In a recent address to the Senate, Dr Yvan Butera, the Minister of State for Health, shed light on the country’s transformative journey in mental health care since 1995, the year Rwanda adopted its first-ever national mental health policy. At the time, the country had a mounting problem of mental health challenges as a result of the 1994 Genocide against the Tutsi, which claimed more than one million lives and left millions more with physical and psychological wounds. “Imagine what it was like in 1995,” Butera told the Senators. “There was only one psychiatrist in the entire country, which reason why the policy came to address trauma.” ALSO READ: Transgenerational trauma: How the past continues to affect future generations Apart from the psychiatric centre at Ndera, there was no other facility to help people with mental health problems, he said. But that year, we opened a small centre called Service de consultation psycho-sociale (SCPS) in Kigali, which was a small unit helping trauma victims. That’s also when we began training our own mental health professionals.” From that lone psychiatrist, Rwanda began systematically building human resources through the Human Resources for Health initiative in the Ministry of Health, training psychologists, mental health nurses, and psychiatrists. ALSO READ: Ketamine medicine set to play role in suicide prevention efforts, Minister Butera says As of March this year, Rwanda had 14 psychiatrists, six neurologists and six neurosurgeons, according to Dr Menelas Nkeshimana, head of the department of Health Workforce Development at the Ministry of Health. There were 334 mental health nurses, 793 psychology practitioners and 208 social work practitioners. Dr Charles Mudenge, a psychiatrist, is one the first cohort to be trained post-1994. “I was among the first beneficiaries of psychiatry training after the Genocide,” Mudenge said. “In 2013, we launched a programme with partners from Belgium and Switzerland. Initially, we could only send a few students abroad. But eventually, local training started through collaboration between the Ministry of Health and the University of Rwanda. Now we have 31 students in psychiatry training; 10 in their second year and 15 in their first year.” ALSO READ: Why Rwandan psychotherapy students need to understand history Charles Nkubiri, Director General of Ndera Neuropsychiatric Teaching Hospital, added that government’s 4x4 reform to increase medical personnel by four times has started to show results, with district hospital now equipped to provide mental health services. “Collaboration with Nyamata, Rwamagana, and Kibuye hospitals has also strengthened mental health services. Some facilities only refer to Ndera one or two patients in a year now, which is a sign of local capacity,” Nkubiri said. ALSO READ: Early alcohol, cannabis use linked to teen mental health struggles in Rwanda Senator Jean Pierre Dusingizemungu, a psychology professor, acknowledged the magnitude of demand for mental healthcare services before and after the Genocide. “This country went through a uniquely devastating history. Before 1994, there was no national mental health policy. People with mental health illnesses were often taken to Ndera or, worse, imprisoned at the 1930 prison,” Dusingizemungu said, adding that some families would chain their mentally ill relatives or abandon them. “Today, Rwanda has taken immense strides not only in general healthcare but especially in mental health.” ALSO READ: How resilience-oriented therapy is transforming mental health, psychosocial support in Rwanda In 2011, Rwanda revised its mental health policy, emphasizing accessibility through coverage under the community-based health insurance, geographic access via district hospitals, and community-based care. “We restructured to ensure services were covered by community health insurance and brought down to the district level, then to communities. We focused on special groups like children, people living with HIV, and substance users and tailored policy interventions.” LSO READ: How Rwanda’s new Rwf7tn strategy plans to improve healthcare By 2020, recognizing the evolution of the country’s mental health needs, Rwanda launched its Mental Health Strategic Plan 2020-2024. “We realized that mental health care shouldn’t only be in public hospitals; therefore, private facilities were brought on board,” explained the Minister. “Our teachers began receiving basic training to identify and support students with mental health issues, and we expanded into schools, national rehabilitation centers, and correctional facilities.” Fred Mufulukye, Director General of the National Rehabilitation Service, pointed out the urgency of early detection. “Drug use and mental health issues are interlinked,” explained Mufulukye. “A person may start using drugs due to a mental condition or develop a condition due to substance use. Families must identify these problems early on to intervene in time.” Minister Butera noted that, globally, one in eight people experiences a mental health condition. In Rwanda, due to its unique history, the figure is one in five. “Major causes include depression affecting nearly 12 per cent of the population, followed by anxiety and trauma. Drug and alcohol use also contribute to and are aggravated by mental health issues. It’s a bidirectional relationship.” Epilepsy is also prevalent, he said, adding that mental health issues are especially high among those aged 26–35, and even more so among those aged 46–55. To address this, last year, mental healthcare was integrated into the Health Sector Strategic Plan (HSSP) 2024–2029, the National Health Policy, and the Healthcare Service Law. The National Strategy for Transformation (NST2) also emphasizes mental health, giving it political and legal priority. ALSO READ: Inside Rwanda’s new five-year health strategy Butera added that access to education could be another protective factor in curbing the rates of mental health problems. “In Rwanda, mental health issues are more prevalent among those with no formal education. The more educated someone is, the lower their risk. That’s why promoting education is one of the government’s long-term strategies for prevention,” he said. “At the village level, we have trained community health workers who identify symptoms and refer cases to higher-level facilities. Health centres have at least one trained mental health professional. District hospitals have expanded their supply of psychiatric drugs from 15 to 45. Health centers now carry over 20 medications, up from eight,” Butera said. But the community has a role to play in preventing and dealing with members with mental health problems, argues Jane Abatoni Gatete, Executive Secretary of ARCT-Ruhuka, a trauma counseling organization. “We need to raise the quality of counseling providers. Even a neighbor’s conversation can be therapeutic, but all levels from the family to health workers must be assessed and supported to ensure effectiveness,” Gatete said. Minister Butera noted that despite the challenges Rwanda still faces due to the effects of the Genocide against the Tutsi, including transgenerational trauma, concerted efforts could help deal with them. “Trauma can be transmitted from parent to child, even if the child wasn’t there. But the good news is that resilience can also be passed down. If today’s generation intervenes effectively, we can break the cycle. This isn’t permanent,” the Minister said.
