Geneva Health Forum 2024

Mental health of detainees in Rwanda, an experience on the field.

Not scheduled

15m

Geneva

Oral presentation Migration, health and equity

Description

Theorical introduction:
Mental health of detainees is a highly sensitive public health issue. Individuals who experience incarceration are prone to suffer disproportionately from poor health , especially those belonging to disadvantaged and minorities groups; disparities by race or ethnicity are largely observed (Wildeman and Wang, 2017). Health inequality between detainees and the general population are widespread and attributed to socio-economic and behavioral issues (Fazel and Baillargeon, 2011). Alcohol misuse, high rates of intravenous drug use leading to increased risk of infectious disease and smoking deserve to be mentioned as causes of this health imbalance.
Robust evidence exists of higher prevalence of mental disorders in detainees compared with the general population (Fazel, Hayes et al., 2016).
Context of the study:
Rwanda is a small country situated in central Africa and belonging to the eastern African community. The historical development of the Rwandan psychiatric system can be described in four phases (Eytan et al, 2018):
1. The pre-colonial period (traditional approaches were the only form of mental health care).
2. The colonial period (starting inputs of western psychiatry).
3. The post-independence period, beginning in 1962. Construction of the sole psychiatric hospital of the country, the Caraes Ndera Teaching Hospital, in Kigali, run by the Brothers of Charity.
4. The post-genocide period, starting after the cataclysmic genocide against the Tutsi in 1994.
Directly after the genocide, the focus of the country was on judicial and other reconciliation initiatives. However, only one year after the end of the genocide the new regime in Rwanda instituted a mental health policy (Sabey, 2019) demonstrating recognition of the psychological burden inflicted to the people by the violence. However, there is still until now a scarcity of mental health professionals in the country and the implementation of this policy is still ongoing, especially regarding the development of forensic psychiatry.
The University of Geneva hosts a long time cooperation with the University of Kigali, Rwanda, with, among others, a specific objective to develop a training program in mental health for Rwandan health professionals. During the years, substantial improvements took place regarding general training in psychiatry. On the contrary, the situation of forensic psychiatry is still a topic of concern (Eytan et al, 2018) due to lack of resources and of mental health legislation.
In this presentation we will present the results of the last two humanitarian missions conducted on the field (2022 and 2023). The focus will be on the assessment of the needs in terms of mental health care for forensic patients in the psychiatric hospital of Ndera, Kigali.
It must be noted that the final aim of this project is to build knowledge about clinical, demographic and cultural factors associated to mental health vulnerability among detainees. The final scope of this work is to inform about clinical practice and to develop specific forensic psychiatry programs of training and task-shifting.