Prison officers have a responsibility of identifying prisoners who may have mental health needs and help them access healthcare services.

It’s in this context that Rwanda Biomedical Center (RBC), through mental Health Division recently organized a five-day training in Musanze, of prison health staff on mental health and management of drug addiction victims.

The aim of the training was to sensitize medical practitioners, social workers and psychologists in charge of inmates to identify changes in behavior that may be indicative of an underlying mental health problem among prisoners.

They are the ones who have the most contact with inmates, and they deal with mental illness on a daily basis, which will make it easier to point out any problem. They can as well refer such inmates to health care teams for further assessments.

Most research suggests that people in prisons are more likely to suffer from mental health problems than people in the community.

Complex social and personal issues such as history of unemployment, substance misuse or trauma are more common among prison population, and being in prison can exacerbate poor mental health and well-being.

According to the Rwanda Correctional Services, 960 inmates are currently receiving treatment for mental health problems although there might be people receiving treatments that are not documented.

According to officials, the number of prisoners with mental health or well-being problems is likely to be higher, because some people may not be receiving treatment.

Factors contributing to mental illness among inmates

Dr Jean Damascene Iyamuremye says inmates are the most vulnerable people when it comes to mental health. When the officers are informed on how to detect mental problem earlier, it’s easier for them to get the treatment required thus less complications.

"Because of isolation from the society and social network, lack of privacy depresses them which puts them in suicidal ideation. This is a big problem because people attending to them can’t identify the signs and they are left to suffer without any help,” he says.

He notes that before they even go to prison, some of them already have unidentified mental disorders, and because there is no one to assess them, they don’t get the support required.

Through the training, professionals are expected to recognize this and work on the issue before it gets out of hand, and if detect any alarming sign, referring such patients to health facilities.

According to Dr. Yvonne Kayiteshonga, National Director of Mental Health, Ministry of Health, people with mental disorders should seek medical care as early as possible to avoid situations getting worse.

She says being detained itself can cause mental disorders.

When inmates start thinking about their past dotted with crimes, they regret which contributes to stress, anxiety and, eventually, mental disorders.

"There are also people who enjoy committing crime and most of the time they find themselves in prisons. Although such people might not have been mentally ill before, this kind of personality itself is not normal and if not handled can worsen the mental disorders,” she says.

She adds that the prison officers should have enough knowledge on mental health, to be able to manage inmates.

"For such officers to be able to manage the inmates well, they also need to be well mentally so that they can be in a position to handle the patients well,” she says.

On top of that, Kayiteshonga says they have 20 nurses in health centers who will partner with other health officers up to the lower level in the community, to be able to make them aware of mental sickness in Rwanda.

There will also be mobilization on fighting against stigma and isolation on mental disorder.

"There is good organization in prisons where there is strong collaboration between prison officers and medical staff to take care of the inmates. This shows how far we are as a country when it comes to handling mental illness in prisons, a practice which could not be found in other countries,” she

Challenges

The main challenge when it comes to mental health, Kayiteshonga says is stigma and discrimination. She notes that people don’t understand the nature of mental disorders.

"People tend to think that the condition is not curable and even if treated, one can still come back to the mental state again. This is not true and people need to change their mind set on this because the condition is curable just like other diseases or conditions,” she says.

She mentions that the society in general should be aware that just like diabetes or any other diseases which are chronic, there are also chronic mental disorders and so victims should not be discriminated.

Drug abuse is another big challenge contributing to mental disorders; she notes that people abusing drugs have the most complicated cases in mental disorders. There is a big number of them who need mental care due to the substances they are using.

Expectations

Robert Kamugisha, in charge of medical service at Huye prison says they have been coming across some challenges in prison, but they didn’t have enough knowledge on how to handle them. With the training, he is optimistic that mental health services within the prisons is going to improve, and inmates will be shown on how to go about their prosecution system easily.

For instance, he mentions that when inmates are brought in, some shows some threatening signs and conditions, but because of lack of enough knowledge, they took them as normal.

"This is going to change as we will be able to detect particular conditions early enough to avoid complications among inmates. This will be achieved because we have been trained on how to screen them when they arrive and find out any alarming situations so that we avail assistance,” he says.

Kamugisha adds that before, they didn’t have the link between RCAS and RBC on mental health service, whereby in case of any problem within the inmates, they had to transfer such patients to specialized centers. With the strong partnership now, he says inmates will get the best services as far as mental health is concerned.

An estimated 450 million people worldwide have a mental disorder. At any given time, approximately 10% of adults are experiencing a current mental disorder, and 25% will develop one at some point during their lifetimes.

The World Health Organization defines mental health as ‘a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.