The “treatment gap” in global mental health reconsidered: sociotherapy for collective trauma in Rwanda
Open accessAbstract
BACKGROUND: 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. OBJECTIVE: 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. CONCLUSIONS: 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.
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Intergenerational legacies of genocide are a risk factor for the internalization of feelings of divisionism.
“Additionally, it was indicated that intergenerational legacies of genocide are a risk factor for the internalization of feelings of genesis of divisionism (sectarianism and ethnic division) that are vague and sweeping, and have been used to silence legitimate dissent.”
From Contribution of community-based sociotherapy interventions for the psychological well-being of Rwandan youths born to genocide perpetrators and survivors: analysis of the stories telling of a sociotherapy approach (2020) · cites this paper as [39]
The section “Sociotherapy in Rwanda: fostering communities as a resource to promote well-being” (page unavailable) describes the genocide’s continuing effects on social ties and tensions between ethnic groups. It does not say that intergenerational legacies cause people to internalize divisionism, or discuss the use of divisionism to silence dissent. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAlternatives to psychocentric mental health interventions exist, which centre users' priorities and social realities.
“As emerging studies show, alternatives to psychocentric mental health interventions do exist, which centre users' priorities and social realities (Haushofer et al. 2021;Jansen et al. 2015).”
From Throwing therapy at the problem mental health and humanitarian intervention in Palabek refugee settlement, northern Uganda (2023) · cites this paper as Jansen et al. 2015
Sociotherapy is an interventional approach found to contribute to the social cohesion of individuals from the same neighborhood or group.
“Sociotherapy is an interventional approach that has been found to contribute to the social cohesion of individuals from the same neighborhood or group [39].”
The genocide and its aftermath created genocide ideology among the second generation.
“The genocide and its aftermath created the genocide ideology among the second generation and this has been resolved though diverse efforts of the government, national and international contributors with the goal to bring the unity, reconciliation, nationalism, patriotism, dignity, and rehumanisation [33, 39, 40].”
From Contribution of community-based sociotherapy interventions for the psychological well-being of Rwandan youths born to genocide perpetrators and survivors: analysis of the stories telling of a sociotherapy approach (2020) · cites this paper as [39]
The section “Sociotherapy in Rwanda: fostering communities as a resource to promote well-being” describes the genocide’s lasting damage to trust and social ties, but does not discuss genocide ideology among the second generation. Searches for that phrase and for second-generation inheritance of ideology found no passage addressing the claim. (LLM, conf=0.74)
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- Authors
- Jansen, S., White, R., Hogwood, J., Jansen, A., Gishoma, D., Mukamana, D., & Richters, A.
- Affiliations
- University of Rwanda (RW)
- University of Glasgow (GB)
- No affiliation
- Community Based Sociotherapy Program, Kigali, Rwanda
- Leiden University Medical Center (NL)
- Corresponding author
- Jansen, Stefan
- Venue
- European Journal of Psychotraumatology
- Publisher
- Informa UK Limited
- Published
- 2015-11-19
- Volume
- 6
- Issue
- 1
- Pages
- 28706-28706
- ISSN
- 2000-8066 (ISSN-L)
- PMC
- PMC4654767
- OpenAlex
- W2177055367
- Cited by
- 84
- References
- 47
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 6 · 2023: 21 · 2022: 10 · 2021: 8 · 2020: 9 · 2019: 7 · 2018: 4 · 2017: 5 · 2015: 1
- FWCI
- 5.47
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Journal of Psychotraumatology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- UvA-DARE (University of Amsterdam) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Figshare (cc-by)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- treatment gap, global mental health, sociotherapy, collective trauma, Rwanda, medicalization of social problems, community mental health, social isolation, collective violence, social distress, psychosocial well-being, mental health service capacity
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