Early this week, Sonia Mugabo, a fashion designer publically shared her past struggle with Post Traumatic Stress Disorder (PSTD) on Twitter, it was applauded by many as a triumph for fighting the stigma of mental illness. Many came out to share their stories on the platform.

The fashion designer was 20, when she was diagnosed with PSTD.  At the time, she was still in college and was going through a series of panic attacks and reoccurring nightmares that resulted from her horrific experience of the 1994 genocide against the Tutsi.

Her family survived the 1994 genocide at Gisimba Orphanage, Nyamirambo and it was there that the killers shot a man right in front of her.

"Growing up, I always had these nightmares and I always feared sleeping alone, or facing the wall because then I would have dreams about the war but it didn’t make sense until I was in college and I kept having the same dream because we survived,” she narrates.

To her, life lost meaning, she often experienced panic attacks and even contemplated suicide. Fast forward, with the consistent support from family, friends and therapy, she was able cope with depression within a year.

Alice Bayingana, a public health worker is one of the victims of mental illnessand also shared her story on twitter.

Since the age of 12, she has also been dealing with persistent depressive disorder (PDD) or dysthymia. It’s also referred to as high functioning depression.

She narrates: "I broke down for the first time in university. I was feeling very suicidal and almost went through with it. I went to see my school’s counsellor and while we were talking she started crying so I left and never went back. I held it together for a while because I knew if I killed myself, it would not go well with my mom.

The second time I broke down was last year. This time I got serious about seeking help. I am currently seeing a psychiatrist and I am on antidepressants and thriving.

I still have bad days and good days but that’s life right?”

Why therapy is a necessity

According to the World Health Organisation and World Economic Forum, mental illness represents the biggest economic burdens of any health issue in the world, costing $2.5 trillion in 2010; this burden is projected to cost $6 trillion by 2030 with two-thirds of these costs attributed to disability and loss of work.

And yet shockingly, of the 450 million people worldwide who suffer from mental health conditions, the majority 60 percent do not receive any form of care, with 90percent of people in developing countries receiving no form of care. 

According to Dr. Jean Damascene Iyamuremye, the Director of Psychiatric Care at Rwanda Biomedical Centre (RBC), 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 the late researcher Naasson Munyandamutsa in 2009 found that 29 percent of Rwandans had symptoms of chronic PTSD and 20% of the general population experience depressive symptoms. 

Iyamuremye adds that more causes are coming up and they include stress due to the increase in workload, individualism that is resulting from lifestyle changes.

"As the world develops there is less of social support that is essential for keeping us mentally alert. Also, taking care of young people is a problem because there are no preventive measures for early childhood,” he says.

During a panel discussion, on Friday evening, to raise awareness on mental health, Jemma Hogwood, a clinical psychologist noted that even though therapy is essential in living healthy, therapy acquired outside Rwanda’s only specialised facility for mental health, Ndera Neuropsychiatric Hospital, is expensive and therefore becomes a luxury to majority of the people that need it.

She added that worldwide, resources are limited and therefore if one is not in a crisis, therapy is not accessible and one has to find it elsewhere.

Sonia Mugabo who was also a panelist said that society ought to realise that therapy is bigger than the value that it is given.

"We sometimes judge young people who turn into alcoholics but we do not realise that it helps them feel better. As a society we are very fragile and life has its ups and down, therefore we should not wait for someone to have panic attacks or become suicidal to take them for therapy, she said.

As someone in the creative arts, she added that being a creative is both a blessing and a curse because creativity comes with feeling things more deeply, making  creatives prone to mental illness.

"When people put out all their energy in an emotional endeavor, their source of inspiration needs to refuel itself, and part of that process may be at the core of this type of distress.”

After seven years of dealing with bipolar disorder, Mugabo wants to address and fight stigma around mental illness.

"I want to be an advocate for mental health especially now that I have a brand. I am writing a book about my journey and I hope that I will be able to start up a center to help people feel understood.

Counselling is very expensive and most insurance companies do not even cover it and so at the same time I feel the centre would be able to offer pre-counselling sessions. Rwanda is moving in the right direction but we need to give attention to trauma,” she reveals.

Dealing with stigma

According to the WHO, 20 per cent of the world’s youth, between 15 and 24, have experienced a mental health condition.

WHO further states that youth with mental health conditions often experience stigma and discrimination, which in turn can lead to exclusion or discourage them from seeking help for fear of being negatively "labelled” or called names.

Bayingana reveals that coping with the condition for her was never easy, especially as someone who always thought she was in control. As a result, the stigma was coming from the inside.

"When I told my mother, brother, and sister what I was going through they were very supportive. My friends were even more supportive of me. So, coping? Right now it’s just me coming to terms with the fact that this is a potential life long journey and that’s a hard thing to come to terms with,” she says.

Most of her work is around youth sexual and reproductive health and access to "quality” and affordable mental health care. Like Mugabo, her experience in dealing with mental illness and working in the mental health field has taught her the importance of raising awareness of the struggles they go through.

"Additionally, we need to make mental health care accessible and affordable to the public. If it were up to me everyone would be in therapy because I think everyone could use a little support. We aren’t taught to cope with trauma and general life issues. Therapy helps with that. Also, as a country that has a high burden of mental illness because of our past, we cannot afford not to invest in mental health. That is why I work in this field,” she says.

Hogwood through her experience working in Rwanda revealed that therapy and counselling is new in the country and it is still stigmatized. She added that intergenerational trauma can be passed on throughout the generations and that it is up to individuals to be supportive and acknowledge it to open up and be kind.

Dr. Iyamuremye says that stigma is the biggest barrier to mental health care, manifests particularly in a phenomenon known as social distancing, whereby people with mental issues are more isolated from others. 

He adds that even though there is always someone to respond to mental disorder in every health facility, negligence from both the caretakers and health workers is the biggest form of stigma.

"Even sending the patient to Ndera without diagnosis is stigma. Rwanda Biomedical Center is fighting stigma in every aspect including the hospitals where bipolar patients are not catered for as other patients. In some cases, psychotic disorders are also sometimes interpreted as trauma.”

"Sensitisation is the biggest challenge because it is still low. We still do not have the means to reach other health projects yet we also struggle with societal beliefs with people relating mental disorders to witchcraft,” he says

During the panel discussion, Emmanuel Rwililiza, a psychiatrist advised that preventative work through therapy is really important before mental illness gets to crisis level.

We shouldn’t focus on diagnosis only but the pain of the person. We need to keep talking about it and reach out to as many people as possible.

What is the best way to care for people with mental illness?

Be sure that if its mental illness by taking the person for diagnosis. Find out the cause of the illness and determine if the patient is psychotic. Seek medical help like you would do for any other illness. Many people choose to stay at home and rely on traditional measures yet they take other physical illnesses seriously.

Prof. Vincent Sezibera, a clinical psychologist, University of Rwanda

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We all need to be concerned with mental health issues because it touches every part of our lives. We all have a responsibility to learn about mental health because  we spend most of our time around people affected by mental illness. We need to learn to be patient around them and give them time to cope with what they are going through.

Jean Apotre Niyigaba, physiotherapist