A funeral is underway. Relatives and friends are mourning the untimely death of a family head. The mood is somber. Suddenly, a woman wearing a thick layer of clothes enters, panting and sweating profusely. In local dialect she shouts, "You’re taking long to finish!” Her loud outcry causes stares, murmurs and even laughter.

A security guard rushes towards her and on seeing him, she takes to her heels. She disappears out of sight with the security guard hot on her heels. "She has been that way since her mother died,” one of the locals is heard saying. That she has not been assisted to find medical care for her condition can be attributed to lack of awareness within the community. It is not uncommon for people suffering from mental illness to be treated as nothing more than public nuisances and subjected to all sorts of human rights abuse and discrimination.

An invisible spiritual curse?

What is it about mental illness that arouses fear and stigma? People with psycho-social disability have been beaten, tied up, locked up and even turned homeless. They lose their status in society, sometimes they lose their property to relatives, they lack platforms to express their challenges because nobody takes them seriously and they barely have access to justice. Even after they have received treatment, it is likely that previously mentally handicapped people won’t find complete acceptance and that they will find it difficult to reintegrate within their societies. Dr Charles Mudenge, a psychiatrist at the University Teaching Hospital of Butare (CHUB) says, "Due to lack of awareness, most people still think that mental illness is an ancestral curse or punishment for wrongdoing or disobedience from God.”

Sam Badege, the founder and head of the National Organisation of Users and Survivors of Psychiatry in Rwanda (NOUPR), agrees with Dr Mudenge saying that indeed, most people link mental illness to spirituality. Badege believes this linkage is caused by the "invisibility and intangibility of the disease.” Andy Behrman, an American author who suffers from Bipolar disorder, a type of mental illness, wrote an article in 2005 titled, ‘Dump the Stigma and Focus on Recovery.’ In the article, he talks about how he felt when he was first diagnosed with the disease. He says, "The guilt I felt for having mental illness was horrible. I prayed for a broken bone that would heal in six weeks. But it never happened. I was cursed with an illness that nobody could see and nobody knew much about.” Behrman also says that the biggest concern his parents had about the disease was that they would face stigma from society. Perhaps this stigma also arises from lack of awareness about the fact that mental illness has a variety of causes and risk factors.

Why everyone is at risk

Anybody can become mentally ill. According to Dr Mudenge, mental illness can affect people of any age, gender, income, educational level, and cultural background.

In Rwanda, one of the most commonly diagnosed forms of mental illness is Post Traumatic Stress Disorder (PTSD). After the 1994 Genocide against the Tutsi, there was an increase in the number of patients with trauma and depression related symptoms. A study done by Naasson Munyandamutsa in 2009 found that 29 percent of Rwandans had symptoms of chronic PTSD and the majority of them experience depressive symptoms. A Commonwealth Health Report in 2011 also indicated the same results.

Another major cause of mental illness in Rwanda is alcohol and drug abuse. Dr Mudenge asserts that at present, the youth are most at risk since this age group is the most involved in alcohol and drug abuse. Statistics from Kigali Health Institute indicate that more than 50 per cent of the youth between 14 and 35 years of age have consumed one or more kinds of drugs. Additionally, statistics from Ndera Mental Hospital in Kigali indicate that at least 11 percent of the patients registered have ailments related to drug abuse.

Another risk factor to mental illness, most especially for the youth is social media. In 2012, Medical News Today, an American health news source reported on a study which suggested that Facebook use may feed anxiety and increase a user’s feeling of inadequacy. This arises from comparing one’s achievements to one’s online friends and it often leads to social insecurity and consequently, depression. In his article, "Well Connected? The Biologcal Implications of ‘Social Networking,’” Dr Aric Sigman, a chartered Biologist and physiologist mentioned that social networking often leads to increased levels of depression and loneliness, worsening of mood and diminished physical and psychological health.

But mental illness is not only acquired as a result of one’s actions. It may be hereditary whereby it is passed on from parents to children through genes. It may also be attained biologically if there is abnormal balance of brain chemicals called neurotransmitters. Another cause of psycho-social disability is psychological trauma suffered as a child for instance; severe emotional, physical, or sexual abuse; a significant early loss, such as the loss of a parent; and neglect. Dr Mudenge also says that environmental stressors such as a death, divorce, a dysfunctional family life, changing or loss of jobs or schools can trigger a disorder in a person and he/she may be at risk for developing a mental illness.

Seek or provide help in time

While some forms of mental illness are chronic and may therefore require long term treatment, some others can be cured in case of early diagnosis. According to Dr Mudenge, some of the signs and symptoms of mental illness may include; recent social withdrawal; an unusual difficulty in performing routine activities; and problems with concentration, memory, or logical thought and speech that are hard to explain. A mentally ill person may also have unusual and/or exaggerated beliefs and fears, dramatic sleep and appetite changes and deterioration in personal hygiene.

Therefore, the first course of action, if someone shows signs of psycho-social disability is to assist them in acquiring healthcare. After the person has acquired the necessary treatment or medication, experts advise that the person be helped as much as possible to reintegrate into their lives. Isolation and stigmatization are likely to cause a relapse.

What’s the best way to care for people with psycho-socio disability?

Franco Maniragaba, Nursing student

Mental illness is sometimes triggered by stressful situations. Therefore, identifying and eliminating push factors for the illness should be the second priority after assisting the person to get professional help.

Gorretti Uwamahoro, Businesswoman

In addition to medical treatment, people with psycho-social disabilities need therapy and attention. Therefore, family members should rally around them to protect and love them or at least manage their situation better.

John Baptiste Tugume, Field and Business Development Officer, NOUSPR

Society members need to stop discriminating against people with mental illness. If they feel stigmatized, it will be hard for them to get back on their feet even after receiving treatment.

M. Martha, Employee, Special Firm Guarantee

After they have received professional help, caretakers should always remember that mentally ill people might not always be well coordinated. They should therefore be treated with kindness

Laurent Kayonga, a dealer in animal feeds

The first course of action should be taking mentally ill people to the hospital, to identify the problem and find a cure or treatment. Patients should also be kept from stressful situations if they are to get better or completely cured.