The Malta Independent on Sunday
Maltese doctor in psychiatry delivers mental health training in Rwanda
Higher specialist trainee in Psychiatry Emma Saliba has sought to take it to the next level as she delivered the Mental Health and High School Curriculum Guide training to a number of professionals in Rwanda, with the aim of increasing mental health literacy.
Saliba was interviewed by The Malta Independent back in 2021 as she sought to raise awareness about a curriculum which is referred to as the Mental Health and High School Curriculum Guide. The aim of this curriculum seeks to increase knowledge among teachers on mental health, reduce stigma and increase help-seeking attitudes.
Fast forward to 2022, Saliba spoke with The Malta Independent on Sunday again to give an update on the progress of the training on this curriculum, primarily highlighting that this was even delivered outside of Europe, in a country in East Africa.
The training that was carried out in Rwanda was a joint collaboration with the Rwanda Paediatric Association (RPA). This is a nonprofit organisation registered with the government of Rwanda. It is a professional body bringing together all pediatricians, thereby bringing them under a forum to promote the betterment of pediatric practice in Rwanda. RPA is involved from preventive to curative and palliative care through advocacy, training and capacity building of healthcare providers, sensitisation of parents and caretakers.
The participants who were a part of the training were mostly pediatricians and other health providers who are involved in the care and management of adolescents with mental health problems.
Mental health curriculum aims to reduce the incidence of mental disorders
Saliba said that she hopes to bring about a continued positive change that will be reflected in present and future generations.
“By introducing a mental health curriculum in schools, we aim to educate adolescents in Rwanda on how to obtain and maintain positive mental health as well as what the early warning signs of mental illness are. Thus, increasing the likelihood of them seeking support early on,” Saliba said.
She added that “by having teachers receive mental health literacy training, we hope that teachers will have more evidence-based knowledge on mental health and mental disorders, therefore helping them identify students who might be suffering from a mental disorder early on so that they can direct them to the appropriate channels for assessment.
“Additionally, by having mental health professionals, we ensure that they are able to correctly advice and guide teachers and school staff with regards to challenges they might face when working with students with mental disorders.”
These mental health professionals will be able to correct any misconceptions or misunderstandings, Saliba said.
She emphasised that this initiative also comprises offering mental health literacy sessions for parents to continue to promote good mental health within the family home.
“Through this guide, they will have increased
knowledge on the signs of mental disorders and know when and where to seek help if their son or daughter exhibits these symptoms. They will also have increased support from the school,” Saliba said.
Saliba’s plan is to continue supporting the RPA in delivering the training to educators in Rwanda, so that the curriculum will then be introduced in schools.
“On a personal level, it is incredibly satisfying and fulfilling to be part of this innovative endeavour. Knowing that this work will positively impact the lives of countless adolescents, parents and families is truly heartening,” Saliba said.
For its part, the RPA said that their aim is to improve mental health literacy among health care providers, teachers and high school students in Rwanda.
It explained that Rwanda, like many other African countries, has a youthful population with adolescents (10-19 years) consisting of 24.2% of the total population.
Rwandan adolescents face similar challenges to other adolescents in low-income countries. Rwanda is one of the top African countries to have access to technology, so adolescents’ exposure to screens and social media contributes to the increase in mental health problems, mainly depression and anxiety.
The association said that the Covid-19 pandemic also impacted adolescent mental health as some lost direct guardians or relatives, other experienced disrupted routines and education and others endured concern for family health and economy, which in turn caused stress, depression and worries about their future.
It further explained that the RPA carried out various activities, some related to the health of adolescents, to improve mental health literacy.
The association is currently implementing a project and said that for the success of the project, the mentors, who are pediatricians, psychiatrists and psychologists, need to have sufficient knowledge and skills in this field.
The project also includes teachers and high school students; thus the mentors need to have the skills of transferring their knowledge to them, using the African school mental health curriculum.
The curriculum will be adapted to the Rwandan settings to achieve the goals of the project. This curriculum helps to tackle and address the common mental health problems among adolescents in Africa, the RPA said.
“Our intention is that once the curriculum is adapted, the RPA will share it with the Ministry of Health and Ministry of Education for use in Rwanda if validated by the Ministries,” it said.
Saliba plays a role in all of this as she is helping the association in the training of health providers to be able to implement all the above.
Saliba is also supporting the adaptation of the curriculum where she provides the association with advice after the formal training.
Why provide training in Rwanda?
Asked on whether there was a particular reason as to why Saliba chose to deliver the curriculum in Rwanda, she said that on a global level, most mental health services remain “underfunded” and “underserved”.
Rwanda is no exception. There is a severe shortage of mental health professionals, Saliba said.
“I am passionate about adolescent mental health and when the Rwanda Paediatric Association contacted me and asked for my input, I was keen to support them,” Saliba noted.
The Mental Health Atlas 2017, issued by the World Health Organisation, demonstrates that there are 0.06 psychiatrists per 100,000 of the population in Rwanda. It also highlights that worryingly, there are no child psychiatrists. In view of this, it is general adult psychiatrists and paediatricians who assess children and adolescents with mental disorders in Rwanda.
Additionally, the mental health of the population in Rwanda was significantly impacted following the 1994 genocide in the country resulting in an increase in mental disorders, particularly post-traumatic stress disorder, depression and anxiety disorders. The Covid19 pandemic also made an impact on this matter, Saliba explained.
She added that “this, together with the reduced resources and lack of funds in mental health services, is concerning”.
Nonetheless, Saliba said that the association demonstrated an excellent initiative to improve school-based mental health literacy.
Despite the lack of resources and limited mental health workforce, they showed a remarkable eagerness, passion and enthusiasm for the introduction and implementation of the guide in their country. They recognised the clear evidence-based benefits of the guide, which has already been implemented in another 12 countries. Keeping in mind that the needs of an African country are different to those of a European country, an African version of the curriculum was shared with the participants, she said.