• Around 800,000 people were killed in Rwanda and the brutality left mental scars.
  • Grace Gatera was diagnosed with PTSD as a young child.
  • She now campaigns to improve access to mental heath services.

Grace Gatera is humble, self-effacing, and quietly spoken. That you can hear her at all is almost something of a miracle.

Born in Burundi on 7 April 1993, she and her family crossed into Rwanda to stay with relatives when she was a baby. They were still there a year later when, on Grace’s first birthday, the country erupted into violence.

Grace and her mother fled to Uganda, escaping a fate that befell hundreds of thousands of Rwandans. In 100 days of slaughter, about 800,000 people were beaten, burned, and hacked to death. Predominantly but not exclusively from the minority Tutsi community, roughly one-tenth of the country’s population perished.

Millions more ran for their lives, carrying with them horrific stories of friends and neighbours turning on one another, of children being targeted by gangs armed with clubs and machetes, and of people being rounded up and locked inside houses that were doused with petrol and set alight.

Grace Gratera mental health campaigner
Grace Gatera pictured at UNICEF Leading Minds 2019.
Image: Mario Llorca

The aftermath of trauma

Their flight created an enormous refugee burden for nearby nations such as the Democratic Republic of the Congo (then known as Zaire), Burundi, Tanzania, and Uganda. But escaping to the safety of a neighbouring country did not mark the end of Grace’s difficulties.

Instead, what followed was years spent living under the shadow of mental illness. For, like many others who had survived the events of 1994, Grace and her mother faced a daily battle with post-traumatic stress disorder (PTSD), anxiety, and depression.

“I was diagnosed with PTSD when I was very young,” she explains. “I think I was four when I realized that I wasn't, you know, what you’d call normal. But I'm pretty sure it was there even earlier than that. My parents tell me that every time I heard the sound of a tree being cut or even someone using a lawnmower, the noise would make me panic.”

But Grace felt her depression wasn't taken seriously in the years that followed. “I remember feeling ignored or punished – it was either one or the other. And it made me very sad,” she says.

“I thought, ‘if I'm pretending to be sick why does it hurt? Is it meant to be painful when you pretend?’ And that's basically how I grew up.”

Facing up to stigma

At university, Grace was the victim of a sexual assault, which triggered another period of depression and once again left her feeling there was nowhere to turn to for help and support. “There is a terrible stigma around mental illness, and you don't want to be a part of it. Plus, treatment in Uganda at that time was limited. The options were that you could either go to the asylum or pretend you're OK.”

Masking her feelings only compounded Grace’s struggles. “I was deteriorating fast and I didn't have any access to care,” she says.

But this period in her life was also a turning point. Grace decided to return home to Rwanda, which had by that time made great progress rebuilding itself – its infrastructure, its identity, and its sense of unity.

The country prioritized mental health support services under an initiative to bring its people back together and heal the psychological scars left by the events of 1994. Rather than being centralized in major towns and cities, these services were made easy to access at community health clinics.

Graphics for the Mental Health Innovation Network
Some key learning's from the Mental Health Innovation Network
Image: Mental Health Innovation Network

Finding a voice

After so many occasions feeling ignored, Grace Gatera says she will no longer stay quiet.

She is now a youth leader, working with My Mind Our Humanity, a campaign for the Lancet Commission on Global Mental Health and Sustainable Development. She also works with NCD Child and the Mental Health Innovation Network: she is a passionate advocate of listening to the voices of the young.

Although some countries, like Japan, are struggling with the problem of an ageing population, for the most part, we live in a world dominated by young people. The global median age is 30, and a quarter of all people alive today are younger than 14. And young people are just as likely to struggle with their mental health as those from any other age group.

Figures surrounding mental health in young people
Recommendations by the Mental Health Innovation Network to prioritise global action on mental health for young people
Image: Mental Health Innovation Network

But the young aren’t routinely included in policy-making, Grace says, even in areas that affect them directly.

“Young people are largely ignored when decisions affecting them are being made,” she says. “But ignoring them is a tragedy. It’s time to pass the mic.”

And it’s not just the young that can be excluded and overlooked, Grace points out. After the 1994 genocide, the women of Rwanda “carried the country on their backs” she says. They rebuilt communities. They acted as caregivers and wage-earners. But, she says, “perhaps they were so busy caring for others that no one stopped to offer them the same kind of support they constantly gave out.''

Starting with a group of just 25 women and girls, the organization Grace works with began offering retreats aimed at helping the survivors of gender-based violence or those who were affected by the genocide. For many, it was the first time they had felt able to talk about their experiences. There are now 125 women and girls receiving help and support.

Making a difference

Spreading the word and encouraging more people to come forward and share their mental health stories is a major focus for My Mind Our Humanity. To get its message out to more young people, the organization is increasingly turning to digital and social platforms. But attendance at high-profile events is also an important strategy.

On Wednesday 22 January, Grace will be speaking at the World Economic Forum’s Annual Meeting in Davos on the topic of protecting mental health in youth. It will be an opportunity for her message to reach world leaders, policy-makers, and the global public. Ask her what she hopes to achieve, and her response is clear – to make a tangible difference.

What is the World Economic Forum doing about mental health?

One in four people will experience mental illness in their lives, costing the global economy an estimated $6 trillion by 2030.

Mental ill-health is the leading cause of disability and poor life outcomes in young people aged 10–24 years, contributing up to 45% of the overall burden of disease in this age-group. Yet globally, young people have the worst access to youth mental health care within the lifespan and across all the stages of illness (particularly during the early stages).

In response, the Forum has launched a global dialogue series to discuss the ideas, tools and architecture in which public and private stakeholders can build an ecosystem for health promotion and disease management on mental health.

One of the current key priorities is to support global efforts toward mental health outcomes - promoting key recommendations toward achieving the global targets on mental health, such as the WHO Knowledge-Action-Portal and the Countdown Global Mental Health

Read more about the work of our Platform for Shaping the Future of Health and Healthcare, and contact us to get involved.

“If just one person hears me and then, as a result, takes the time to actively support and listen to someone – maybe a loved one – who is struggling with their mental health, I will have succeeded.

“But I have higher-level goals, too. I want decision-makers, governments, and politicians to really hear what we are saying. Listen to young people, involve them in your policies and strategies. Commit to finding the resources and the money to make life-changing mental health initiatives a reality.”