Thirty-year-old Martina Mutoni (real names withheld on request), a scientist with a master’s degree in her field of work was seriously contemplating suicide in August 2020. Mutoni, an employee in a strategic public institution in Kigali who is among the few dedicated experts there, was then suffering from depression and did not know anything about this mental health problem. “Before I sought medical help, I was not even aware of depression. I used to think everything was stress. I lost interest in life, lost appetite, couldn’t sleep and just felt suicidal,” she told The New Times. According to Dr Cindi Cassady, PhD, a Clinical Psychologist at Icyizere Psyhotherapeutic Center, a specialized mental health care facility in Kigali, a national survey conducted in 2018, the Rwanda Mental Health Survey, found the most prevalent mental health disorders were major depressive episodes (12 per cent), panic disorder (8.1 per cent), and posttraumatic stress disorder (PTSD) (3∙6%) in the general population. Mutoni’s problems had worsened during the very first Covid-19 lockdown last year when she found herself alone upcountry and “completely cut off from family” and friends’ support. “I lost interest in everything. I no longer wanted to even watch a movie, or, as any lady, bathe and dress well. I felt a sorrow so deep that words cannot express. I was shut in a very dark box and it was so hard to smile.” Stigma in society was one of her worst enemies as it made things worse, and delayed her from getting help. “When I first got depressed, people said I was bewitched. Others said I was poorly brought up and was merely a spoiled child. People just said depression does not exist as a real issue,” Mutoni said. “The stigma just worsened things for me. Worst of it all was the labeling I got that I was mad, Umusazi, or that I was pretending to be sick, yet no one, other than mental health experts, can identify mental health issues.” After seeking help at the Neuro-Psychiatric Hospital (CARAES Ndera), however, Mutoni is now her usual self, full of life and optimistic. And she is delivering at work too. “Right now, I no longer want to die,” she laughed. “I enjoy life, I love my work and I have plans for the future. I realized that one has to have courage; accept it as a normal disease and be willing to seek for medical assistance. It is important to get the right diagnosis and treatment. You can live a normal life.” They can work and be married In his World Mental Health Day message on Monday, October 10, Dr. Bizoza Rutakayire, a psychiatrist at CARAES Ndera tweeted: Mentally sick patients are human beings like others. We have to give them the value of their humanity. We have also to give them opportunities to live well like others. After their treatment, Dr. Rutakayire noted, they can work and be married. “We have to avoid any kind of stigmatization of those persons, and we have to help them avoid any self-stigma; because sometimes self-stigma can be even more painful than external stigma,” he added. First celebrated in 1992, World Mental Health Day is an international day for global mental health education, awareness and advocacy against social stigma. In October, a national mental health awareness campaign was started with a focus on shining a light on depression and suicide risks especially among children and adolescents. Mutoni’s struggles with stigma are not so different from Jessy Mugisha’s. The only difference, perhaps, is that Mugisha, 32, a professional dog therapist and basketball coach, openly speaks about his ailment and issues that affect people with mental health problems. Mugisha said he was diagnosed with a condition doctors called attention deficit hyperactive disorder, which “comes with a lifelong dose of depression.” He added: “I can’t really focus that much and it gets worse with age. All I did was read books as a kid. Id consume thousand page books overnight. My mind is always going super-fast...latching on to things left and right.” “Now theres an opposite of it though, and its hyper focus. I am a compulsive learner and I need to constantly feed my brain; learn challenging things. But once I have understood them I am done...you literally couldn’t pay me to focus on it again because theres so much to learn and so little time plus zero interest in that which we already understand because it is officially now boring.” This, Mugisha said, makes it a horrible condition to have for school, and that’s how he dropped out. All this, he did not know until last year when, just like Mutoni, he met Dr Cassady. Serve those around us in the most humane way possible Like in Mutoni’s case, stigma and discrimination made Mugisha’s health problems worse. Stigma and discrimination trapped them in a cycle of illness. Mugisha narrated several sad stigma incidents including one when, last year, his now retired mother “wanted to get me on to her health insurance.” He said: “We got a medical certificate of my condition and met with a social security board medical practitioner....I dont remember his name....I was really interested in the whole process. Anyway, this man said, without skipping a beat or batting an eyelid, that I dont have a disability because I am not in a wheelchair.” “I was very quiet the entire time but that was the moment that got me going...I got angry and decided to educate him a little on just how inappropriate, harmful, disrespectful, and ignorant he was.” Mugisha said there is a lot of work to do educating the public that these things are real” and “also having to educate medical practitioners on this too.” “I personally think the current biggest hurdle we face [is] to be able to make massive strides in this journey to help ourselves and serve those around us in the most humane way possible.” Dr Cassady said it is important to understand why people stigmatize others. Most often, she noted, incorrect information, fear, and a lack of accurate knowledge or awareness are the bases for a majority of the stigma against mental illness. She explained that stigma is dangerous because it 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,” she said. She listed seven types of stigma including public stigma which happens when the public endorses negative stereotypes and prejudices, resulting in discrimination against people with mental illness, and self-stigma, which happens when a person with mental illness or substance use disorder internalizes public stigma. Avoid labels that are insulting or degrading On the best practice as regards ending stigma, Dr Cassady thinks “we are beginning to talk more openly about mental health and mental illness.” “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 judgment toward people with mental health issues. Focus on the positive. Mental illnesses, including addictions, are only part of anyones larger picture. Avoid labels that are insulting or degrading.” Emotional support can make all the difference, Dr Cassady said. In Rwanda, Dr Celestin Mutuyimana, a psychotherapist, noted that public stigma is most detected in the lack of understanding by family, friends, co-workers, or others. It results in fewer opportunities for work, school or social activities or trouble finding housing, he said, as well as bullying, physical violence or harassment. Dr Mutuyimana said people wrongly think that mental health issues will never be changed. “Stigma in Rwanda is still a big challenge at family, community and institutional levels. For example, I was driving back from Ndera and in front of me there was a new car in the road. A patient with medicine was standing on the road asking for a lift,” Dr Mutuyimana said. “He tried to stop the car in vain. I tried to go fast and ask those people why they didn’t help that person and they said: ‘how can you give a lift to a mentally challenged person, Umusazi?” The best ways to eradicate the stigma, Dr Mutuyimana said, includes anti-stigma social campaigns; people speaking out and sharing their stories; and enacting a law against stigma at family, institutional and community levels. A facility expected to play a significant role in tackling mental health challenges is being built in Kigali.
