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5 Facts About Mental Health in Rwanda 

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

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Mental Health in Palestine: The Hidden Plague

Mental Health in Palestine
Palestinian refugees and citizens in the Occupied Territories are exposed to a great amount of violence and terror as a result of the Israeli occupation. This exposure has increased the prevalence of mental health disorders such as PTSD, insomnia and even schizophrenia. This article will provide some insight into the mental health issues that are prevalent among Palestinians, the healthcare system and the possible solutions to help facilitate a better mental health response.

The Conditions 

Palestinians in the Occupied Territories live in a very volatile and unstable region. Recently, there has been an increase in the awareness of the effects that living through decades of continuous political aggression and violence have on mental health. Mental health disorders amount to one of the largest – but the least acknowledged – health problems in Occupied Palestine. Almost a third of Palestinians are in dire need of mental health interventions. However, mental health services in Occupied Palestine are amidst the most under-resourced fields of healthcare provision.

Palestinians have experienced a series of traumatic events that range from imprisonment and torture to unemployment, house demolitions and land confiscation. All these experiences foster an environment of continuous instability, stress, uncertainty and anxiety, which can dangerously affect mental health. 

Mental health is a concern for both adults and children in the Occupied Territories. Adults who are exposed to house demolitions exhibit a higher level of anxiety, depression and paranoia. However, the psychological effects of the conditions in Occupied Palestine are especially traumatizing for children. Many injured children have developed severe psychological impairments. The prevalence of behavioral issues and psychopathic symptoms among children is incredibly high. About 32.7% of children in the Gaza Strip suffer from severe levels of PTSD, 49% of children suffer through moderate levels of PTSD and 16% of children suffer from low levels of PTSD.

The Healthcare System

As of now, mental health services in the West Bank and East Jerusalem are provided by both the government and the non-governmental sector. General services are provided by the Ministry of Health but the majority of the system is operated under and funded by humanitarian organizations like UNRWA. There are only 13 community mental health clinics in the West Bank, and one psychiatric hospital in Bethlehem. In 2013, the clinics with outpatient facilities treated over 2400 patients. Of the 2,400 patients, 24.2% were diagnosed with neurotic disorders (PTSD, generalized anxiety disorder and clinical depression) and 12.2 % were diagnosed with schizophrenia. 

Generally, mental health services in Gaza and the West Bank are difficult to come by and inconsistent in quality. There is no legislation that addresses mental health and no budget allocated by the Ministry of Health. The region does not have mental health policies or an overview plan to address ongoing care and services for the severely mentally ill and those directly affected by trauma and loss. 

What Needs to Be Done 

The healthcare system in Palestine relies heavily on humanitarian aid and assistance. However, this funding and aid could easily be subjected to budget cuts from countries like the United States. Currently, the Ministry of Health does not allocate any funds to mental health services.

To effectively address mental health in Palestine, the government must create a fund for mental health services. The government should also promote legislation that addresses mental health. This legislation could include the protection of employment rights for those mentally ill, the integration of mental illness within the education system as well as civil legislation to address the rights to vote or own property.

It is also important for the Ministry of Health and NGOs to work together to create a comprehensive plan that addresses mental health. In collaboration, these organizations can acquire more hospital beds and help hospitals accommodate a greater number of patients. If mental health is made a priority, it can be effectively addressed in the coming years.

– Nada Abuasi
Photo: Flickr

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Poverty and PTSD

Poverty and PTSDCommonly associated with combat veterans, Post-traumatic stress disorder (PTSD) impacts more of the global population than maybe expected. Recent studies have found a link between poverty and PTSD that reveals that socioeconomic status contributes to the majority of anxiety disorders.

How Poverty Contributes to PTSD

Mental disorders manifest in distinct ways for many people. However, the common underlying origin of Post-traumatic stress syndrome (PTSD) remains a terrifying or traumatic life event. Living in poverty often means surviving daily in vulnerable conditions, and with financial instability that limits access to necessities such as food, shelter and water. The inability to pay for expenses starts to become emotionally and mentally taxing. Poverty acts as a traumatic experience in many people’s lives and even after graduating in class status, difficulty persists to enjoy day to day life.

Symptoms of PTSD can appear within months of the traumatic event and include:

  • Avoiding: Detaching from the traumatic event by avoiding triggers such as places, situations or people.
  • Reliving: Flashbacks and nightmares due to memories that force reliving the traumatic experience.
  • Increased Arousal: An increased blood pressure or heart rate accompanied by outbursts of anger and difficulties sleeping

Some people with PTSD may exhibit all these symptoms, while others exhibit just a few. The severity of PTSD also varies from person to person. PTSD can be broken down into subtypes such as:

  • Delayed on-set PTSD: This variation refers to when symptoms of the disorder develop many years after the traumatic event.
  • Complex PTSD: This type of PTSD usually surfaces after ongoing childhood physical or sexual abuse.
  • Birth Trauma: This type occurs after traumatic childbirth.

Women with PTSD

Research estimates that 284 million people globally suffer from anxiety disorders such as PTSD. About 63 percent of people that suffer from anxiety disorders are women. In addition, women living in poverty tend to face PTSD at higher levels than any other group within the general population. The relationship between poverty and PTSD embodies that of the domino effect. Poor women’s PTSD symptoms often worsen due to the fact that living in impoverished neighborhoods risk ongoing exposure to triggers of the traumatic incident. A study undertaken by the Social Cognitive Theory also reveals that most of the women living in poverty with PTSD share a history of domestic violence and lack social support.

Treatments

It can feel nearly impossible to live a normal life with PTSD. Luckily, effective treatments exist that minimize the symptoms of the disorder. One of the best treatments for PTSD is Psychotherapy. Psychotherapy allows PTSD victims to talk about their cognitive behavioral process to a mental health professional to reduce and change reactions to triggers. Another important tool for managing PTSD is having a strong support system. The help of friends and family means everything during a mental health crisis. A support system of others that have suffered from PTSD also helps signify that a person is not alone in the experiences of the mental disorder. There are also organizations such as the PTSD Alliance, who work to educate and empower people with PTSD psychologically, economically and emotionally to thrive beyond environmental barriers. The organization currently has five international partners that provide programs to help improve the lives of those living in poverty with PTSD.

Overall, poverty and PTSD remain two prominent issues impacting people on a global scale. The connection between poverty and PTSD only further emphasizes that the more work that is done to reduce global poverty also diminishes the mental health crisis.

– Nia Coleman
Photo: Wikimedia

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How Therapy Helps Victims of Boko Haram in Nigeria

Victims of Boko HaramSince 2002, the Islamic militant group, Boko Haram, has killed more than 27,000 people and displaced nearly two million from their homes in the northeast regions of Nigeria. For victims of Boko Haram, recovery will be a lifelong process. Although it has been estimated that nearly 4.5 million people remain food insecure since the insurgency, it is the psychological toll that remains most difficult to measure and treat. With the help of organizations such as the U.N., the Neem Foundation and Tender Arts Nigeria, victims of Boko Haram in refugee camps are offered much-needed psychological treatment, including art therapy and training on how to reintegrate into society.

The Role of Therapy in Combating Trauma

Many victims of Boko Haram are taken as children and forced to both witness and commit acts of unspeakable violence, even to members of their own families. Girls as young as 11 are forced to marry and undergo rape. These girls are frequently used as suicide bombers, while the boys are trained as soldiers. The victims of Boko Haram are indoctrinated and occasionally radicalized themselves. For this reason, they are often shamed or feared upon their return, being referred to as epidemics.

The Neem Foundation highlights the importance of therapy to help victims recover from psychological trauma. After being kidnapped, witnessing their villages being attacked and their loved ones being killed, many people suffer severe Post-Traumatic Stress Disorder (PTSD). Children also frequently suffer from cognitive delays and a proclivity towards violent outbursts.

The Neem Foundation brings individual and group therapy to refugee camps, visiting the camps on motorized tricycles called kekes around the country. Terna Abege, a clinical psychologist with the Neem Foundation, uses various methods of therapy, including visualization techniques called “thought-stoppers” to help victims of PTSD deal with disturbing flashbacks. The Neem Foundation and other nonprofits, such as MANI, seek to fill the gap in mental health care in any way they can, including offering therapy to suicidal victims over Twitter and WhatsApp.

How Art Therapy is Used in Nigerian Refugee Camps

Art therapy is also being integrated in refugee camps to help people sort through their mental trauma. The use of drawing and painting, among other art forms, can divert attention from negative thoughts and help people communicate in alternative ways. Art therapy can also help victims preserve their broken cultures and identities and express feelings that they cannot put into words.

In an emergency school set up by UNICEF in Cameroon, children gather in groups to draw as a form of art therapy. The trauma is evident in the scenes of violence and bloodshed that seem to flow naturally from the reservoirs of their memories. Under Boko Haram, children are beaten for crying at the violence they witness and not allowed to play with toys or make noise. When they return, they are often desensitized to violence and either act out violently or withdraw entirely. The art therapy helps the children to express what they have been suppressing and helps therapists identify those in most need of treatment.

Since 2013, Tender Arts Nigeria, created by Kunle Adewale, has used art therapy to help children suffering from physical and mental illnesses and impairments, such as cancer, Down Syndrome and behavioral problems. Since the war with Boko Haram, Tender Arts has reached out to victims of violence and radicalization. They use art therapy to assist in deradicalization efforts and to heal those traumatized from the violence.

Like the Neem Foundation, Tender Arts believes its efforts are not only important avenues of healing but important in helping people avoid radicalization or other areas of crime. More than 10,000 victims have already benefited from the art therapy offered by Tender Arts Nigeria. Because Boko Haram preys on the poor, young and uneducated, Adewale believes that valuing the arts and education is the best way to fight Boko Haram, whose name means “Western education is forbidden.”

The Importance of Greater Access to Mental Health Care in Nigeria

The Neem foundation highlights the importance of increasing the availability of psychological treatment for refugees in Nigeria. There is a major deficit in mental health care in Nigeria, with only one mental health facility available in the northeast and only one therapist per 375,000 people. The Neem Foundation is working to implement programs that will train more people to offer therapy. They now offer an intensive nine-month program in Maiduguri to train lay counselors who can work more immediately as therapists for the traumatized population.

Although the road to recovery is a long one for victims of Boko Haram’s violence, the Neem Foundation believes in the need to act quickly to prevent more severe mental illnesses from developing. They are working to spread awareness about mental health and want to gain more governmental support for the mental health crisis in the coming years. In the meantime, as more therapists become available throughout Nigeria, it is their hope that these victims can recover and start to live normal lives again.

– Christina Laucello
Photo: Flickr

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4 Organizations Improving Mental Health in Cambodia

Improving Mental Health in CambodiaThere are two main factors that have lead to the need for improving mental health issues in Cambodia today.

First, is the Khmer Rouge. The Khmer Rouge was a genocide in the late 1970s that ultimately killed four million Cambodians. The ruthless regime of the Khmer Rouge left many survivors with PTSD (post-traumatic stress disorder) from witnessing such horrific crimes against humanity.

Second, is the high rates of poverty that plague Cambodia. The mass destruction of Cambodia’s infrastructure during the Khmer Rouge left the country poverty stricken, losing decades of development in a just few years. As a result, living in poverty poses itself as a large risk factor for mental illnesses, causing many Cambodians without PTSD from the genocide to still be at a high risk of struggling with mental health.

Specifically targeting educated people and those unable to work, the Khmer Rouge left the country with only a few dozen medical professionals by the genocide’s end. Moreover, it has taken decades for Cambodia to develop the organizations necessary to combat such deeply-rooted mental health struggles. Here are four organizations improving mental health in Cambodia today.

4 Organizations Improving Mental Health in Cambodia

  1. Transcultural Psychological Organization (TPO Cambodia)
    TPO Cambodia recognizes the gap between mental health services needed and the mental health services provided in Cambodia. Through recognizing this gap, TPO Cambodia has developed an extensive array of mental health services. For instance, services are aimed at community building, raising awareness and providing psychological treatment. By focusing on the cultural context of Cambodia, TPO Cambodia aims to develop culturally aware treatment options for patients. Some of the many services available at TPO Cambodia are:

    • Offering the training of already-established community leaders to be key mental health resources for the community
    • Trauma treatment
    • Counseling and therapy
    • Self-help groups for victims of sexual assault and of the Khmer Rouge
    • Protection of children
  2. Cambodian National Program for Mental Health
    Secondly, training mental health professionals are just the beginning for the Cambodian National Program for Mental Health. With its primary goal being to support the Cambodian Ministry of Health, this program continues to help increase the number of properly-trained mental health professionals in Cambodia. This is so foundational as Cambodia needs more trained mental health professionals to properly address the mental health needs of the country. In addition to training mental health professionals, the Cambodian National Program for Mental Health:

    1. Provides mental health services to 23 out of 24 Cambodian provinces
    2. Introduced computerized documentation for client’s files
    3. Supports the primary psychiatric facility in Phnom Penh
    4. Develops the Psychosocial Rehabilitation Centre
  3. Center for Child and Adolescent Mental Health (CCAMH)
    Also dedicated to supporting the mental health struggles of children and their families, CCAMH strives to help children in the community, at school and at their center. So, by providing counseling and awareness-building services at school and in the community, CCAMH’s primary resources are at their center. For example, some of the services available at the center are:

    • Play therapy
    • Behavior therapy
    • Psychosocial Education
    • Multi-Model Therapeutic Intervention
    • Individual and family counseling
  4. Social Services of Cambodia (SSC)
    Finally, the primary focus of SSC is to dismantle the negative stigmas associated with mental health professionals in Cambodia. For example, SSC aims to change the negative public opinions by spreading messages busting stigma-centric myths about mental health professionals to schools, government officials and the public. Additionally, SSC encourages future university students to get involved in social work and recognize the value of social work professionals.

Overall, with very little allocated to mental health services in Cambodia’s public health budget, government-run mental health programs are severely underfunded. Therefore, compiled with the severe stigma against psychiatric help in Cambodia, the discouraging of many health professionals to go into the mental health field leave Cambodia with a monetary and human resource deficit to properly manage nationwide mental health struggles. Fortunately, there are these four organizations improving mental health in Cambodia to help pave the way towards a solution.

– Amy Dickens
Photo: Flickr

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Mindfulness in Education Systems of India

Mindfulness in Education Systems of IndiaIn recent years, India has improved its education system greatly. An increasing number of children have access to education and enrollment rates in primary school are on the rise. Over 98 percent of Indians have access to a primary school within one kilometer of their home. Yet, the nation still faces challenges with poor education and high dropout rates. In an effort to combat these challenges, India has introduced mindfulness in education systems across the country.

Education Challenges in Delhi

India is among the top five countries for children not attending primary school. There are over 1.4 million students between the ages of 6 and 11 not enrolled. Approximately 29 percent of children drop out of school before finishing the five years of primary school, and only 42 percent of students complete high school.

Many schools are not able to handle the needs of all the students. Only 74 percent of schools have drinking water and over 50 percent of schools have working restrooms for girls. Recent reports show that learning levels are not being reached, and standardized tests show that countless children will not progress in the school system. This highlights the need to improve the quality of education in India.

The Lasting Ramifications of Stress

Many students face external problems, such as poverty, that can seriously hinder their education. New Delhi slums have astounding illiteracy rates of 70 percent; however, the entirety of New Delhi has an impressive literacy rate of 86 percent. In the 2011 census, it was reported that 3.9 million residents of New Delhi live in slums. Non-government reports have estimated that the number of impoverished people living in the slums is much higher, sitting around 8 million. Residents of the slums lack access to adequate plumbing, drinkable water and transportation.

Children who are constantly exposed to poverty-related stress can have serious health consequences later in life. Physical reactions from stress, such as increased heart rates, stress hormones and adrenaline take a serious toll on a child’s health. Eventually, these children are at a higher risk of developing diabetes and other life-altering illnesses.

Over time, the structure of a child’s brain is forever altered. Cognitive functions are impaired, which can have disastrous consequences on a child’s emotional responses and attention span. Impoverished children are also at a higher risk of suffering from depression. In fact, one out of four children surveyed between the ages of 13 and 15 face the challenges of depression in India. In contrast, children who do not experience stress or depression experience healthier sleeping habits and are able to easily fight off illnesses due to having stronger immune systems.

Mindfulness in Education

India is combating stress-related illnesses and the inability to focus in class among children with an additional course in “Happiness.” The course objective is to improve the students’ emotional well-being through meditation, story-telling and other activities that focus on mental health. The students will learn mindfulness, empowering them to be less distracted and to improve their ability to focus. Apra, a primary school teacher, believes that mindfulness in education will help many students in Delhi. She adds that the course will specifically benefit children from poorer families as they will have “time to be happy.”

Mindfulness in education has shown encouraging results in urban schools. Created as an alternative to detention, Robert W. Coleman Elementary School in Baltimore has implemented an afterschool program dedicated to meditation and mindfulness. Success can be noted by the drop in suspensions at school. During the 2012-2013 school-year, 4 students were suspended. However, the following year there were no suspensions, something the school attributes to this program. Moreover, a study by Stanford University found that mindfulness in education has also helped lessen symptoms of PTSD.

Mindfulness in education is not the solution to end poverty, but it is a method that can be used to lessen the disastrous effects on impoverished children. Studies on mindfulness in education are still very new, but studies point in the direction that mindful practices will have tremendous results for students. Furthermore, the evidence shows that disadvantaged children will greatly benefit from this practice. For India, this could mean that retention rates in school will rise, and more children will be able to receive a quality education.

– Stefanie Babb

Photo: Flickr