These illnesses have been treated for decades at Ndera Neuropsychiatric Hospital, which has been providing mental health services in Rwanda for nearly 57 years. However, the facility is currently operating at 116% of capacity, as the number of patients continues to exceed its capacity.
Data indicates that in 2024/2025, the hospital received 119,859 patients, a 17.7% increase from the previous year.
In an interview with IGIHE, Dr. Arthur Rukundo, who has worked at CARAES Ndera Hospital for 20 years, discussed the factors driving this trend, the most affected groups, and what can be done to reduce the growing burden.
He explained that the hospital treats both neurological disorders and mental illnesses, and clarified that not everyone who goes to Ndera is mentally ill in the way many people assume.
'Someone might come to Ndera because they've suffered paralysis in an arm. But when people hear someone has gone to Ndera, they automatically think it's a psychiatric case. Not everyone who seeks care at Ndera has a mental disorder,' he said.
In 2024/2025, Ndera received 66,335 psychiatric cases and 53,524 neurological cases.
Most common mental disorders
The most common condition treated was epilepsy, which accounted for 36,097 patients (29.08%) of all admissions. The second most prevalent was schizophrenia, a severe mental disorder often associated with psychosis. The hospital treated 24,991 schizophrenia patients, making up 20.14% of all cases.
Another frequent condition is Acute and Transient Psychotic Disorder (ATPD), a short-term psychotic episode that can be triggered by stress, trauma, or drug use. It usually resolves faster than other psychiatric illnesses and is sometimes locally described as 'nervous breakdown' or 'overstress.'
Ndera Hospital operates through several branches across the country. Its main facility, CARAES Ndera, located in Gasabo District, serves as the primary treatment centre and receives the largest number of patients, about 67%, equivalent to more than 68,000 people in the 2023/2024 fiscal year.
The CARAES Butare branch in the Southern Province accommodates around 21% of patients, while the Icyizere Psychotherapeutic Centre in Kicukiro District accounts for the remaining 12%.
Men are more affected
Dr. Rukundo noted that men make up the majority of patients, accounting for 54%, while women represent 46%. Young people are the most affected demographic overall.
'Young men represent the largest group of patients we treat. Most of them come due to severe depression often triggered by drug abuse,' he said.
He explained that while sadness is a normal emotion, prolonged depression caused by factors such as grief or loss requires medical intervention.
'When sadness persists and begins to affect one's ability to work or function, that person needs to see a doctor. Many of those cases are treated in our psychiatry department,' he added.
Acute psychosis on the rise
Acute psychosis is also among the leading conditions treated at Ndera. It often affects individuals who have gone through extreme stress or trauma, leading to abnormal brain function.
The condition manifests through symptoms such as talking to oneself, seeing or hearing things that others cannot, or acting out of fear and confusion.
'You'll find someone running away from things they believe they see. They can't stay still; some lock themselves in their houses or say they've been hearing threatening voices for weeks. They often stop taking care of themselves,' Dr. Rukundo said.
He added that cannabis use is another common cause of psychotic episodes.
'When someone smokes marijuana, the active chemical interacts with brain hormones, especially dopamine, causing overstimulation. This can make the person hear voices or see things that don't exist, and their behaviour becomes erratic,' he explained.
Some Patients have stayed at the hospital for over 30 years
At Ndera Hospital, 36 patients remain with no families to return to. Among them is one man who has lived at the facility for more than three decades, having originally come from Burundi. Over the years, all attempts to trace his relatives have failed, and he has grown old within the hospital's care.
The hospital provides both outpatient and inpatient services. For patients with severe mental health conditions, treatment may last from a month to nearly two months. However, during that time, some families abandon their relatives, leaving them permanently under the hospital's responsibility.
According to Dr. Rukundo, most patients arrive at Ndera either through referrals by security agencies or are brought in by their families. Yet, he notes that stigma and denial surrounding mental illness remain deeply entrenched in society.
'Even today, many people have not yet accepted what it means to have a loved one with a mental illness,' he said. 'Some bring a patient here and then disappear, never returning to check on them. There is still stigma, both toward the patients and their families. That's why many of the people you see here have been here for years. Some were already here when I first arrived.'
Because of its long-standing reputation as a national referral and teaching hospital, Ndera also receives patients from neighbouring countries, including the Democratic Republic of Congo, Burundi, and Nigeria, among others.
Mental health care starts before birth
Dr. Rukundo emphasised that mental health prevention must begin as early as pregnancy. He explained that one of the main drivers behind the rising number of mental health disorders is poor parenting, as many parents spend long hours working and have limited time to nurture emotional connections with their children. The rapid growth of technology, particularly unregulated exposure to social media, has further compounded the problem.
According to World Health Organisation (WHO) data, one in every twenty children aged 10 to 19 exhibits signs of mental health problems linked to excessive or inappropriate social media use.
'When a 12-year-old watches movies intended for adults, it harms rather than builds their mental development,' Dr. Rukundo said. 'We are seeing more children struggling emotionally because they are exposed to content that is not appropriate for their age.'
He explained that a child's emotional and mental well-being begins developing in the womb.
'A child starts to experience emotions and movement before birth. Their mental health is influenced by the bond they share with their mother during pregnancy. That's why sometimes a baby may be born appearing emotionally unresponsive,' he said.
Such early developmental challenges can manifest as autism or Attention Deficit Hyperactivity Disorder (ADHD), often seen in children who avoid eye contact or have difficulty forming emotional connections.
Dr. Rukundo also raised concerns about parents who delegate childcare to domestic workers without understanding their background or emotional well-being.
'Sometimes, when a child cries, the caregiver just gives them a phone to quiet them. We've had cases of children as young as three or five being abused by caregivers. When you leave your child with someone, do you know their upbringing or emotional stability? How would they react if the child angers them? We must also care about the mental state of those who look after our children,' he cautioned.
One in five Rwandans has experienced a mental health problem
National statistics released in August 2025 show that one in five Rwandans has experienced a mental health problem at some point in their life. The most common conditions include depression, anxiety, post-traumatic stress disorder (PTSD), and substance use disorders.
Depression affects 11.9% of the population, anxiety disorders 8.1%, and PTSD 3.6%. Severe mental illnesses such as psychosis are found in 1.3%, while antisocial behaviour disorders affect 0.8%, and suicidal tendencies are reported among 0.5% of Rwandans.
'War is one of the biggest contributors to depression,' Dr. Rukundo noted. 'We went through the 1994 Genocide against the Tutsi, and global crises, conflict, and the fast pace of life continue to fuel these numbers. The rates here are above 10%, and we must address this through prevention because most of these illnesses can be avoided.'
He added that personality disorders are also becoming more prevalent, often linked to poor emotional upbringing and weak moral foundations during childhood.
'When that foundation is missing, people grow up without emotional resilience. They struggle to handle life's challenges and easily fall into depression. Sometimes a breakup or emotional loss leads someone into despair, even suicide, which is often misjudged as weakness,' he said.
'When a young man loses a relationship and takes his own life, it's not because he's a coward. It's because he invested all his emotional energy in that one person. When they're gone, he feels life has lost meaning.'
Too few specialists
Despite the growing demand for mental health care, Rwanda continues to face a severe shortage of specialists. Currently, there are only 15 psychiatrists serving a population of 15 million.
This shortfall means that many patients do not receive the attention they need. Ideally, a psychiatrist should spend 50 minutes to one hour per patient, handling about nine patients per day or roughly 30 per week. However, at Ndera, the caseload per doctor is far higher, placing heavy strain on both the health system and its professionals.
IGIHE
