Mental health is an integral part of an individual’s overall health. A pregnant woman who is depressed will not able to adequately care for herself or her child, but all too often I see mental health considered as separate from clinical care. We won’t achieve high-quality health care until mental health care is fully integrated into all levels of the health system.
— Hildegarde Mukasakindi, Associate Director Mental Health Program

 Two decades after the genocide, the impact can still be felt; one in four Rwandans suffers from posttraumatic stress disorder and nearly one in every six adults suffers from depression. The challenge to treating this high burden of mental health illnesses is made harder by the limited number of mental health professionals in country. We work in partnership with the Ministry of Health to improve access to quality mental health care to those who need it by implementing a model that is effective in rural low-income settings.  

We support Rwanda’s plan to integrate mental health into the primary health care package and decentralize care to the district hospital, health center, and community levels in order to make it accessible to rural populations. We train and mentor health care providers on mental health care at the hospital level, health center level and at community level. 

Capacity building

To support the development of a quality mental health care model we work to build the capacity of health care providers from the community level up to hospital staff. Community health workers operate on the frontlines; identifying people living with mental illnesses and connecting them to care. We have trained over 700 community health workers to fight stigma, detect mental health illness, and help patients navigate the health system. We also provide mentorship for community health workers and social workers who regularly visit patients’ homes to ensure their treatment is progressing well and when needed advocate on their patient’s behalf. Mental health illnesses are surrounded by harmful stigma, so we promote educational sessions for families and communities on the realities of mental illness.

We regularly provide trainings in mental health care for nurses working at the health center level and physicians working at the district hospital level. Trainings led by psychiatrists, psychologists and mental health nurses cover topics including assessment and diagnosis, management of mental health disorders, crisis and agitation management, psychiatric interviews, and mental health human rights. These experts provide continued mentorship to physicians in order to improve the quality of care. To strengthen the district hospitals ability to serve mental health patients, our staff provides clinical supervision of mental health cases. 

Social and economic support

We believe it is crucial to not only treat a patient’s symptoms, but to also address their social and economic determinants of health. Poverty and stigma can often negatively affect patient outcomes. Community health workers and social workers build connections with patients’ families and communities to create a supportive environment. Poor and vulnerable patients are eligible to receive food packages and have their transportation costs to health facilities covered. 

We organize support groups for patients living with mental illnesses to meet up and share their experiences. We also lead psycho-rehabilitation programs that teach patients useful and therapeutic skills like how to create handicrafts or care for animals. 

Scaling-up mental health care

We have implemented our innovative model of mental health care in all 19 health center and the district hospital in the mountainous district of Burera in northern Rwanda. Our interventions are currently serving more than 3,500 patients , but this is just the beginning. Based on our experience and lessons learned, we are planning to expand our program to the two other districts we support; Kayonza and Kirehe. The Government of Rwanda is planning to replicate the model we developed in Burera to other districts. We continue to play a key role as advisers to the Ministry of Health as they work to make mental health care accessible to all Rwandans.