Overview
Overview
Promoting mental health and reducing the burden of mental illness around the globe has been a cornerstone of GEI’s work for the past decade. The high prevalence of mental, neurological and substance use disorders (MNS) poses a key challenge to achieving universal health coverage, the SDG target 3.8. While many of these disorders can be prevented and treated effectively, treatment coverage is very low (less than 20% in low- and middle-income countries) and treatment quality is frequently very poor. Stigmatization and discrimination further aggravate the situation.
Our priority intervention country, Rwanda, faces a particularly serious challenge. The 1994 genocide has left an enormous scar on society. The individual suffering was immense, and an estimated 26% of survivors continue to suffer from post-traumatic stress disorder. Additionally, an entire post-genocide generation has inherited a legacy of trauma, with hundreds of thousands suffering from undiagnosed symptoms such as anxiety, depression and self-destructive behavior. Since only about 5% of them seek mental health services, experts fear that this situation might fuel an array of potential knock-on effects such as poverty, social exclusion and conflict. As a result, trauma-healing efforts are one of the top priorities for ensuring sustainable peace and development in Rwanda.
Further interventions, particularly relating to capacity development, focus on our other main destinations – Kenya, South Africa and Vietnam.
Strategic objectives 2020-2022
Based on our comprehensive Theory of Change for Mental Health, we strive to achieve the following objectives:
Multi-stakeholder partnership
GEI is a convener, facilitator, broker, implementer and advocate. To achieve our goals, we nurture partnerships with very different stakeholders. We not only welcome new partners but strongly encourage institutions, organizations and individuals to join hands with us.
Current key partners in mental health include the following:
- Rwanda Ministry of Health
- University of Rwanda
- Rwanda Psychological Society
- Various Rwandan civil society and institutional partners
- Integrative Trauma Treatment International
- National Board for Certified Counselors – International Capacity Building
- Center for Mindful Self-Compassion
- Spectrum Counseling Psychology
- University of Missouri, St. Louis
- SUNY – University at Buffalo
- Youngstown State University
- Freie Universität Berlin
- Texas Christian University
Service delivery
Strengthening of service delivery
We strengthen the delivery of quality mental health care services in Rwanda with interventions at both ends of the pyramidal mental health system. In order to complement available specialist care and to develop additional services and capacity currently unavailable in the country, we operate an Integrative Trauma Treatment Center (ITTC) in Kigali. At the same time, we roll out community-based interventions to improve the general availability of psychosocial care at the non-specialist level across entire communities.
Integrative Trauma Treatment Center
Our Integrative Trauma Treatment Center (ITTC) in Kigali is a state-of-the-art outpatient clinic as well as a center of excellence for the training and learning of clinical skills.
Staffed by licensed clinical professionals as well as faculty of the University of Rwanda and supervised graduate students, we provide low-cost, high-quality psychosocial care with a specialist focus on integrative trauma treatment. Training and learning opportunities are available also for international partner institutions. Furthermore, ITTC is a general hub for trauma-related workshops and research.
Key intervention partners include Integrative Trauma Treatment International (ITTI), a Portland-based 501c3, and the University of Rwanda’s Center for Mental Health (CMH).
Service delivery at the community level
At the other end of the pyramidal mental health system, we support the Ministry of Health-led efforts to strengthen service delivery at the community level. This envisage various components several of which are currently at the pilot stage:
- We encourage the delivery of self-care and support through family and community networks. We plan to develop digital technology to provide information and psychoeducation, facilitate screening and assessments, mobilize social support and community engagement, strengthen self-monitoring and self-management, and provide skills training.
- We desire to strengthen non-specialist care systems at partner locations. After an assessment of available mental health and social care services, we develop a sustainable system consisting of information provision, training, supervision, mentoring, support, and monitoring and evaluation, administered both in-person and via digital technology. Target groups for non-specialists include, among others, nurses and community health workers, teachers, community leaders, pastors, criminal justice workers, and professional as well as lay counselors and social workers.
Opportunities for international institutions, organizations and individuals
Integrative Trauma Treatment Center:
Service delivery at community level:
Capacity development
Capacity development
We provide a range of pre-service and in-service education and training measures. Together with our local partners, we identify capacity development gaps and then address the resulting needs for professionals – both specialists and non-specialists – and for students. These activities are frequently connected to interventions for the strengthening of service delivery, but also go beyond them.
Mental health professionals and students in areas such as clinical psychology, psychiatric nursing, counseling and social work have the opportunity to learn about specialized integrative trauma treatment at our Integrative Trauma Treatment Center in Kigali. They can develop and practice their clinical skills under the training, supervision and support of our staff as well as international and local experts.
We also regularly host additional workshops, conferences and summer schools, typically in collaboration with local and international partners. Topics include, among many others, positive psychology, basic counseling, mind-body connections, expressive arts therapy or mindful self-compassion. Master trainings are further available in non-specialist curricula for professionals interested to become trainers, especially in mental health facilitation, mental health first aid, trauma-informed care, dementia awareness and skills for lay social workers. Beyond the specialist mental health professions, we provide core mental health skills as a training module in pre-service and in-service settings.
At the university level, we offer mental health-related workshops particularly in health education, teacher training and social sciences. At the professional level, we integrate workshops into the training of non-specialists in the communities. This includes, among others, nurses and community health workers, teachers, community leaders, pastors, criminal justice workers, and professional as well as lay counselors and social workers. The training modules not only comprise of the initial workshop, but also include continuous support, supervision and refresher training as part of the continuum of education.
Opportunities for international institutions, organizations and individuals
Capacity development:
Profession advancement
Profession advancement & community building
We believe that strong representative bodies are crucial for the advancement of professions. As such, we support existing and help to create new professional umbrella associations in relevant areas. Our initial focus in Rwanda is on representative bodies for general mental health, including psychology and psychiatric nursing, and for social work.
Professional umbrella associations can be strong community platforms. They raise awareness, provide professional development and continuing education, offer tools and resources, organize conferences, influence policies, laws and education, and generally facilitate networking opportunities. We assist professionals to build such flourishing communities, help to develop organizational as well as leadership capacity, co-develop engaging digital platforms, and co-host a range of campaigns, workshops, conferences and other events.
A particular goal of ours is that these representative bodies increasingly co-own our interventions and lend crucial additional degrees of sustainability and scale to them. We further support and integrate special university chapters to engage and empower students as the future leaders of their professions.
Opportunities for international institutions, organizations and individuals
Professional advancement & community building:
Promotion
Mental health promotion
Mental health promotion helps to prevent mental illness in the first place, fights the pervasive stigmatization and human rights violations that people with MNS conditions frequently encounter, and generally seeks to maximize the mental health and well-being of individuals and communities. The mental health promotion interventions that we desire to roll out follow a general life-course approach:
- The first intervention focuses on babies and infants. We plan to integrate a training module on mental health care for pregnant women and parent-infant interaction into existing primary care services such as antenatal care visits and postnatal follow-ups. Among others, we recommend measures such as the early initiation of breastfeeding and close physical contact such as “kangaroo mother care”. Special attention is placed on low birth-weight infants. Their mothers require appropriate advice and training from nurses and midwives to prevent poor intellectual development.
- The second intervention focuses on children aged 3 to 6 years. We plan to provide general information for parents as well as training on parenting skills through digital platforms. We further plan to integrate basic modules into the capacity development of non-specialist multipliers, such as nurses and community health workers, teachers, community leaders, pastors, criminal justice workers, and professional as well as lay counselors and social workers.
- The third intervention focuses on school-aged children and adolescents. We plan to partner with selected schools as well as youth groups to establish social and emotional learning programs that prevent problematic conduct in childhood and reduce the risks of adolescents for substance misuse, self-harm and suicide. Programs also focus on life skills and raise awareness of the benefits of a healthy lifestyle. Particular attention is given to the capacity development of teachers and social workers, as already discussed previously. Additionally, we plan to create engaging stories that we share via relevant media.
- The fourth intervention targets the workplace. We plan to partner with selected employers to promote safe and supportive working conditions and environments. This includes, among others, training on mental health for managers and courses on stress management and workplace wellness. Given the special historical environment in Rwanda, education and training relating to PTSD is of particular relevance, especially for those members of the population who have been impacted by the 1994 genocide. We plan to offer special workshops and information sessions and materials to employers.
- Last but not least, we strive to generally increase public knowledge and understanding about mental health, for example through digital platforms, media awareness and campaigns to reduce stigmatization and discrimination. Subjects include, among others, life skills, parenting skills, promotion of physical activity, healthy eating and social connectedness. This further relates to social inclusion for specific vulnerable groups of society as well as older people who might suffer from depression or dementia.
Opportunities for international institutions, organizations and individuals
Mental health promotion:
Research
Research
We believe that research is vital to enable policies and actions to be based on evidence and best practice. This particularly means that we strive to integrate timely and relevant information or surveillance frameworks into all of our interventions. As a result, we are able to monitor implemented actions and detect desirable improvements.
Additionally, we are also interested in further priority mental health research in the SDG framework and therefore launch collaborative research projects – both quantitative and qualitative – with international and local partners. Areas of interest include, among others, expanded access to quality care, advanced prevention and promotion, human resource capacity development, prenatal and perinatal mental health care, early childhood development, and complex trauma.
Opportunities for international institutions, organizations and individuals
Research:
