Suicide data released by the Rwanda Investigation Bureau (RIB)’s Spokesperson Thierry Murangira this past weekend provoked the need for open conversations about mental health issues. Murangira, who was appearing on a local radio show, said that a total of 576 people in Rwanda have committed suicide in the last two years. Broken down, between July 2019 and June 2020 alone, 291 people ended their lives while from June 2020 to July 2021, another 285 such deaths were recorded. Although it has been a hot debate in Rwanda in the past few days, what most people don’t know is that suicide is a result of mental illness. Mental illness refers to a wide range of mental health conditions that affect your mood, thinking and behaviour. Examples include depression, bipolar disorder, anxiety, schizophrenia, eating disorders and addictive behaviours. For instance, the 2018 Rwanda Mental Health Survey found that depression among the general population is 11.9 per cent, and at least one of five Rwandans have a mental health condition. Mental disorders among youth aged 14-18 years old stand at 10.2 per cent. Although no new data is available at the moment, a spike in the numbers is expected with the outbreak of the Covid-19 pandemic and the challenges that came with it. The New Times talked to a cross-section of people who told us how the mental health challenges can be dealt with and more lives saved. 1. Invest in comprehensive research In a telephone interview with The New Times, the youth representative in the Lower Chamber of Parliament Ernest Kamanzi said that there is need to hastily invest time and resources in a comprehensive fact finding mental health research to ascertain the depth of the issue. He explained that the results of the research will pave a way for all the stakeholders to come together and formulate a long term strategy that will help the patients, mental health treatment service providers and the community as a whole. “Research plays a vital role in the understanding of the causes of mental illnesses, the development of treatment and preventive strategies, and the overall promotion of mental health within our society,” he said. Kamanzi said that there is little to no knowledge about mental health issues and this itself can be a problem. 2. Beat stigma with education Justine Mukamwezi, a Clinical Psychologist doing consultancy at ‘Solid Minds’, a local clinic that provides counselling services agrees with the legislator, saying that lack of enough information continues to force many not to seek help. She explained that without adequate information, many people in society still consider mental health challenges like depression ‘a complaint of the rich or spoilt’. “People will ask why would you want to end your life yet your life is perfect? This is an indication that many lack the information that allows them to know that mental illness mostly has nothing to do with what you see on the outside,” she said. Mukamwezi explains that lack of enough information later also translates into stigma where those who feel unwell fear seeking help for fear of being branded or called derogatory names like ‘insane’. 3. Own the programme Sylvie Nsanga, a gender rights activist, says that although good mental health is at the core of everyday life, there is still no tangible ownership when it comes to ensuring that the citizenry has the right information on how to recognise signs, what to do and who to go to. “Mental health and its challenges is something that we talk about in passing but having good education or local government systems that work well are all dependent on how well the citizens are mentally,” she said. She called for a comprehensive and updated mental health policy that can be mainstreamed into every aspect of local and central government. “We may not have the funds to do everything right now but as long as the laws, policies and services are readily available, we can change mind-sets that have for instance taught people a dangerous habit of keeping their problems to themselves,” she said. 4. Start early enough The Head of the Mental Health Department at CHUB Dr Vianney Nyirimana, said that with the correct information targeting the right people, mental health challenges can be mitigated early enough. Nyirimana was basing this on his research papers titled ‘Prevalence of Childhood Adversities among Inpatients with Mental Disorders at Caraes Ndera Neuropsychiatric Hospital in Rwanda’. He said that most Adverse Childhood Experiences (ACEs) are very common with patients with mental disorders who walk through his doors every day and as a result, 61 per cent of the ones in his research did not go beyond primary school and 42.6 per cent were unemployed. ACEs are potentially traumatic events that occur in childhood (0-17 years). These events may include traumatic experiences like child abuse and neglect, growing up in dysfunctional households that are characterised by domestic violence, incarceration, parental divorce, and drug and alcohol abuse. He called for the involvement of employers, family and friends as far back as when the child is still in the womb. “Childhood is the foundation of adult health outcomes. If a child has insecure attachment in early development and lack of love and trust eventually as a consequence, they will vent in a different way in their adulthood. This is why it is important to tackle these issues early,” he said. 5. Fund the mental health initiatives In a recent interview, the Director of Psychiatric care unit at the Rwanda Biomedical Centre (RBC) Dr Jean-Damascène Iyamuremye called for funds to be injected in this area to support treatment. “Mental health is still underfunded yet we need to coordinate activities of treatment and prevention, fighting stigma against victims and we need to raise awareness regarding access to treatment,” he said. He added that these funds would go to help in identifying mental disorder triggers such as poor psychological health, alcoholism, diseases such as HIV, hepatitis, cancer, poor diet, rapid development and technological changes among many others. “At least 18 per cent of HIV positive people get mental health disorders while some mental conditions are related to poverty. Every health general nurse and doctor should have knowledge and skills to assess, diagnose and treat patients with mental disorders as an integrated way of handling the issue,” he said. Currently, Rwanda has 12 psychiatrists specialising in mental health issues and over 2,000 psychologists. The World Health Organisation says that there is only one psychiatrist per 100,000 people in half of the countries in the world. 40 per cent of the countries have less than one hospital bed reserved for mental disorders per 10,000 people. Currently, more than 40 per cent of the world nations have no mental health policy.
