Implementation of Mental Health Reform and Policy in Post-Conflict Countries: The Case of Post-Genocide Rwanda

Abstract

Mental health has been receiving increasing amounts of attention in recent years. Despite this, there are still many barriers to receiving mental health care in all parts of the world. Post-conflict countries have the dual challenge of increased mental health problems among their populations and trying to respond to these problems with low resources as their economies are often destroyed by the effects of war. This research studies the implementation of Rwanda’s post-genocide mental health policy to assess the challenges and best practises of implementing mental health reform in a low-resource, post-conflict country. The thesis found that the implementation of Rwanda’s mental health policy has relied on policies of rapid decentralization and integration to increase accessibility to mental health care. Decentralization has ensured that mental health services are available at every level and relies on a referral system. Mental health care is integrated into the general healthcare system by training generalists in hospitals and health centres to respond to mental health issues, therefore making these services available at nearly all health institutions. These policies were viewed positively by stakeholders, but there were still many gaps and challenges in the implementation of Rwanda’s mental health policy. One of the major challenges was stigma acting as a barrier to accessing services while one of the largest gaps was that the implementation relies too much on institutionalized, individualized, and Westernized care, which participants pointed out is not always suitable in the Rwandan context. Recommendations included an increase in sensitization campaigns, shifting towards community-based mental health care, expanding personnel and services, as well as increasing funding. The analysis, relying on complexity theory, found that many of the gaps are missed by the government because of a lack of collaboration with local organizations and service providers working in the domain.