Mental health care in post-genocide Rwanda: evaluation of a program specializing in posttraumatic stress disorder and substance abuse

Abstract

BackgroundFollowing the genocide, millions of Rwandans are likely living with posttraumatic stress disorder (PTSD). Le Centre Psychothérapeutique Icyizere provides the only specialized treatment for PTSD in the Rwandan healthcare system.MethodsDemographics, diagnosis, treatment, outcomes, and scores on assessments of functioning and PTSD were recorded from clinical charts of all patients receiving care between October 2013 and 2014. Descriptive statistics and within-group t tests comparing functional impairment and PTSD symptoms at intake to discharge and follow-up were calculated.ResultsA total of 719 patients (55.08% male) received care. Patients were more educated, more likely to live in the capital, and less likely to be married than the general population. Patients reported high desire for, and strong satisfaction with, care. Most patients (55.60%) were still in care by the end of the program evaluation. Functioning improved from intake to discharge (p < 0.001), and improvements were sustained at follow-up (p < 0.001). Most adults were diagnosed with psychotic disorders, substance use disorders, or depression. Only 20 patients were diagnosed with PTSD, and symptoms were improved at discharge (p = 0.003).ConclusionsThis program evaluation demonstrated the utility of a low-resource information management system to provide clarity about the patient population and outcomes. Results suggest that services are effective and sustainable, although people with PTSD were not the primary recipients of care. Disparities in care by diagnosis, education, marital status, and geography are discussed. Results have contributed to changes in service delivery and care and efforts to increase access to care.

Realization of the rights of persons with disabilities in Rwanda

“…One of the underlying issues is that only 1 per cent of the national health budget is allocated to mental health needs [ 17 ]. Rugema, Krantz, Mogren, Ntaganira, and Persson [ 10 ] found that mental health services were underfinanced and described a situation in which “the total number of mental health nurses were 293 in 2012 and only two mental hospitals specialized in mental health care in Rwanda.” Additionally, it was found that as of 2014, no health centers within Rwanda had a quality assurance team or system to track mental health patient data [ 18 ]. However, enhancements to pre-existing programs such as the Rural Health Scale-Up National Strategic Plan have been initiated to address the need for mental health care in the country [ 19 ].…”

Extrinsic Factors Influencing the Person’s Motivation for Engagement and Retention in the Addiction Recovery Process. A Systematic Literature Review

“…In some studies, retention was defined as number of substance use during the last 30 days or compliance with a treatment plan. Mason et al [34] assessed retention through self-reported numbers of days a person used substances, such as alcohol, cannabis, during the last month [35]; while in the Ng and Harerimana's study, [36] retention was determined by attendance to scheduled follow-up appointments. Retention was also operationalized as a period representing days on treatment from the first dose to the last dose of methadone or last date of the study period.…”

“…In a one-year research on post-traumatic stress disorders and SUDs treatment, Ng and Harerimana, [36] highlighted the role of acknowledging people's beliefs about treatment and family involvement in improving retention outcomes. The research found a retention rate of 55.6% and attrition rate of 37.1% at one-year followup.…”

“…The research found a retention rate of 55.6% and attrition rate of 37.1% at one-year followup. [36] People who optimally benefited from the care program had family support in the form of accompaniment (85.6%), and believed that treatment was helpful, relevant, and/or necessary (90.2%). [36] Nonetheless, family relatives and peer network may compromise motivation outcomes by exerting pressure for treatment on the patient.…”

Forensic psychiatry in Rwanda

“…With a population of approximately 12 million inhabitants, the country is currently undergoing a rapid economic development. The Rwandan government has invested heavily in delivery of quality health care, and physical health indicators have improved dramatically during the last decade [16]. However, there is still a scarcity of mental health professionals and most services are concentrated in the urban areas [17].…”