Decentralising mental health and psycho-social support services in Rwanda
Close to three decades after the Genocide against the Tutsi in Rwanda, Rwandans are still experiencing its effects on mental health, socio-economic development, social cohesion, and reconciliation. The recent Rwanda Mental Health Survey conducted in 2018 by the Rwanda Biomedical Centre (RBC) revealed that the prevalence of mental health disorders among the Rwandan population is higher than the global average and is particularly elevated among genocide survivors. Interpeace’s recent research studies corroborated the findings of the 2018 national survey. The most commonly diagnosed mental illnesses are major depression, post-stress traumatic disorder, anxiety, panic disorder, substance dependency, and social phobia. To address these longstanding consequences, strengthening and supporting the decentralisation of the National Mental Health and Psycho-social Support System is of paramount importance.
Over the past 20 years, the Government of Rwanda has made significant efforts to decentralise mental healthcare in referral and district hospitals and integrate it into primary healthcare (health centers) across the country. However, the country still faces challenges such as the scale of mental health needs that outstrips the capacity of available professionals, low awareness and knowledge of mental health issues, poor mental health infrastructure, and low utilisation of mental health services, which stands at 5.3%.
Through its societal healing programme implemented with the financial support of the Government of Sweden, Interpeace works with the Ministry of Health through the Rwanda Biomedical Centre (RBC) to find innovative solutions to those challenges. The programme strengthens the capacity of mental health professionals through training and the provision of equipment. With its partners such as Prison Fellowship Rwanda, Haguruka, Dignity in Detention (DIDE) Rwanda, and Groupe des Anciens Etudiants Rescapees du Genocide (GAERG), Interpeace has also introduced a community-based healing approach known as the Resilience-oriented therapy protocol, a multi-phase group-based treatment for emotional regulation, behavioural self-management, and identity development to complement the one-on-one approach usually used in health facilities across the country.
In July 2023, Interpeace trained 58 clinical psychologists and mental health nurses from seven district hospitals, 32 health centres, and four correctional facilities from the five districts of programme intervention, namely Musanze, Nyabihu, Nyamagabe, Nyagatare and Ngoma, to implement resilience-oriented therapy at health centre level.
Clementine Sezicyeye, a Mental Health Nurse at Kigeme Hospital, located in Nyamagabe District, Southern Rwanda, is among the trainees. Her unit receives over 200 cases of various mental health disorders every month. She mainly offers medication-assisted treatment. She is convinced that the community-based Resilience-oriented healing spaces will contribute to ensuring easy access to mental health care for more people.
“The one-on-one approach we have been using is good and effective, but it is not enabling us to help as many people as the scale of needs requires. We have learnt a new group-based approach that allows us to help many people at the same time with the possibility for facilitating more than two groups a week. This is an innovative solution to this challenge. We are ready to implement this protocol,” commented Sezicyeye.
The trained health professionals will facilitate resilience-oriented healing spaces created in their health centres, accommodating a group of 10 people each. Group members attend healing dialogues for a period of 30 weeks, composed of 24 weekly healing sessions and six follow-up sessions. Community members are allocated to appropriate healing groups after screening sessions conducted in communities to assess the level of their psychological distress and their needs.
The programme has supported health centres and hospitals with tablet computers for adequate data collection and management during the screening and healing processes. They will also be provided with motorcycles to facilitate the transportation of mental health professionals to remote communities.
“There are many people in communities who don’t even know or recognise that they have mental health issues and those who know but have limited means to access health care. As a health centre, we have a very limited budget to organise large-scale activities in communities. I believe that enabling us to reach out to them is the best way to support them,” said Emmanuel Mbarushimana, the Head of Muhoza Health Centre, located in Musanze District, Northern Province of Rwanda, who added that community screening sessions will be an opportunity to carry out awareness campaigns to increase awareness and knowledge among the community members as well as combat the stigma that people with mental health issues usually face.
The low mental health literacy among heads of health centres still constitutes a stumbling block to service delivery. All 32 heads of health centres from five districts of the programme have been trained to increase their knowledge and strengthen their capacity in mental health and psycho-social support care. “My colleagues and I used to undervalue the work of psychologists and mental health nurses because we had little knowledge of what they do and what it requires. We often used them as backup staff when we faced staff shortages. Now I have understood that they do a lot of work and need more time and safe space,” stated Mbarushimana.
