Mental Health in Rwanda Rwanda is a small country in sub-Saharan Africa. Rwanda has struggled to become a stable country economically and politically since it became independent in 1962. As a developing country, Rwanda is still trying to develop its healthcare system. With years of conflict and instability, people especially struggle with mental health in Rwanda.

5 Facts About Mental Health in Rwanda

  1. The Rwandan Genocide plays a significant role. Roughly 25% of Rwandan citizens struggle with PTSD and one in six people suffer from depression. The reason why so many Rwandans have mental health conditions can be explained by one key event in Rwandan history. During the Rwandan genocide of 1994, members of the Hutu ethnic majority murdered as many as 800,000 people, mostly of the Tutsi minority. The mass genocide caused severe trauma to survivors who still suffer from mental health issues 26 years after the event.
  2. Rwanda has very few resources. According to the World Health Organization, Rwanda has only two mental health hospitals, zero child psychiatrists, and only 0.06 psychiatrists per 100,000 people. With a large amount of the population plagued by mental health issues, Rwanda needs more resources to help the mentally ill.
  3. Suicide rates have greatly decreased in Rwanda. In 2016, the suicide rate in Rwanda was 11 deaths per 100,000 people. This is a great improvement compared to the 24.6 suicides per 100,000 people in 2000. An increase in mental health resources contributes to the lowering of the suicide rate in Rwanda.
  4. Increased mental health funding is essential. The average mental health expenditure per person in Rwanda is 84.08 Rwandan francs. Most citizens of Rwanda do not have the financial resources to afford mental healthcare. The government currently uses 10% of its healthcare budget on mental health services. Considering how large the mental health crisis is, the government should increase its expenditure to address the crisis. Since citizens cannot afford to pay for mental health resources, the government will need to help provide more free or affordable resources.
  5. The Rwandan Government is updating policies to address mental health. In 2018, Rwanda’s updated strategic plan for its health sector set new targets for expanding mental health care services. Its purpose is to help increase access to mental health resources by decentralizing mental health and integrating it into primary care. Also, this plan calls for a decrease in the cost of mental healthcare and an increase in the quality of care. The plan hopes to accomplish strategic goals by 2024. If successful, this plan may be used as a method to help other countries establish a quality mental health plan.

The Road Ahead for Rwanda

Considering Rwanda’s violent history, it is no surprise that the population struggles with mental health. Over the years, progress has been made with regard to mental health in Rwanda. However, many more resources are needed to help address the mental health crisis in Rwanda. With Rwanda’s updated strategic plan to address the issue and an increase in expenditure, the well-being of Rwandan’s will be positively impacted.

Hannah Drzewiecki
Photo: Flickr

Mental Health in South Asia
South Asia, a group of nine countries including India, Pakistan and Nepal, is home to more than 1.8 billion people. Of this population, between 150 and 200 million people suffer from mental illness. However, the severity of depression and mental health is often overlooked throughout the region, leaving millions without treatment and support. Here are eight quintessential facts about depression and mental health in South Asia and how the conditions are currently being addressed.

8 Facts About Depression and Mental Health in South Asia

  1. Depression affects 86 million people in Southeast Asia. The World Health Organization estimates that almost one-third of people suffering from depression worldwide live in South Asia, making the region home to a large majority of the world’s depressed.
  2. Mental illness is taboo in many South Asian communities. Professor Dinesh Bhugra, a mental health expert at London’s King’s College, states that the South Asian population carries “a bigger notion of shame” with them than other ethnic populations. South Asian religious and cultural influences often do not consider mental health a medical issue, referring to it as a “superstitious belief.” A 2010 study by the campaign Time to Change found that South Asians rarely discuss mental health because of the risk the subject poses to their reputation and status. Discussing mental health in South Asia has yet to be socially normalized.
  3. South Asian languages do not have a word for depression. Many South Asians are unable to express the specific condition of depression in their language. As a result, they often have to resort to downplaying it as part of “life’s ups and downs.” This language limitation also makes diagnoses and treatment difficult.
  4. Depression is a major contributor to global disease. Medical experts have found a correlation between the symptoms of depression and the perpetuation of disease. The World Health Organization has found an “interrelationship between depression and physical health,” such as depression leading to cardiovascular disease. As mental illness rates continue to rise in South Asia, so does the risk of physical diseases and illnesses.
  5. Postpartum depression in South Asian women is often undiagnosed and unrecognized. The gender of the baby, domestic violence and poverty are all factors that put new mothers at a higher risk for postpartum depression. The stigma surrounding mental health prevents new mothers from receiving any form of mental health care or support.
  6. Bangladesh, Sri Lanka, and Indonesia have made mental health a “top priority.” These countries, along with a few others in South Asia, have created policies to address mental health on a national scale. The World Health Organization has recently lauded their work and the important step it takes towards normalizing and treating depression and mental illness.
  7. Non-government organizations (NGOs) have had a positive impact on mental health care. In countries where the government is not willing or able to make mental health a priority, NGOs are providing crucial support to people suffering from mental health issues. NGOs in South Asia have expanded their community-based programs and are providing specialized mental health services. For example, in the Maldives, a number of NGOs are offering rehabilitation, life-skills training and “resilience-building around social issues” to citizens. These efforts have drastically increased the access South Asians have to mental health care.
  8. Human capital increases when mental health is strong. Although poverty rates in South Asia are declining, the region accounted for nearly half of the world’s “multidimensionally poor” in 2017. Providing mental health care to South Asians is a major step in eradicating poverty within the region. According to the World Bank, strong mental health is a contributing factor to not only the wealth of nations but to the wealth and capital accumulation of individuals.

Improving mental health in South Asia requires not only the social recognition and normalization of depression and mental illness but the continued action of both government and non-government programs. With increased access to mental health care and support in South Asia, the expansive issues of poverty and illness will be positively affected.

Karli Stone
Photo: Flickr

Mental Health and Poverty
Although mental health and poverty are two things that one might not always group together, there is a serious link between people living below the poverty line and mental health disorders. According to a Substance Abuse and Mental Health Services Administration SAMHSA report, around 9.8 million people living in the United States had mental health disorders in 2015, and 25 percent of those people were living below the poverty line.

Both poverty and mental health can bring about the other. For instance, a Gallup poll found that about 15.8 percent of people not living in poverty reported having diagnosed depression, while 31 percent of people living in poverty reported depression. In addition, a McSilver Institute for Poverty Policy and Research study based on data from the National Center for Education Statistics found that a household is likely to experience a 50 to 80 percent increase in food insecurity if the mother has diagnosed depression. While it is not clear whether the depression leads to living in poverty or living in poverty results in depression, the link between the two issues is clearly prevalent. Therefore, it is crucial that others address and treat the mental health of people living in poverty.

Ways to Treat Mental Health

One large issue with impoverished people having mental health disorders is that they often do not have the insurance and money to seek therapy and get medical help. This can be especially harmful to children living in poverty. The Official Journal of the American Academy of Pediatrics has three main recommendations for low-income families to seek help for mental health disorders, including education and training, establishing relationships with providers and creating multidisciplinary teams.

The best way to help and treat mental health in low-income families and communities is education. By integrating mental health education in schools and free programs that schools offer to families and communities, more people can learn about how to cope with mental health disorders and keep themselves and their families healthy and happy. In addition, integrating mental health services into school health services allows children to seek help for any mental health disorders right at school.

Further, establishing relationships with school health providers and counselors allows children to feel comfortable enough to seek the help that they need, in a safe space that they are used to. Communication between children/families and health care providers also allows the providers to be available more quickly and could result in more effective treatment.

Effects of Improving Mental Health

Poverty can strain a person’s mental health due to stress and instability. Therefore, public mental health has a huge impact on communities and the mental health of the people. People do not widely recognize public health, which is why is it crucial that communities are actively working to prevent mental health problems and to educate the community on how to cope with mental health strains.

Mental health problems and poverty have a serious link and it is vital that people are aware of the strains of poverty and understand their community and who is at risk. Only by monitoring and evaluating impacts of mental health, creating educational programs and addressing both physical and mental health, both mental health and poverty can improve together.

Paige Regan
Photo: Flickr

Depression in the Developing WorldDepression is one of the most common conditions affecting Americans each year. In a country as developed as the U.S., health professionals can readily provide high-quality care to patients struggling with depression. Prescription medications have proven successful in treating and helping patients manage their depression, as have therapy and counseling programs. This is unfortunately not the reality for people affected by the same mental illness in the developing world.

It is estimated that 350 million people suffer from depression worldwide, yet less than 10 percent of people in developing countries have access to adequate treatment and care options. A study conducted in rural India found that just under 40 percent of the entire population suffered from some form of mild to moderate depression. Another study conducted in Pakistan found that 50 percent of all women living in rural areas suffered from some form of depression or anxiety. A study published in the Journal of the American Medical Association found that patients who had previously endured a traumatic event – such as conflict or fleeing their countries as refugees – had a significantly increased risk of experiencing recurring depression.

The World Health Organization (WHO) has recognized the severity of depression and its nature as a global health crisis. Conditions that commonly exist in developing countries, such as social and political instability, armed conflict, refugee crises, economic instability and food instability are all extremely high-risk triggers for anxiety and depression disorders. According to the WHO, a disproportionate number of the world’s medical professionals practice in developed countries. There is far greater availability of healthcare in places where it is least needed.

Depression is a disease that can limit a patient’s functioning and cause them a great deal of discomfort and suffering. The WHO has listed depression on their Mental Health Gap Action Program, and as a result, they aim to curb the rising number of individuals suffering from depression in the developing world. The plan is to provide adequate training and assistance to people who might not have extensive healthcare backgrounds so that they can better assist people suffering from depression in developing nations.

There is a real and dire need to determine ways in which to combat depression in the developing world. With the support of the international aid community, organizations such as WHO can implement aid strategies to hopefully bring an end to the disproportionately high number of untreated depression patients living in the developing world.

Tyler Troped

Photo: Flickr

Cost of Living in GreeceAlmost ten years after the global financial crisis, the cost of living in Greece has continued to climb, while wages and available jobs have dropped considerably.  This unceasing contraction of the Greek economy has led to a sharp increase in the percentage of the population living in poverty to 23.2 percent in 2015.

The Greek recession, now on track to become a Greek depression, has devastated personal incomes. A Greek person living in 2014 had the same amount of disposable income that they did in 2003. Due to lost incomes and cut pensions, Greece is, by some estimates, 40 percent poorer than it was before the crisis.

However, it is not just wealth that has suffered. Nearly one million Greeks are unable to afford to pay for healthcare, and many smaller local clinics have closed down. As a result, wait times at larger facilities have increased. Furthermore, scores of workers have been discouraged from entering the workforce. Long-term unemployment has skyrocketed to 20 percent. That number is even higher among young Greeks.

Many families in Greece now rely on the pensions of one or two family members to live and eat. Pensions have been, and are scheduled to be cut due to new austerity measures introduced through the E.U. and International Monetary Fund’s bailouts. There is little money left after these families pay rent for anything else. More than 40 percent of Greeks have fallen behind on utility payments. This rate is the highest in all of Europe.

For many, the cost of living in Greece has become too high. Currently, more than half a million young and educated Greeks have left the country in search of better opportunities elsewhere.  However, there may be hope for those dismayed by the oppressing cost of living in Greece. On July 24, for the first time in three years, Athens has collected on new debt through bond sales.

Athens hopes that the 3 billion euro bond will lead to more investor confidence in the Greek economy. As confidence and credit returns, many are hopeful that people can go back to work and the country can pull itself out of this depression.

Thomas James Anania

Photo: Flickr

Depression in India
According to the American Psychiatric Association, depression is defined as “a common and serious medical illness that negatively affects how you feel, the way you think and how you act.” Depression is not just about someone being sad, but rather about an individual lacking the motivation to do anything, from their favorite activities to simply eating. With the disorder affecting 322 million people worldwide, it is a major health concern on a global level. Depression in India is, according to recent reports, at a severe level.

While depression has no limitations as to whom it affects, there are certain areas that have an exceptionally high number of people suffering from the disorder. India is one nation that has been proven to have high rates of depression. In 2016, the World Health Organization (WHO) ranked India as the most depressed country on the planet. The WHO also reported that more than 4.5% of the Indian population suffers from mental illness. While 4.5% may not seem like a significant amount, it is actually equivalent to 56 million individuals.

Depression can be treated with several methods such as medication and therapy. However, Indians who suffer from the disorder lack the resources that they need, due to the fact that only .06% of India’s health budget is used for mental health purposes. This number is shockingly low in light of the fact that well-developed countries usually utilize at least four percent of their health budgets for mental health.

As recent studies have shown, there are only 0.301 psychiatrists per 100,000 individuals in India. With not enough psychologists, nurses and social workers, many who suffer from depression in India are not given the opportunity to receive professional help.

With depression rates in India on the rise, the government is making an effort to decrease depression rates. In March, Parliament passed the Mental Health Care Bill. This bill offers all Indians mental health care, prohibits electroconvulsive therapy on minors and decriminalizes suicide.

Despite advancements, depression still remains a serious issue in the country. However, with new policies constantly being devised, depression in India, as well as throughout the world, will hopefully decrease over time.

Raven Rentas

Photo: Pixabay

Feeling down or uneasy? It could be time to donate to a worthy cause. A growing body of evidence shows a strong correlation between poverty and multiple forms of mental illness, including depression. The good news is that the inverse is also being proven true; reducing poverty improves mental health, not only for those receiving aid but also for those who provide it. Here are some of the most recent findings on how advocacy cures depression:

According to, people in the U.S. have become 5 percent less happy over the past decade, despite average household earnings increasing in the same period of time. The same study determined that Norway and Denmark were the happiest countries, compared to America’s position as the 14th happiest.

“I don’t think Denmark has a monopoly on happiness. What works in the Nordic countries is a sense of community and understanding in the common good,” Meik Wiking, CEO of Copenhagen’s Happiness Research Institute stated by way of explanation. The effects of poverty on depression were shown to be quite clear: the unhappiest countries, which include Liberia, Yemen, Rwanda and Syria are all among the poorest on earth.

The implication of the study seems to add another line to the old adage: money may not be able to buy happiness, but it may be able to buy happiness for someone else in need. Science is discovering that the giver also benefits—one study of 846 people from the American Journal of Public Health found that the act of helping others creates an increased tolerance to stressful life events.

Altruistic acts, such as raising awareness for charitable causes, have been shown to result in numerous psychological and physical health benefits including reducing stress, maintaining a positive life perspective and even boosting longevity.

Crick Lund, University of Capetown psychologist and head of the international consortium called PRIME (Programme for Improving Mental Health Care), is another key researcher in determining how advocacy cures depression. He has dedicated his career to providing mental health treatment for people living in low-income and low-resource areas. His research on the link between poverty and depression is being conducted across five sub-Saharan countries in Africa and is expected to show early results by 2018.

The next time the blues hits, it may be worth considering getting the squad together to volunteer at the local shelter or make a donation to a nonprofit such as The Borgen Project. Since advocacy cures depression, not only will it make life better for someone who truly needs it, it will make the giver feel great too.

Dan Krajewski

Photo: Flickr

Syrian Mental Health
During a 2015 study, the German Federal Chamber of Psychotherapists found that half of Syrian refugees had mental issues, while nearly three-quarters of those affected have witnessed violence and 50 percent have been subjected to violence themselves. The United Nations High Commissioner for Refugees (UNHCR) cites that the most common clinical disorders regarding Syrian mental health are “depression, prolonged grief disorder, posttraumatic stress disorder and various forms of anxiety disorders.”

A Chinese study found that children who experience the deprivation of parental care are at higher risk of intellectual and emotional struggles. Larger volumes of gray matter, which indicates “insufficient pruning and maturity of the brain,” appeared in children subjected to substantial parental absence.

Essential rights including education and access to health services are often absent among displaced refugees and children are more likely to be exposed to human trafficking. According to the United Nations High Commissioner for Refugees, Syrian refugees total 4.8 million and almost half of that number are children.

The International Medical Corps (IMC) found that Syrian refugees and internally displaced persons (IDP) have extremely limited access to mental health facilities and 54 percent suffer from severe emotional disorders like depression and anxiety.

Refugee policies in Syria’s neighboring countries such as in Lebanon are also harmful to fostering Syrian mental health for refugees, such as the inability for the establishment of permanent refugee camps and forbiddance of Syrians to work in the country. The United Nations Population Fund (UNFPA) found that 41% of Syrian youth in Lebanon have experienced suicidal compulsions.

However, during the Obama administration in the summer of 2016, Secretary Kerry announced a rise of an additional $439 million in humanitarian assistance for Syrians including increased access to mental health services. Emergency relief funding aims to support non-governmental organizations (NGOs), international organizations and United Nations operations, especially those addressed in the eight billion dollars U.N. appeal of 2016 for Syrian aid. Included in the funding is $130 million to the UNHCR to provide mental health support and child protection for IDPs and refugees, while an additional $36 million to Turkey also provides mental health support through the International Organization for Migration (IOM).

Amber Bailey

Photo: Flickr

With thousands of students vying for acceptance into top colleges, adolescent suicide rates in South Korea increasingly mirror rising scholastic pressure. These uncompromising education standards, as many suggest, continue to compromise happiness nationwide.

The bodies of two 16-year-old girls were found on a cement sidewalk in early March. A note reading, “We hate school,” was found following their jump from the multistory Daejeon hospital building.

Less recently, at the Korea Advanced Institute of Science and Technology (KAIST), students grappled with the loss of four peers and one professor to suicide. As the region’s most prestigious institution, test anxiety and copious amounts of schoolwork are part of the daily routine.

“Day after day we are cornered into an unrelenting competition that smothers and suffocates us. We couldn’t even spare 30 minutes for our troubled classmates because of all our homework,” the KAIST student council said. “We no longer have the ability to laugh freely.”

These grim narratives dominate headlines in South Korea – a country where the number of teen suicides has increased by 57 percent since 2001.

While secondary schools hold candlelight vigils and Seoul subway stations install barriers to prevent commuters from jumping, some are questioning the actual education system itself and its effects on adolescent suicide rates in South Korea.

For a typical high school student, class begins at eight in the morning and finishes at four in the afternoon. From there, however, military-style cram sessions at private institutions can last until 11 at night.

This pressure hits its peak in November, when students from around South Korea gather to take a single college entrance exam – the “suneung.” While mothers pray at churches or temples and the South Korean Air Force lands all planes, adolescents hunker over booklets and answer sheets for the nine hour test.

The “suneung” determines which university, if any, the student will attend. Most strive for the so-called SKY schools – Seoul National, Korea or Yonsei universities.

“To get admitted there decides what you can do in life and who you can marry. It determines your future,” Young Hwan Kim, a 17-year-old at Shinil High School said.

This race to success contrasts sharply with pre-World War II conditions. Though now an economic powerhouse, South Korea was once one of the poorest countries in the world, with only $64 per capita income.

Severely undereducated, only five percent of the population had attended secondary school or pursued advanced degrees.

Investment in infrastructure and human capital, in addition to foreign aid from both Japan and the U.S., pushed the country to its contemporary state. An unyielding focus was also placed on education, perhaps to make up for South Korea’s lack of tangible resources.

“We don’t have enough natural resources; the only resources we have [are] human resources,” said Kim Mee Suk, a researcher at the Korea Institute for Health and Social Affairs.

Now, in response to this mindset, roughly 75 percent of students attend a university – something many call the “Korean education miracle.”

This blessing, however, has also been a curse.

While overall suicide rates in developed countries are falling, adolescent suicide rates in South Korea continue to climb. A February survey released by the Korea Health Promotion Foundation even found that just over half of the country’s teens had suicidal thoughts this year.

Inchae Ryu, a 17-year-old student also at Shinil High School, spends 12 hours per day studying. Hunkered down in the library, clad in a navy uniform and green tie, he looks over notes for an extra English class he attends twice a week.

“I have no time to think about my future or my dreams,” Ryu said.

While attempting to stimulate the economy today, South Korean officials have blatantly disregarded what may happen in the future. In addition to overall drops in mental health, many parents are choosing not to have children because private tutors and lessons cost too much.

If this pattern continues, both in terms of diminished family size and augmented suicide rates, the country may face a deficit in that highly valued human capital. Numbers aside, South Korea may be facing an entire generation of unhappy citizens as well.

“It’s kind of alarming actually. If young students [are] not happy, we cannot guarantee their happiness when they grow up, so our future will be really dark,” Kim said.

Lauren Stepp

Sources: Aljazeera, NPR, The New York Times, The Wall Street Journal
Photo: Flickr

Poverty and Depression
In 2003, psychiatrists Vikram Patel and Arthur Kleinman suggested that there is a correlation between poverty and depression, as well as other common mental illness, in developing countries. They argued that the “experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health” explain why impoverished people are so vulnerable to mental illnesses such as depression.

In the United States, as of 2011, 30.9 percent of people in poverty are depressed. While this isn’t a global statistic, it does illuminate the relationship between the global depression phenomenon and global stressors, such as insecurity, violence, etc. These external factors are crucial to the development of depression, but so are internal or hereditary ones; a combination of the two is what neuroscientists now believe causes the neurological disorder.

Studies of the neurology of depression center around the neurotransmitter serotonin, a chemical messenger found in the brain associated with feelings of well-being, mood regulation, memory and cognition. Neurons release serotonin into the synaptic cleft, the space in-between neurons, and receptors on adjacent neurons receive it.

Different receptors have specialized effects. The two most important serotonin receptors in depression research are 5-hydroxytryptamine receptor 1A (5HT1A) and 2A (5HT2A.) The former is associated with increased activity, while the latter is associated with decreased activity.

One theory is that depression is caused by an uneven ratio of 5HT1A to 5HT2A receptors, with an excess of 5HT2A. This is an hereditary occurrence that leaves one more prone to depression, though not necessarily depressed. If there is insecurity, violence, etc. in this person’s environment, however, he or she is likely to develop symptoms of depression.

Another theory suggests that people suffering from depression naturally produce less serotonin than those who do not. This is, again, genetic and will only ever make one vulnerable to depression; it’s most likely a combination of genetic predisposition and external influences from one’s environment that cause this mental illness.

To counteract genetic predispositions to depression, neurologists, commonly use an antidepressant medication called selective serotonin re-uptake inhibitor (SSRI) drugs. They block what is called re-uptake, a process during which neurotransmitter transporters limit the amount of a neurotransmitter – in this case serotonin – in the synaptic cleft by taking it from receptors and driving it to other areas of the brain. Blocking re-uptake increases one’s serotonin levels where it counts, in the synaptic cleft where neurons communicate.

The effects of this medication may seem counter intuitive.

“Regardless of the emotion being happy or sad it would seem SSRI drugs dampens the experienced intensity of the emotion,” said Albert Gjedde, a neuroscientist who studies antidepressant SSRI drugs. “People in treatment with SSRI dugs describe it as if the peak of their emotions are cut away.”

Drugs such as SSRIs can help people with innate biases toward depression, but until poverty and its consequences are reduced, there will always be those at risk. Neuroscientists and philanthropists must work in tandem to mitigate the effects of depression and, eventually, to annihilate it.

Adam Kaminski

Sources: The Atlantic, ScienceNordic
Photo: Salon