Mental health, a key aspect of human well-being, influences thoughts, emotions, and the ability to deal with life’s challenges. Globally, 1 in 8 people is affected by mental illnesses, with depression and anxiety disorders being the most common [1]. Factors such as poverty, conflict, economic insecurity, political wars, urbanization, and climate change contribute to both physical and mental ill-health [2]. Between 2000 and 2015, Africa observed a 52% increase in years lost to disability due to mental and substance use disorders [3]. Tragically, mental healthcare services delivery and utilization are scarce across the African continent. The region has approximately 99% fewer mental health consultations and 85% fewer mental healthcare workers than the global average [3]. In Africa, mental health care is hindered by a lack of government funding, a scarcity of professionally trained providers, and stigmatization linked to traditional beliefs.

Thirty years have passed since Rwanda endured the atrocities of the 1994 Genocide against the Tutsis, which have damaged the social structure leaving behind psychosocial problems such as chronic fear and mistrust, social isolation and discrimination, guilt, collective angst, victimhood, and shame [4]. Genocide survivors experience more than double the rates of mental health disorders compared to the general population, with significantly higher prevalence rates of depressive disorders (35% vs 12%) and posttraumatic stress disorder (PTSD) (27.9% vs 3.6%) [5]. Additionally, ex-prisoner genocide perpetrators face social and family rejection, loss of social and professional identity due to long periods of incarceration, emotional suppression, and feelings of hopelessness [4]. Although 62% of the population are aware of available mental healthcare services, only 5.3% utilize them [5]. This low level of mental healthcare-seeking behavior results from numerous barriers including lack of awareness, financial constraints, geographic inaccessibility, and cultural stigma [6].

Western paradigms of mental health treatment focus primarily on the individual’s traumas, often overlooking communal, socio-cultural, and historical factors [7, 8]. In contrast, the socio-ecological model of mental health addresses six levels of influence on human behavior: individual, relationships, organizations, communities, policy, and society [9]. This model aligns with the World Health Organization’s definition of mental health, which emphasizes not only the absence of mental illness but also the person’s capacity to manage stress, reach their full potential, and maintain emotional and social well-being, resilience, and the ability to work effectively, thereby contributing to their community [10]. The socio-ecologic model is consistent with the Pan-African philosophy of Ubuntu, which underscores the authenticity of an individual as inherently connected to a larger relational, communal, societal, environmental, and spiritual network [11].

Ubuntu is a fundamental moral and relational ethic in African culture that promotes right actions, values fellowship, reconciliation, friendliness, harmony, reciprocity, mutual caring, and dignity, all in service of communality and justice [12]. The Ubuntu way of living improves mental health by fostering social support, nurturing environments, and peaceful coexistence [13]. The quality of social relationships and support, which increases resilience to stress, has been shown to significantly reduce symptoms of depression and decrease the likelihood of developing PTSD [14, 15]. Additional factors contributing to mental healing within social cooperation include empathy, emotional contagion, emotion regulation, compassion, and consoling behavior [16,17,18]. The African philosophy of Ubuntu, a culturally sensitive approach to the emotional and relational dimensions of healing, could help bridge the mental healthcare gap in Rwanda and Africa, where current systems are often limited to Western approaches.

Community-based social healing (CBSH) model is a holistic intervention developed by the Ubuntu Centre for Peace to promote psychosocial healing and support individuals experiencing mental health conditions resulting from traumatic events including genocide, mass killings, sexual abuse, domestic abuse, and other forms of violence. The CBSH combines Breath-Body-Mind practices with collective narrative and rituals, facilitated by Community Healing Assistants within therapeutic groups. A pre and post-evaluation of the CBSH pilot project, conducted from July 1, 2020, to June 30, 2021, for 1889 participants, revealed significant reductions in rates of depression, anxiety, and PTSD. The intervention also led to improvements in work productivity and reductions in intimate partner violence [19]. CBSH addresses trauma, mental health conditions, and relationships within families and communities [19].

Breath-body-mind (BBM) practices help restore autonomic balance, improve emotion regulation, and alleviate trauma-related symptoms through various mechanisms, as described by Drs. Gerbarg and Brown [16, 17, 20, 21]. These mechanisms likely include the use of voluntary, regulated breathing techniques that activate parasympathetic pathways, decrease the sympathetic nervous system overactivity, promote the release of inhibitory neurotransmitter gamma-aminobutyric acid (GABA), inhibit excessive activity in the amygdala (responsible for emotion processing), and enhance activity in the brain’s higher centers, which mediate safety assessment, executive functions, decision-making, and interoceptions (perceptions of internal bodily states) [16]. Evidence suggests that BBM practices increase awareness of feelings, emotions, and thoughts by focusing attention and stimulating the brain’s interoceptive pathways [20]. Additionally, they may stimulate pro-social neurophysiological processes, increasing empathy, love, and social engagement. The overall effect is a positive shift in the psycho-neurophysiological state from one of defensive fear, anger, isolation, and mistrust to a state characterized by feelings of safety, calmness, connectedness, flexibility, cooperation, and compassion [16, 17, 21].

Breath-Body-Mind was selected for the CBSH model due to its demonstrated benefits for anxiety, depression, and PTSD in previous studies and fieldwork, including in South Sudan, Uganda, and Rwanda [22, 23]. It has shown positive effects even among individuals with extreme trauma [22, 23].

The CBSH model also incorporates local rituals, such as singing, dancing, and drumming, to create a safe space for authentic storytelling and attentive listening [24]. Sharing personal narratives in a secure group setting allows participants to reinterpret their life stories, restoring their sense of belonging, self-worth, purpose, and hope [25]. The stories shared by therapeutic group members influence and inspire one another, challenging unhealthy perspectives and perceptions, and facilitating transformation into healthier ones.

The CBSH model aligns with Ubuntu African philosophy, which fosters individual wellbeing within a collective environment, supportive relationships, personal and societal healing, and economic growth. Nevertheless, the relationship between the improvements in Ubuntu and mental health, along with other positive outcomes associated with the CBSH model have not yet been evaluated. Additionally, there is currently no validated and reliable Ubuntu measurement tool that reflects the nuances of Rwandan culture and language. Consequently, this study aims to culturally adapt and validate a psychometrically validated and reliable scale for measuring Ubuntu. This study investigates the effects of CBHS on Ubuntu, mental health (depression, anxiety, PTSD, mental wellbeing, resilience, and psychosomatic symptoms), and psychosocial outcomes (intimate partner violence and social capital) in post-genocide Rwanda.

Study objectives 1.

To culturally adapt, translate, and rigorously test the reliability and validity of an existing Ubuntu scale in the Rwandan context.

2.

To assess the impact of the community-based social healing (CBSH) model on Ubuntu in Rwandan participants.

3.

To evaluate the effects of the CBSH model on mental health outcomes, including depression, anxiety, post-traumatic stress, mental well-being, resilience, and psychosomatic symptoms among Rwandan participants.

4.

To investigate the CBSH model’s impact on psychosocial functioning, focusing on outcomes such as intimate partner violence and social capital within the Rwandan community context.

5.

To explore the extent to which Ubuntu mediates the effects of the CBSH on mental health and psychosocial functioning, determining how changes in Ubuntu influence improvements in these areas for Rwandan participants.

Study hypotheses 1.

Participation in the CBSH model will be associated with significant improvements in Ubuntu compared to a control group receiving no intervention.

2.

CBSH participation will be associated with significant improvements in mental health, demonstrated by reductions in depression, anxiety, post-traumatic stress, and psychosomatic symptoms, along with improvements in mental wellbeing and resilience, compared to a control group receiving no intervention.

3.

CBSH participation will be associated with significant improvements in psychosocial functioning, characterized by reduced intimate partner violence and increased social capital, compared to a control group receiving no intervention.

4.

Improvements in Ubuntu will correlate positively with improvements in mental health and psychosocial functioning.