The "treatment gap" in global mental health reconsidered: sociotherapy for collective trauma in Rwanda.

Journal: European journal of psychotraumatology

Volume: 6

Issue: 

Year of Publication: 2015

Affiliated Institutions:  Center for Mental Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; stefanjansen@khi.ac.rw. Mental Health and Well-being, The University of Glasgow, Glasgow, UK. No affiliation. Community Based Sociotherapy Program, Kigali, Rwanda. Center for Mental Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.

Abstract summary 

The "treatment gap" (TG) for mental disorders refers to the difference that exists between the number of people who need care and those who receive care. The concept is strongly promoted by the World Health Organization and widely used in the context of low- and middle-income countries. Although accepting the many demonstrable benefits that flow from this approach, it is important to critically reflect on the limitations of the concept of the TG and its implications for building capacity for mental health services in Rwanda.The article highlights concerns that the evidence base for mental health interventions is not globally valid, and problematizes the preponderance of psychiatric approaches in international guidelines for mental health. Specifically, the risk of medicalization of social problems and the limited way in which "community" has been conceptualized in global mental health discourses are addressed. Rather than being used as a method for increasing economic efficiency (i.e., reducing healthcare costs), "community" should be promoted as a means of harnessing collective strengths and resources to help promote mental well-being. This may be particularly beneficial for contexts, like Rwanda, where community life has been disrupted by collective violence, and the resulting social isolation constitutes an important determinant of mental distress.Moving forward there is a need to consider alternative paradigms where individual distress is understood as a symptom of social distress, which extends beyond the more individually oriented TG paradigm. Sociotherapy, an intervention used in Rwanda over the past 10 years, is presented as an example of how communities of support can be built to promote mental health and psychosocial well-being.

Authors & Co-authors:  Jansen Stefan S White Ross R Hogwood Jemma J Jansen Angela A Gishoma Darius D Mukamana Donatilla D Richters Annemiek A

Study Outcome 

Source Link: Visit source

Statistics
Citations :  Abbo C. Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda. Global Health Action. 2011;4
Authors :  7
Identifiers
Doi : 10.3402/ejpt.v6.28706
SSN : 2000-8066
Study Population
Male,Female
Mesh Terms
Other Terms
Collective violence;Rwanda;community;global mental health;sociotherapy;trauma;treatment gap
Study Design
Study Approach
Country of Study
Rwanda
Publication Country
United States