Giving priority to the mentally ill

One of four patients visiting a health service has at least one mental, neurological or behavioral disorder but most of these disorders are neither diagnosed nor treated. Fifteen years after the 1994 Genocide against the Tutsi, many people in Rwanda still live with trauma, loneliness and extreme depression that cause mental illness and madness. Due to the nature of these non communicable diseases, people spend hours deeply pondering about what happened in the past and live in grief and fear. Alfred Ngirababyeyi, a specialist in mental health care at Ndera Hospital disclosed that, “a person who is not mentally stable will display immediate symptoms which astonish his or her relatives and close friends who eventually tend to isolate them.” Ngirababyeyi added that, “If a person is mentally troubled, they should not be abandoned. Instead take care of them because they can regain their normal life and be able to tell the difference between good and bad.” He also advised people to take patients who are mentally ill to specialists in order to prevent further progress of mental abnormality in the patient’s life. According to Boniface Harerimana, a psychiatrist at the University Central Hospital of Kigali (CHUK), mental health means, “a state of wellbeing in which every individual realizes his or her own potential, to cope up with the normal stress of life, work productively and are able to make a contribution towards their community.” Harerimana noted that most countries, particularly low and middle income countries, still have a long way to go in terms of delivering mental health services. “We are severely short of both human and financial resources and yet the health care resources available are mostly spent on the specialized treatment and care of the mentally ill, and to a lesser extent on an integrated mental health system that provides care in large psychiatric hospitals,” Harerimana said. He noted the need for countries to integrate mental health into primary health care. This he said would provide mental health care in general hospitals and develop community based mental health services. However, there is less funding for mental health awareness and promotion within communities in Rwanda. This he said is the cause of the lack of a positive attitude towards the mentally ill. “Encouragement of individual resources and skills, and improvement in the socio-economic environment should be among the core strategies for consideration,” he said. Adding that, “mental health promotion requires multi sectoral action, involving a number of government sectors and non governmental or community based organizations.” On the other hand, Innocent Musonera, a doctor at Ndera hospital pointed out the necessity for countries to focus on mental health awareness at individual levels as a way of ensuring a healthy start in the life of children and to prevent mental disorders in adulthood and old age. “Mental, neurological and behavioral disorders are common in all Provinces of Rwanda. There is immense suffering where a number of people with these disorders are often subjected to social isolation, poor quality of life and has led to increased mortality,” Musonera said. He further explained that some disorders are a direct result of staggering economic and social costs. Dr Fidel Sebera, from the department of mental health care in the Ministry of Health pointed out that, hundreds of millions of people worldwide are affected by disorders due to substance use. According to 2002 estimates from the World Health Organization (WHO), 154 million people globally suffer from depression and 25 million people from schizophrenia; 91 million people are affected by alcohol use disorders and 15 million by drug use disorders. Another WHO report that was recently published, showed that 50 million people suffer from epilepsy while 24 million from Alzheimer and other related diseases. Sebera said that, mental illnesses are alleviated by chronic conditions like cancer, heart and cardiovascular diseases, diabetes and HIV/AIDS. “There are cost effective treatments for most disorders and, if correctly applied, could enable patients to reintegrate into the society,” Sebera said. To overcome barriers associated with mental health, there is a need for policy makers, insurance companies, health and labor organisastions as well as the public to discriminate between physical and mental problems. Even though most middle and low-income countries devote less than one percent of their health expenditures on addressing this problem, consequently mental health policies, legislation, community care facilities, and provision of treatment of mentally sick people, will have to be given the priority it deserves. karangua_p@yahoo.com