Depression is a common mental health illness characterized by persistent sadness and a loss of interest in activities that people normally enjoy, accompanied by an inability to carry out daily activities. Nowadays, depression is the major cause of disability in the world.
According to Dr Olu of the World Health Organization (WHO), “Depression is an illness like any other chronic illnesses and the society needs to understand and accept it so that people can openly talk about it and seek appropriate medical help. The first step towards addressing depression in the society is to talk about it. As long as people do not understand the gravity of the illness, they will not seek medical attention and will continue to suffer in silence,”.
Dr Yvonne Kayiteshonga, Mental Health Division Manager at the Rwanda Biomedical Center (RBC) explains that at least 90% of people who committed suicide in the world were suffering from a mental illness, of which 60% were depressed at the time of committing suicide. In addition, a third of suicide cases have a history of alcohol dependence and 5-10 per cent of people with alcohol dependence end their lives by committing suicide. Also, depression is often associated with chronic conditions like diabetes, high blood pressure, HIV-AIDS, cancers and others.
To address depression in the country, the Government of Rwanda through its Ministry of Health created a Mental Health Division in RBC with the mandate to implement the Mental Health Policy in line with the Health Sector Strategic Plan and the National Health Policy. The Division is composed of 3 units namely Psychiatric Care Unit, Community Mental Health Rehabilitation Unit and Drug Abuse and Alcohol Prevention and Treatment Unit.
In line with the National Health Policy, the Ministry of Health has decentralized mental health care services and integrated them into the primary healthcare where care is provided by mental health nurses, psychologists, and well trained medical doctors and general nurses. Currently there are 7 psychiatrists working in the health system in Rwanda at Ndera Hospital, Rwanda Military Hospital, CHUK, CHUB, Huye and Ruhengeri hospital. The number of psychiatrists is expected to reach 15 in 2018 – a significant improvement on the situation in 2000 when the country had no psychiatrists. In 2013 the University of Rwanda launched a post graduate training in Psychiatry; currently 10 students are enrolled in this program among them 3 students are expected to graduate this year. Upon graduation the psychiatrists are appointed to referral mental health care facilities and district hospitals to bring mental healthcare services closer to the population.
Furthermore, RBC is regularly involved in carrying out awareness programs about mental health including depression throughout the country right from the villages. Access to medical help for depression has been brought closer to the people: Community Health Workers with basic training on dealing with common mental disorders are tasked with spreading information about depression in the local communities, identifying signs of depression and advising people with depression and their families to seek help from nearby health centres. According to Dr Kayiteshonga it is not necessary for patients to visit hospitals where psychiatrists are stationed in order to get help for depression as general practitioners and nurses are in a position to diagnose and treat it.
“Doctors and nurses undergo periodic training and mentoring on depression diagnosis and treatment. This means that as a doctor is treating a patient for a physical illness they could at the same time identify signs of depression in the patient and go ahead to prescribe medication for depression alongside that of a physical condition. This greatly reduces the burden on the patient in terms of having to incur expenses to travel to see a psychiatrist. Only critical cases of depression are referred to hospitals where a psychiatrist is stationed,” Dr Kayiteshonga explained.
RBC is continually building the capacity of health professionals on mental health care. All health centers have at least one general nurse trained to treat depression and other common mental illnesses and every district hospital has a Mental Health Unit staffed with at least 2 mental health nurses, one psychologist; these health care providers work under the supervision of one medical doctor skilled to treat depression and other mental illnesses. In 2015/2016, 43 medical doctors working in district hospitals and 281 general nurses working in Health Centres were trained. This year, 394 general nurses working in Health centres and 45 doctors working in district hospitals have been trained.
In order to enhance accessibility to good mental health care for all, Rwanda is among the few countries in Africa that have fully integrated Mental health care in Community Based Health Insurance (Mutuelle de santé). This means that in the country, the financial burden to treat mental illnesses is reduced as the poorest can now afford mental health care.
WHO advocates to the Ministry of Health and is also involved in raising awareness about depression to stimulate and catalyse action at the national level. “We work with the Government to strengthen public awareness about depression and to refer to WHO’s global mental health strategies and plans that will be useful in planning action to address depression effectively in Rwanda. We also support the Government to implement the National Mental Health Plan,” Dr Olu explained.
Access to medication is a key factor in dealing with depression in the country and WHO is also involved in improving access to medication. Last year the organization supported the Ministry of Health to develop and distribute a list of essential medicines for the country which included medication for mental health illnesses including depression. In addition, WHO regularly organizes regional trainings to support continuous skills development on mental health for health workers in African countries including Rwanda.
Rwanda has no doubt made significant progress in addressing depression although more awareness efforts are required to educate the public and reduce the stigma associated with mental disorders. This year’s World Health Day Theme: “Depression – Let’s Talk” is a wake-up call to all nations to stimulate open discussions about depression in communities, to end its stigma and prioritize treatment.