengthen facilities or integrate mental health into primary healthcare. These are important questions, particularly in a country where access to mental health support remains limited. But if we only look at mental health through the lens of expenditure, we miss half of the economic argument. We also need to ask what poor mental health is already costing Uganda.

The cost is not only found in the health budget. It is found in classrooms when a student is struggling to concentrate or stops attending school. It is found in workplaces when someone is present but unable to function at their best. It is found in families when a parent or caregiver has to stop working to support someone who is unwell. It is found when young people leave school, struggle to enter employment or withdraw from social and economic life. It is found when people live for years with conditions that could have been recognised and treated much earlier. And it is found in lives and potential that cannot be recovered.

The State of Uganda Population Report 2025 puts some numbers behind this reality. The report 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. It also estimates that Uganda lost approximately UGX 833.9 billion in 2021 when direct mental health care costs and productivity losses were combined. Of this, UGX 137.3 billion was associated with direct mental health care costs, while UGX 696.6 billion was associated with productivity losses. Under a business-as-usual scenario, the report projects that these economic losses could rise to approximately US$4.5 billion annually by 2040. These figures should make us pause. The cost of mental health is not something Uganda will face in the future if we decide to invest. We are already paying it.

And we are not paying it in one place. We are paying through lost productivity, disrupted education, household pressures, health-system costs and the loss of opportunities for people who are unable to participate fully in society. When a young person drops out of school because of an untreated mental health condition, there is a cost to that individual, but there is also a cost to the family, the education system and the country. When someone is unable to work because of a mental health condition, the loss is not limited to their income. There is also lost productivity, reduced household income and potentially greater dependence on others. When a caregiver has to leave work to support a family member, the economic consequences extend beyond the person experiencing the condition.

This is why mental health should not be placed at the end of the development conversation. It should be built into it. Uganda is investing heavily in education because we understand that an educated population is essential to economic development. We are investing in skills because we want young people to be able to participate in the labour market. We are investing in healthcare because healthy people are better able to learn, work and contribute. Mental health is connected to all three. If we invest in education but ignore the mental health of the children and young people in our schools, we weaken part of that investment. If we invest in skills and employment but ignore the mental wellbeing of the people we are preparing for work, we leave another part of the investment vulnerable.

This matters even more because Uganda is a young country. More than seven out of every ten Ugandans are below the age of 30. We often describe this young population as one of Uganda's greatest opportunities and talk about the demographic dividend it could create. But a demographic dividend is not automatic. It depends on whether young people are healthy, educated, skilled, economically engaged and able to participate meaningfully in society. Mental health is therefore not separate from the demographic dividend. It is one of the conditions that will determine whether Uganda is able to realise it.

The investment case is also about when we invest. There is a tendency to wait until a mental health problem becomes severe before support is offered. By then, the individual may have been struggling for months or years, their education or employment may already have been affected, relationships may have broken down, and the cost of intervention may be much greater. Investing earlier does not remove the need for specialist mental health services, but it creates opportunities to recognise problems earlier, provide appropriate support and connect people to professional care before difficulties become crises.

This is where we need to think differently about the places in which we invest. Mental health support cannot be built only around hospitals and specialist services. Those services are essential, but they cannot carry the entire burden of mental health in a country of Uganda's size and population. We also need to invest in primary healthcare, communities, schools, families, prevention, early identification and referral. The question is not whether one should replace another. The question is how we connect them so that a person can receive the right support at the right time.

Schools are particularly important in this conversation. Uganda already has a system that brings millions of young people together every day. Schools provide an opportunity to reach young people early, before problems become crises. Teachers are often among the first adults to notice when a student's behaviour, attendance, relationships or academic performance changes. They do not need to become therapists or diagnose mental illness. But with the right skills and support, they can recognise concerns, respond appropriately and help connect a young person to the next level of support.

This is not simply a mental health argument. It is an investment argument. If we can support a young person earlier, help them remain engaged in education, reduce the likelihood that a problem escalates and connect them to appropriate care when necessary, we are protecting an investment that Uganda is already making in that young person's future. The same principle applies to communities, workplaces and primary healthcare. The earlier we can recognise and respond to mental health needs, the greater the opportunity to prevent avoidable human and economic costs.

There is evidence that this kind of investment can generate returns. Uganda's mental health investment-case research found that evidence-based interventions for conditions such as depression can produce economic benefits through increased productivity. For depression, the estimated benefit was approximately 2.4 times the investment when productivity gains alone were considered, rising to approximately 6.5 times when wider social benefits were included. These are modelled estimates for specific interventions, not a promise that every mental health programme will generate the same return. But they demonstrate an important point: mental health investment can produce economic value; it is not simply expenditure that disappears into the health system.

This should change how we think about funding mental health in Uganda. The question should not only be how much money we can allocate to mental health services. We should also ask where investment will have the greatest effect, which interventions provide the strongest evidence of benefit, how we can reach people earlier and how mental health can be integrated into systems that already reach large parts of the population.

We should also become more demanding about what we measure. Counting how many people attended a mental health training or how many schools received awareness materials tells us about activity and reach, but it does not tell us whether the investment made a difference. We should be asking whether teachers are 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 completed, whether people are reaching appropriate care and whether young people are experiencing healthier and more supportive environments. An investment case becomes much stronger when we can demonstrate not only what we delivered, but what changed because we invested.

At Twogere, this is why we focus on strengthening school-based mental health systems. We do not see schools as a replacement for the health system, and we do not believe teachers should be turned into mental health professionals. We see schools as one important part of a wider system that can help close the gap between a young person experiencing distress and the support they need. By equipping teachers with practical skills, supporting student mental health champions, strengthening referral pathways and connecting schools with families, communities and health services, we can help build a system that responds earlier rather than waiting for crisis.

The same thinking needs to extend beyond schools. Mental health should be considered when Uganda designs youth employment programmes, education policies, community interventions, primary healthcare services and social protection programmes. If mental health continues to be treated as a separate issue, we will continue to pay for its consequences somewhere else. A young person's mental health can affect their education, employment, relationships, physical health and ability to participate in society. It therefore makes little sense to design policies around those areas without considering mental health.

The question, then, is not whether mental health deserves investment because it is a good thing to do. It does. But that is not the whole argument. The stronger argument is that mental health is an investment in the people Uganda is already investing in.

We are investing in children through education. We are investing in young people through skills development. We are investing in employment and entrepreneurship. We are investing in healthcare. We are investing in Uganda's economic future. Mental health should not sit outside these investments. It should help protect and strengthen them.

Uganda has a choice. We can continue to treat mental health as a specialised service that people access when problems become severe, or we can recognise mental health as part of the country's human capital and development agenda. We can continue to ask what it will cost to invest in mental health, or we can start asking what it is already costing us not to invest.

At Twogere, we believe the second question is the one Uganda needs to ask more seriously. We need to invest in prevention and early support alongside treatment. We need to strengthen the systems that surround young people, particularly schools and communities. We need better data to understand what works and where investment produces the greatest return. And we need government, funders, schools, health services, communities and young people themselves to see mental health as a shared responsibility. The cost of investing in mental health is real. But so is the cost of not investing. And for a young country like Uganda, that cost is too high to ignore.