Most mental health problems affecting children in Rwanda are caused by family conflict and other preventable environmental factors rather than biological conditions, mental health specialists have said.

Doctors say many children receiving treatment are experiencing psychological distress triggered by difficult home environments, including domestic violence, neglect, substance abuse and persistent family disputes.

According to Rwanda Biomedical Centre (RBC), 12,391 children and adolescents under the age of 20 received mental health services in 2025/26, down slightly from 13,247 in 2024/25 but significantly higher than 8,022 in 2023/24.

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The 2018 Rwanda Mental Health Survey estimates that mental disorders affect 10.2 per cent of children and adolescents below 18.

During a recent visit to CARAES Ndera Neuropsychiatric Teaching Hospital, children as young as five were admitted to the hospital&039;s child mental health unit, alongside pupils in primary school and secondary students.

Doctor Xavier Butoto, a psychiatrist specialising in child and adolescent mental health at CARAES Ndera, said psychosomatic disorders are among the most common conditions seen at the hospital.

These disorders occur when psychological distress manifests through physical symptoms such as headaches, stomach aches or fainting, despite no underlying medical illness.

"A child may show physical signs of illness, yet they are simply expressing emotional distress. Most of these children come from families affected by conflict," Butoto said.

"Children often cannot put their feelings into words, so their bodies express what they are going through."

He said that, apart from autism and some genetic or neurodevelopmental disorders, most childhood mental health conditions treated at the hospital are linked to children's living environments. Even children born with such conditions, he noted, fare much better when raised in stable and supportive families.

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RBC Mental Health Division Manager Dr Darius Gishoma echoed this view, saying psychosocial and environmental factors account for most mental health conditions affecting children and adolescents.

"Most child and adolescent mental health conditions are linked to preventable environmental and psychosocial factors such as family conflict, violence, poverty, alcohol and substance use, child maltreatment, and the long-term effects of the 1994 Genocide against the Tutsi," he said.

He identified depression, anxiety, trauma-related disorders, behavioural and emotional disorders, epilepsy and neurodevelopmental conditions as the most common mental health challenges among young people in Rwanda.

Warning signs parents should watch for

Butoto urged parents to pay close attention to sudden behavioural changes, saying they are often early indicators of emotional distress.

Children may become unusually aggressive or withdrawn, experience changes in appetite or sleep, struggle academically or display emotional reactions that are disproportionate to their age.

"When children face problems they cannot solve, their bodies begin to speak for them. This may happen, for example, to a child living with a parent who abuses alcohol," he said.

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He added that excessive parental pressure can also contribute to mental health problems.

"Parents may compare children or expect one child to perform like a high-achieving sibling. When a child realises those expectations are beyond their ability, emotional symptoms begin to appear," he said.

Fear itself, he noted, can trigger physical illness.

"You may tell a child they are going to school the next day, then they wake up sick. They are not pretending. Their body is reacting to the fear they feel," he explained.

Butoto cautioned parents against dismissing troubling behaviour as mere indiscipline.

Some behavioural problems, including persistent aggression or destructive behaviour, may point to underlying mental illness, while naturally occurring conditions such as autism and intellectual disability often present through delayed speech, communication challenges, heightened sensitivity to sound or light, and learning difficulties.

Recovery starts at home

According to Butoto, treatment mainly involves counselling and psychotherapy, with medication reserved for severe cases such as hallucinations or situations where a child poses a danger to themselves or others.

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However, he stressed that recovery depends largely on improving the child&039;s home environment.

"Some parents bring children for treatment but fail to follow the advice given. The child improves, goes home, then returns because nothing has changed at home," he said.

He encouraged parents to identify the situations that trigger their child's distress and address those causes rather than focusing only on medical treatment.

One of the biggest barriers to early treatment, he added, is denial.

Some parents refuse to accept diagnoses such as autism, while others first seek help from traditional healers because they believe mental illness is caused by witchcraft or evil spirits.

"Many families come to the hospital only after exhausting other options. Those beliefs delay treatment, and delayed treatment delays recovery," he said, urging parents to seek professional care early.

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Family support remains critical

At the children&039;s ward, patients follow a structured daily routine that includes personal hygiene, group discussions with clinicians, medical consultations and recreational activities designed to support their recovery.

Valentine Niyonsenga, manager of the children's unit, said parents do not usually stay with admitted children unless they are very young or critically ill.

In some cases, visits are temporarily restricted when contact with parents worsens the child's condition, particularly where family conflict contributed to the illness.

She estimated that about 70 per cent of children admitted to the unit have mental health conditions rooted in family problems.

"If families protected children from family conflicts, we would have far fewer mental health cases and mainly remain with chronic conditions," she said.

The hospital works closely with the National Child Development Agency (NCDA) and other institutions to help vulnerable children access stable family environments.

"A child often cannot explain what is troubling them. Parents need to become their child's friend, observe them closely and create an environment where they feel safe to share their experiences," Niyonsenga said.

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Expanding mental health services

Gishoma said Rwanda has significantly expanded child and adolescent mental health services through hospitals, schools and communities.

Every district, provincial and referral hospital now has trained mental health professionals, while Community Health Workers have been equipped to provide mental health first aid and refer children for specialised care.

Since 2021, a school-based mental health programme has been rolled out in secondary schools and TVET institutions across 22 districts, with at least two trained teacher-counsellors in every participating school.

Despite these efforts, family conflict, violence, abuse, poverty, alcohol and substance use, teenage pregnancy, harmful social media use, orphanhood, biological conditions and the lingering effects of the 1994 Genocide against the Tutsi continue to contribute to mental health problems among children.

"The mental well-being of Rwanda&039;s children and adolescents is a national priority," Gishoma said.

"We encourage families, schools, communities and health providers to work together to promote positive mental health, prevent mental health problems and seek help early. These conditions can be prevented, managed and treated."