Health practitioners and researchers say mental health challenges continue to worsen due to a lack of effective response especially for those with mental disorders.

Recent improvements in the country’s healthcare system such as insurance for all, enrolling pregnant women with HIV on antiretroviral therapy and drastic reductions in maternal and infant mortality rates have not extended to mental healthcare.

Officials from the Ministry of Health who spoke on condition of anonymity said mental health lacks financing and human resources.

Until early February, the most recent survey on mental health was carried out in 2009. This means that most interventions for mental health disorders are not informed by research findings, a government official said.

This finding is corroborated by the National Rehabilitation Service (NRS) Director-General Bosenibamwe Aime who said that the starting point for responding to mental disorders is research.

The Rwanda Mental Health Survey Report 2018 released in February at the University of Rwanda College of Medicine and Health Sciences showed that between 25 per cent and 37 per cent of respondents suffer from a mental illness.

The survey is the most comprehensive on the state of mental health in the country despite its many limitations. For instance, while it provides statistical data on trends of mental disorders, it does not explain the causes.

It shows Gasaba District has the highest rate of mental disorders at 36.7 per cent followed by Huye at 30.2 per cent. The research also showed that mental illnesses are more common among the least educated and in the rural areas.

Psychotic disorders account for 25.1 per cent of mental illnesses. Post-traumatic stress was at 11.5 per cent among respondents.

Overall, prevalence of depression in the country was at 11.9 per cent; panic disorder 8.1 per cent; obsessive compulsive disorder was at 3.6 per cent; alcoholism at 1.6 per cent and bipolar disorder at 0.1 per cent.

“These are not mere statistics but lives of people. Something needs to be done. We need to research on causes to understand more than we know now,” said Vincent Sezibera an associate professor of clinical psychology at UR School of Health Medicines, and the lead researcher of the survey.

The research also showed that 61.7 per cent of the respondents who suffer from mental illness know where to seek professional help from. However, only 5.3 per cent of them sought this support.

Officials at Rwanda Biomedical Centre (RBC) said about 223,500 people visited the centre for mental illness diagnosis last year. About 10 per cent of them were new cases while the rest are chronic sufferers who require hospitalisation of not less than six months.

Currently, Rwanda only has one referral neuro-psychiatric hospital CARES Ndera which was founded by Fathers of Charity Catholic Church. There are only 12 specialised psychiatrists in the country.

Recently, other centres such as Ikizere which is part of CARES Ndera and Isange in Huye, have been set up. Their services, which are considered costly, are said to be largely limited to confinement.

Ministry of Health officials said the government is committed to easing access to mental healthcare services, as evidenced by the country’s national mental health policy. The policy provides for decentralisation and integration of mental healthcare services from health centres to referral hospitals.
However, a section of practitioners say these services are not readily available at most public health facilities in the country and even when they are there, there is a lack of skills to diagnosis mental illness.

The other challenge is lack of medicine for mental disorders, which increases chances of a relapse.

The director of Psychiatric Care Unit at RBC Jean Damacene Iyamuremye said the challenge of limited resources for mental healthcare is a global one.

A World Health Organisation Report on Mental Health in 2001 said depressive disorders were the fourth leading cause of the global disease burden and are expected to rank second by 2020, behind heart disease.