The impact of mental health care on Rwanda’s economic recovery and growth: Why we should care more

Mental health is often misconstrued as the absence of mental illness, but it is much more complex than that. Medical literature shows that mental illness is pervasive and costly. It is also estimated that, at any given time, one in five working-age adults has a mental health problem, with the lifetime prevalence rate reaching up to 50 per cent. In 1994, Rwanda experienced a devastating Genocide against the Tutsi that claimed the lives of over one million people, in a period of just 100 days. The Genocide was characterised by brutal violence and killings, with the use of machetes, firearms, and other improvised primitive weaponry, as well as widespread rape, torture, and other forms of barbaric abuse. In the years that followed, Rwanda has worked tirelessly to rebuild, reconcile and foster unity and healing among its people. The Genocide did not only have a devastating impact on the country’s already weak healthcare system but also had a profound and lasting impact on the mental health of many Rwandans. Mental health disorders can significantly impact a society’s ability to fully become productive through direct and indirect causes. However, this marked loss of productivity is often overlooked or ignored. Underscoring the loss of productivity related to mental health in Rwanda is imperative and understanding the economic consequences can allow our country to provide a timely response to this challenge. There is a growing body of medical research on mental health in Rwanda as a country and Africa as a region, however, many challenges remain. Historically, mental health has been an area of lower priority in healthcare, and mental health services are often under-resourced in the region in favour of other infectious medical conditions. The vast majority of academic and health programme research done has covered areas around the prevalence and burden of mental health disorders, access to care and treatment, human resources requirements, and similar areas, but not much has been done to clearly study and understand the economic impact of this problem. Research studies in more developed settings clearly show that economic factors influence well-being and not surprisingly, poor economic conditions will create a rise in poor mental health for many. This may be attributable to increased unemployment, reduction in pay and salaries, heavier workloads, struggling family relationships or emotional abuse, increased use of alcohol or other forms of drugs, and many other factors. On the other hand, people who suffer from a mental illness are more likely to drift into or remain in poverty as a result of reduced productivity, loss of employment, and increased health expenditure. This is known as the social drift pathway. More emphasis on mental health would ultimately result in several positive outcomes such as medical experts' better understanding of mental health as a field, improved and culturally appropriate diagnosis and treatment, and possibly added investment and funding for mental health, among others. Although measurable progress has been made, failing to understand the economic impact of mental health head-on would ultimately create several negative consequences. Poverty leads to poorer mental health – and vice versa – leading, in turn, to reduced opportunities for economic development and increasing the risk of lifelong poverty. Hence the vicious cycle. Improving mental health is likely to boost engagement in education and employment, and improve economic opportunities for people affected. Because of the paucity of information in this field, more research is clearly needed to explicitly examine the relationship between poor mental health and workplace productivity, especially among younger people. Mental illness takes a toll on worker productivity resulting in substantial economic costs for institutions, employees, and society in general. Highlighting the impact of mental health on productivity can help to raise awareness of the importance of mental healthcare and reduce the stigma associated with mental illness. By demonstrating the economic and social costs of untreated or poorly managed mental health conditions, leaders, policymakers and the public may be more likely to prioritise tangible and sustainable investments in mental healthcare, and support efforts to improve access to treatment as there is no price too high to pay. If the nation recognises the importance of mental health on productivity and prioritising steps to resolve this, we will be that much closer to achieving an inclusive, sustainable, and more productive economy. As famously stated by Dr Brock Chisholm, without mental health there can be no true physical health. Dr Vincent Mutabazi is an applied epidemiologist mutabazivincent@gmail.com

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The impact of mental health care on Rwanda’s economic recovery and growth: Why we should care more