Where three leaders are finding hope in the challenges of mental health education.

November 12, 2020
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What’s your role in working with mental health and where is that work located?

JANE | I am the Youth First Rwanda | YFR Program Coordinator. YFR is an evidence-based resilience development program aimed at promoting social, emotional, and physical wellbeing of adolescents as well as helping them improve their academic performance.

The program targets adolescents in marginalized settings and equips them with skills, knowledge, and attitudes to help them to thrive and achieve their life goals amidst challenges. The program is conducted in partnership by CorStone and Inspire, Educate, and Empower Rwanda.

KATE | I’m the Chief Program Officer at CorStone, based in Baltimore Maryland, which means I oversee all aspects of our programs on the ground. I work with so many wonderful people in India, Rwanda, and Kenya to help vulnerable kids build resilience and overcome challenges.

Our programs support mental health by coming at it from a strength-based, promotive and preventive framework—helping kids to find what’s already strong about them and promoting more of that while helping them to reduce some of their risks for mental health problems in the future.

GRACY | I lead CorStone’s program in India. CorStone has been developing, implementing, and evaluating resilience programs for youth and other marginalized populations in India since 2008.

While we mainly work in Bihar, our work has also been implemented through partners in other states such as Rajasthan, Uttar Pradesh, Jharkhand, and Uttarakhand.

Jane Nungari

What do you wish policy makers and education stakeholders knew or understood about mental health?

JANE | I wish that government ministries and stakeholders in the education sector would acknowledge the fact that students have mental health needs which are often ignored and side-stepped in educational planning.

Even very young students can get depressed, and suffer from diverse mental health problems and disorders. When support is not availed, adverse outcomes are realized. Hence; affordable, accessible, quality, and timely mental health support should be made available at this phase of growth and development.

Teachers who have been tasked with supporting the students with mental health challenges are also in dire need of support too! The teachers working in difficult settings equally face diverse challenges. The healer also needs a healer and therefore a program that would provide teachers with skills to live with their challenges is vital.

KATE | Oh wow, there are so many things I’d like people to know! Here are my top two.

First, everyone can improve their mental health. Far too often, we think of people who have mental illnesses as the only ones who can benefit from mental health interventions, and so we focus on how many people meet the diagnostic criteria for mental illnesses as a proxy for how many people can benefit.

And we make decisions about priorities, programs, and funding based on that. But this is so not true! Mental health exists on a continuum from mental ill-health to thriving, and all of us fall somewhere in between. So that means we could ALL benefit from interventions that improve our mental health!

Second, it doesn’t take as much as you think to improve mental health. We all have this image of people on a therapy couch with a highly trained professional. BUT there are actually simple, evidence-based things that we can all do to improve our mental health and resilience to challenges.

Simple things, like writing a letter of gratitude to a loved one and reading it to them. Or, thinking about three good things at the end of each day and how you contributed to them. Both of those examples are out of Positive Psychology research, but there are lots of others from related fields as well.

These two things are so important for the following reasons:

  1. | It shows everyone can benefit from improved mental health
  2. | It doesn’t have to be complicated or expensive to improve mental health

This means that mental health programs are actually much more needed, and can actually be much more affordable and scalable than many might assume.

GRACY | Most people view and understand mental health entirely from a clinical perspective. If we ask people what they understand by mental health—most will talk about depression and anxiety and other disorders.

I would like for the public and education influencers to understand that mental health is much more than simply the absence of illness. I would like people to look at mental health from a holistic perspective as well.

Kate Sachs Leventhal

With access to mental health services still limited in many LMICs, what’s being done to increase it where it’s needed most?

JANE | The 1994 genocide in Rwanda left a large portion of the population with mental disorders. There was profound Post-Traumatic Stress Disorder | PTSD in addition to other disorders including depression and drug-related diseases.

According to Dr. Yvonne Kayiteshonga, the Mental Health Division Manager of Rwanda Biomedical Center Ministry of Health “After the genocide, the government decided to design a mental health policy in order to address the mental health issues. A mental program was also added which eventually became the Mental Health Division.”

This division ensures accessibility of mental health services, the hiring, and training of human resources, the purchase of drugs, and advocacy about mental health. It has trained communities on how to deal with mental disorders and this has helped in early detection and treatment.

At all levels of the Rwandan health system, mental health care has been integrated. The department works with psychiatrists, psychologists, psychiatric nurses, general medical doctors, and nurses with mental health training, trauma counselors, victim associations, and community health workers.

Through Rwanda Biomedical Centre, the Ministry of Health is committed to implementing high impact interventions for the promotion of mental health awareness, for the management of mental illness, and for the rehabilitation and social reintegration of the mentally ill.

This is all good, however, the strong emphasis on mental health came about because of a terrible event in the country’s history. These kinds of measures can be put in place elsewhere in Africa as well. Rwanda is a strong blueprint for other countries to follow.

KATE | Access to mental health treatment services in lower-middle-income countries | LMICs is definitely increasing right now, but it absolutely is not at a high enough level to meet the needs. Access to preventive and promotive mental health services is lagging even farther behind in LMICs and needs even more attention.

At CorStone, we’re working on a number of initiatives that bring evidence-based, scalable, preventive, and promotive mental health programs directly to vulnerable kids in their schools and communities.

During COVID, it’s also really important to make sure that we are using available technologies to access kids. I think we’re all well aware that many (most) kids in LMICs don’t have access to smartphones or the internet, and neither do many more vulnerable kids in high-income countries.

“Remote” programming right now is frequently synonymous with internet or smartphone-delivered programs; we need to creatively work within the systems that will actually reach kids, like feature phones, radios, TV, and paper workbooks, to provide programs that are more accessible to all kids to improve mental health.

We’re working on a new program right now that leverages these “low-to-mid-tech” options for kids. Stay tuned for more about that as it develops 🙂

GRACY | I do agree that access to mental health services should be increased in LMICs but I think the approach has to change. I believe the first step is advocacy around mental health—bringing in more emphasis on the wellbeing and strengths perspective.

Second, is integrating psychosocial support within other health services such as family planning; child health, etc. I think this would make huge strides in overall accessibility. Finally, making people aware of when they need specialized services is needed.

What makes you hopeful right now about the future of mental health education and access?

JANE | The potential for scale and success of the YF program makes me very hopeful and excited about the work we are doing! I remain hopeful that proactive strategies and programs to support/promote adolescents’ mental health will be put in place. I am hopeful that life-skills training, guidance, and counseling programs will be hastened to support Rwandese adolescent’s wellbeing.

If Youth First Rwanda program could be scaled up to all the schools in Rwanda, the program could provide widely-available training and manuals and further equip the guidance counselors and teachers with skills needed to support and promote adolescent’s mental health. So the benefits of this program will continue to be felt by students and teachers even long after we have phased out our direct support.

KATE | Kids! I know it’s cliche, but it’s true. My own kids, the kids we serve, the kids we have served and will serve.

There is so much that all of these kids can accomplish and will accomplish as they grow and tackle the absolutely insane challenges of the world they have been given. Instead of feeling like they are destined for failure given this terrible hand they’ve been dealt, I’m so hopeful.

I watch kids all over the world every day tackling and making positive changes for themselves and their communities, in ways that I never thought possible. I’m mostly just watching in wonder, but also doing what I can in the background, hoping that I can support at least some kids to find their own strengths and come up with creative solutions to challenges.

GRACY | For many years, mental health was given the absolute least amount of attention within health services. However, in recent times (and particularly as a result of the onslaught of COVID-19) the importance of mental health has gained considerably more attention.

Also, the need for building resilience as a subset of mental health seems to have become an area of prime focus and this too makes me hopeful.

Gracy Andrew

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