title: The "treatment gap" in global mental health reconsidered: sociotherapy for collective trauma in Rwanda.
abstract: 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.
authors.affiliation: Center for Mental Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; stefanjansen@khi.ac.rw.
authors.forename: Stefan
authors.initials: S
authors.lastname: Jansen
authors.affiliation: Mental Health and Well-being, The University of Glasgow, Glasgow, UK.
authors.forename: Ross
authors.initials: R
authors.lastname: White
authors.affiliation: No affiliation.
authors.forename: Jemma
authors.initials: J
authors.lastname: Hogwood
authors.affiliation: Community Based Sociotherapy Program, Kigali, Rwanda.
authors.forename: Angela
authors.initials: A
authors.lastname: Jansen
authors.affiliation: Center for Mental Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Darius
authors.initials: D
authors.lastname: Gishoma
authors.affiliation: Center for Mental Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Donatilla
authors.initials: D
authors.lastname: Mukamana
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.|Amsterdam School for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Annemiek
authors.initials: A
authors.lastname: Richters
keywords: Collective violence; Rwanda; community; global mental health; sociotherapy; trauma; treatment gap