For many years, Patrick Rutayisire grappled with drug abuse addiction, and the problem led to his expulsion from school. The former drug addict says getting over the vice was one of the biggest challenges he has ever faced. 

"I started abusing drugs as a result of peer influence. I thought it was something cool. It all started as something simple by consuming little amounts of cannabis, but later I got addicted. I used to be among the bright students, but I was expelled from school because of this,” he recalled.

The wake up call for Rutayisire came after he realised that his former classmates had completed their studies and were pursuing successful careers.

"I realised I had taken the wrong path and decided to stop using drugs much as it was hard. I went back to school and now I own a construction company,” he says.

Rutayisire is among the few who have managed to get over the vice which is the major cause of mental health problems. He calls upon the youth to refrain from such habits because they not only negatively affect their lives but also their future, families and the country.

Research carried out by Ministry of Youths and ICT (MYICT) in 2015, showed that dependence on drugs and other psychoactive substances is a threat to society and is main cause of mental health problems.

According to the World Health Organisation (WHO), one in four people in the world will be affected by mental or neurological disorders at some point in their lives. Around 450 million people currently suffer from mental conditions, placing mental disorders among the leading causes of ill-health and disability worldwide. Stigma, discrimination and neglect prevent care and treatment from reaching people with mental disorders.

What is mental health?

According to Dr Frederic Nsanzumuhire, the prevention of mental diseases and disability senior officer at Rwanda Biomedical Centre (RBC), mental health is a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his or her community.

Innocent Turate, the head of Institute of HIV/AIDS Disease Prevention and Control at RBC, says there has been an increase in the use of drugs in the country and therefore an indication that efforts should be doubled to stop the trend.

He says with the current magnitude of drug abuse, stakeholders including government and private institutions should join hands to fight this adversity.

Statistics from the Ministry of Health indicate that in 2014, Ndera Hospital handled over 440 cases related to drug abuse, and last year, over 2,800 mentally ill patients were treated at the facility.

Turate notes that people should understand that the abuse of drugs not only affects the abuser’s health but also the development of the country in general.

"I think the effects of drug abuse can evidently be seen and this doesn’t mean that these are the only people who were treated for drug abuse in our country. It is a very big number for sure; this is why we need to work together to fight it,” he says.

He advises that the fight should start now to avoid worse consequences in future.

Factors contributing to mental illness

Nsanzumuhire says factors leading to mental disorders are complex, and vary according to the particular disorder and individual.

For example, he says genetics, early development, drugs, a loss of a family member, disease or injury, psychological mechanisms, and life experiences, society and culture can all contribute to the development or progression of different mental disorders.

Also, data from the Ministry of Youth and ICT shows that 52 per cent of the youth between the ages of 14-35 used drugs once or more than once in their lifetime, while 7.5 per cent are addicts.

"In fighting drug abuse we need to put effort in sensitising people about the effects of drug abuse,” adds Turate.

The situation in Rwanda

As a consequence of the 1994 Genocide against Tutsi, Nsanzumuhire says, Rwanda faces a burden of mental health disorders. During the post-genocide period new challenges related to trauma and their complexity emerged within the community.

A nationwide study conducted in 2009 showed that post-traumatic stress disorder (PTSD) prevalence affected 28.54 per cent of the adult population. In the same study, a comorbidity (the simultaneous presence of two chronic diseases or conditions in a patient) affected 53.93 per cent of the population suffering from PTSD.

The 2016 report from Health Management Information System indicates that epilepsy, depression and anxiety disorders are among the top five leading causes of people inactiveness in Rwanda, while in 2005, a Ministry of Health study estimated the prevalence of epilepsy to be 4.9 per cent.

Interventions in place

According to Emmanuel Ntakiyisumba, a nursing coach at Ndera Neuro-Psychiatric Hospital, the government has decentralised and integrated mental health care into primary health care. Mental health care services are being provided in all district hospitals by a mental health professional.

For instance, he says official referral procedures for persons with severe mental disorders from primary care to secondary/tertiary care exist as do referral procedures from tertiary/secondary to primary care.

The management of mental illnesses is done from the health centre to referral hospital.

He adds that at least two general practioners and general nurses working in hospitals have received in-service training on mental health care. In addition to that, at least two nurses working in health centres were trained on common mental disorders.

Furthermore, guidelines are available in primary health care facilities to help health care providers in assessment and management of mental disorders, he says.

Nsanzumuhire points out that there are seven psychiatrists working in referral hospitals such as Ndera Neuropsychiatric Hospital, University Teaching Hospital of Kigali, University Teaching Hospital of Butare, Ruhengeri Referral Hospital and Huye Isange Rehabilitation Centre.

He, however, notes that mental health care services have been integrated into community-based health insurance (CBHI) for easy accessibility and affordability. In order to improve the quality of mental health care, medicines used in mental health have been integrated into a National Essential Medicines List.

"Activities aimed at sensitization on mental health issues and fighting against drug abuse are conducted regularly,” he adds.

Community health workers are now able to recognize and make an orientation for everyone who is suffering from mental problems at village level, he adds.

Nsanzumuhire says, in collaboration with Rwanda National Police, Huye Isange Rehabilitation Centre has been established in Huye District, Southern Province, to offer required rehabilitation services for drug and alcohol addicts, as part of a strategy to prevent gender-based violence, child abuse and related health consequences such as HIV/AIDS.

The Centre is also contributing to improved mental health for the population of Rwanda.

Challenges

According to Nsanzumuhire, challenges encountered in mental health include limited funds for mental health care; lack of qualified mental health professionals; as well as stigma which is still threatening people with mental disorders.

However, Ntakiyisumba says most people still believe that mental problems cannot be cured and only seek help when the condition is in late (chronic) stages.

"This misconception has led to many patients developing serious problems on the nervous system, stroke and paralysis, a stage where little can be done to cure the condition permanently. At this stage, the only cure is to prescribe certain medications to the patients just to manage their mental illness,” he says.

He advises that to avoid such problems, patients should be given early treatment when they experience signs such as insomnia, aggressiveness, nightmares, withdrawal from friends and activities, as well as extreme mood swings.

Perspectives

Ntakiyisumba says introduction of psychiatric emergencies, day treatment, child psychiatry and specialised services for people suffering from addictions, are expected soon.

Also, reinforcing the management of certain mental and neurological disorders such as epilepsy, construction of a treatment centre and providing the necessary equipment is key, he says.

Additionally, Ntakiyisumba says implementing the mental health law (draft available), increasing awareness of mental health issues in the community, increasing the number of mental health professionals as well as reinforcing formative supervision of mental health services will go a long way in improving mental health services across the country.

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EXPERTS SHARE TIPS

Gonzalue Niyegaba, medic at University Teaching Hospital, KigaliThose who are mentally ill should be helped to get treatment early enough so that they prevent further complications. Healthy eating and engaging in different types of physical activities can help keep mental problems at bay.

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Joseph Uwiragiye, nutritionistNutrition plays a big role in boosting one’s mental health. For example, consuming foods rich in omega-3 fatty acids, such as fish, have been shown to reduce symptoms of some mental disorders such as schizophrenia, depression and attention deficit hyperactivity disorders.

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Lucy Uwihesha, health officer at Kabarore Health Centre in Gatsibo DistrictCommunities should not stigmatise people living with mental health problems, but rather give them support to access medical treatment. This helps patients to get the required treatment on time, which prevents further complications.

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Julius Habimana, general nurseMaking some adjustments in your life is important. For instance, people should avoid things that can lead to depression such as not getting enough sleep as well as not excercising. This is because depression can also result to mental problems such as anxiety and eating disorders.