Dr Cassady: Although it may sound strange, Covid-19 has helped to normalize mental health problems.
Shedding light on what more needs to be done to make mental health care a reality for people, Dr Cindi Cassady, PhD (pictured below), a clinical psychologist at Icyizere Psychotherapeutic Centre, a specialized mental health care facility in Kigali, told The New Times’ James Karuhanga that misinformation, fear and a lack of accurate knowledge or awareness are the basis for a majority of the stigma against mental illness.
In an interview as part of efforts to raise awareness of mental health issues and to mobilize efforts in support of mental health, Cassady emphasized, among others, that organizations and institutions need to address mental health issues in the workplace.
The excerpts:
What have been your observations as regards the issue of mental health and related stigma in Rwanda?
Before I share my observations regarding stigma around mental illness, I think it’s important to understand why people stigmatize others for any reason and specifically regarding mental illness. Most often, incorrect information, fear, and a lack of accurate knowledge or awareness are the bases for a majority of the stigma against mental illness, people with disabilities, or any people whom you feel are different from yourself.
Even before Covid-19 and the lockdowns, one thing I observed over the last three years, is a tremendous shift in the way young people in their 20s and 30s talk about mental health issues. I call this generation the ‘change makers’ because they are changing the mental health landscape from the bottom up. They are tweeting about mental health, depression, suicide and drug use. They blog about their therapy sessions. They share their therapists’ contact details with friends at lunch.
They are encouraging their aging parents to seek therapy and they are the family barometer for how they think their family members are doing with regard to mental health matters. I’m seeing an increasing number of men of all ages, seeking psychotherapy and managing to overcome some of the cultural stereotypes of how Rwandan men are supposed to deal with personal or family problems. These examples make me feel incredibly hopeful that cultural and societal attitudes and beliefs about mental health are changing.
How did the pandemic impact things?
Although it may sound strange, Covid-19 has helped to normalize mental health problems. Many people, who would never have thought of looking for a therapist, decided during three months of lockdown, that they needed help coping with some of their thoughts and behaviors.
People, who normally could distract themselves with going to work, having a drink after work, and or attending weddings on weekends, suddenly found themselves at home day in and day out, and started doing a lot of self-reflection.
Some found they were not happy in their marriage, others felt sad about their struggle communicating with their teenage children, and some found themselves drinking a lot more than usual. These individuals were key players in the process of socially de-stigmatizing mental health problems because they realized you don’t have to be ‘crazy’ to ask for help in figuring out some difficult areas in your life.
Why is stigma around mental health issues bad, or dangerous?
Stigma divides people from each other based on fear and ignorance. It ‘others’ people which can lead to hate and in the extreme, even to violence. What I mean is that when we view a group of people as different from ourselves in a negative way, we make them the ‘other’ group and then we can be against them.
Think about the 1994 Genocide and how the Tutsi became the ‘other’ and were killed because they were thought of as not even human. Genocide is the extreme version of ‘othering.’
Any chance we could conquer mental health stigma because of what the ‘change makers’ alone are doing?
I wish it were that simple! Unfortunately, no, they cannot do it singlehandedly. All sectors of society can play an important role in creating mental health campaigns that create awareness, provide accurate information and offer access to mental health services.
It also starts in families with parents understanding that having depression is no more of a personal weakness than having diabetes is. It’s difficult to ask for large amounts of funding when we have been struggling to keep ahead of the Covid-19 pandemic and there is financial uncertainty. But ideally, increased funding for mental health could make a significant impact in many people’s lives and especially for the youth who are struggling with depression, anxiety, bullying in schools, and substance abuse.
What types of mental health issues are most diagnosed in Rwanda?
A national survey by the Rwanda Biomedical Centre in 2018, the Rwanda Mental Health Survey, found the most prevalent mental health disorders were major depressive episodes, 12.0%, panic disorder, 8.1%, and posttraumatic stress disorder, or PTSD, 3∙6%, in the general population.
In genocide survivors, the major depressive episode was at 35.0%, PTSD and panic disorders at 27.9% and 26.8%, respectively. There are also significant problems with addiction to alcohol, cannabis and pornography. There seems to be a tendency to normalize alcohol consumption for men and often men have a difficult time seeing when they’ve moved from social drinking to problem drinking.
Alcohol also has an interesting cultural tie to masculinity in Rwandan culture and this makes it more difficult for men to stay sober if they have a problem with alcohol. In general, there is a need for research looking at addiction and factors leading to alcohol and substance use addiction.
How does mental health stigma generally manifest in society?
According to the National Alliance on Mental Illness, or NAMI (a US-based advocacy group), there are seven types of stigma when it comes to mental illness. Public stigma happens when the public endorses negative stereotypes and prejudices, resulting in discrimination against people with mental illness.
I think we are seeing this lately with the issue of suicide and a tremendous lack of knowledge about suicidal behavior and suicide prevention.
Self-stigma happens when a person with mental illness or substance use disorder internalizes public stigma. Perceived stigma is the belief that others have negative beliefs about people with mental illness. Label avoidance is when a person chooses not to seek mental health treatment to avoid being assigned a stigmatizing label.
Label avoidance is one of the most harmful types of stigma because it prevents people from getting the help they need. Stigma by association occurs when the effects of stigma are extended to someone linked to a person with mental health difficulties.
Then there is structural stigma. Institutional policies or other societal structures that result in decreased opportunities for people with mental illness are structural stigma. Finally, there is what is called health practitioner stigma. This takes place any time a health professional allows stereotypes and prejudices about mental illness to negatively affect a patient’s care.
What are the best practices as regards ending stigma?
I think we are beginning to talk more openly about mental health and mental illness. I’m seeing this in social media and also in people expressing the desire for more opportunities to discuss mental health issues within a public format in order to reach more people. CARAES Ndera Neuropsychiatric Hospital will be engaging in some exciting community projects early next year specifically designed to decrease stigma toward mental health.
You don’t have to be a mental health facility to challenge the issue of stigma. Two dynamic women CEOs of NCBA and BRD, Lina Higiro and Pitchette Kampeta Sayinzoga, respectively, found ways to establish EAP (employee assistance program) mental health services for their employees because they noticed a need.
Many more organizations and institutions need to address mental health issues in the workplace. Besides talking openly, educate yourself about mental illness. For example, what exactly is depression? How do you get it and how is it treated? Be aware of your attitudes and judgement toward people with mental health issues. Focus on the positive. Mental illnesses, including addictions, are only part of anyone's larger picture. Avoid labels that are insulting or degrading.
Besides these two, do other employers in the country have an idea what an EAP is?
Actually, yes. I think the banking sector is leading the way in terms of introducing the concept of EAPs and I think other institutions and NGOs will follow. There has been more discussion on social media about mental health in the workplace, sexual harassment at work, how to provide a healthy workplace environment.
I’m very optimistic. And again, I think Covid-19 may have had a positive hand in forcing us all to look at our work lives very differently and the importance of finding balance between work and home.
Any other pertinent comment?
As parents, we have an important role to teach our children to have empathy and to appreciate diversity and be curious or interested in people who may be different from them. They can be taught their part by looking out for other children by including them in group activities, sending text messages to check up on how they’re doing and meeting them for playdates.
It’s usually a lack of social interaction that makes people feel unloved or not valued. Emotional support can make all the difference. It’s comforting for each one of us to know that someone cares.