RESEARCH PROPOSAL

THE PREVALENCE OF MENTAL DISORDERS AMONG PRISONERS AT BUTARE

PRISON

By

HABYARIMANA Charles and KANGABE Valentine

Submitted in partial fulfillment of requirement for Advanced

Diploma in

MENTAL HEALTH NURSING

In the

Department of Mental Health

FACULTY OF NURSING SCIENCES

KIGALI HEATH INSTITUTE

i

Supervisor: PROF SIMBA KANANGA

Co-supervisor: Mr. GASOVYA Augustin

Kigali December 2010

ii

DECLARATION

We do hereby declare that this project submitted in partial

fulfillment of the requirement for the Advanced Diploma in

Mental Health, at Kigali Health Institute, is our original

work and has not previously been submitted elsewhere. Also, we

do declare that a complete list of references is provided

indicating all the sources of information quoted or cited.

 

HABYALIMANA Charles

And

KANGABE Valentine

iii

DEDICATION

We dedicate this research proposal to:

Our Parents,

All our siblings, and

Our best friends.

iv

ACKNOWLEDGEMENT

We deeply thank the Government of RWANDA for the scholarship

provided to help us achieve this level of education.

We highly appreciate the administration of KIH especially the

staff of Mental Health Department, and all lecturers who

provided us with excellent nursing skills.

We would like to thank also the clinical supervisors who

supported us during our practice in different hospitals.

We indeed thank PROF SIMBA KANANGA and Mr. GASOVYA Augustin,

our research project supervisors, for their professional

thoughtfulness and the contribution provided during the

preparation of this research proposal.

v

SUMMARY OF THE STUDY

The purpose of this research project is to evaluate the

Prevalence of Mental Disorders among prisoners population of

Butare Prison. Background: Prisoners are particularly

vulnerable to developing mental health problems. Findings from

recent studies indicate that the prevalence of mental illness

is higher in prisons than in the community, and co-morbidity

is common.

vi

Problem statement: Even though prison population is at high

risk to develop mental disorders, prevalence of mental

disorders in Butare prison is not known. Significance of the

study: The study will help health care givers to promote the

mental health of prisoners, as well as moral and mental health

of prison staff and should therefore be one of the central

objectives of good prison management.

Methodology: This cross sectional study will be carried out at

Butare prison, and selected participants will be observed and

interviewed by researchers. A sample of this study will be

selected by systematic random sampling. The prevalence of

mental disorders among prison population of Butare prison will

be presented according to the categories of mental disorders,

age group and sex of prisoners. The research will take three

months and the total budget will be 3481800 rwfs for period of

four months .

 

vii

TABLE OF COTANTS

DECLARATION.................................................ii

DEDICATION.................................................iii

ACKNOWLEDGEMENT.............................................iv

SUMMARY OF THE STUDY.........................................v

TABLE OF COTANTS............................................vi

LIST OF SYMBOLE AND ABREVIATIONS/ ACRONYMS..................ix

LIST OF TABLES...............................................x

CHAPITER 1.INTRODUCTION......................................1

1.1DEFINITION OF KEY TERMS PERTINENT TO THE STUDY..........1

1.2 BACKGROUND OF THE STUDY................................1

1.3PROBLEM STATEMENT.......................................3

1.4 OBJECTIVES.............................................4

1.4.1 Main objective......................................4

1.4.2 Specific objective............................4

1.5 RESEARCH QUESTIONS.....................................4

1.7 SIGNIFICANCE OF THE STUDY..............................4

1.8 SUBDIVISION OF THE STUDY...............................5

CHAPITER2. LITERATURE LIVIEW.................................6viii

2.1. THEORY ABOUT MENTAL DISORDERS.........................6

2.2. ETIOLOGY OF MENTAL DISORDERS..........................7

2.3. MENTAL HEALTH OF PRISONERS............................8

2.4. FACTORS CONTRIBUTING TO MENTAL DISORDERS AMONG

PRISONERS..................................................8

2.4.1 The inmates’ social world...........................9

2.4.2 Prison violence.....................................9

2.4.3 Isolation...........................................9

2.4.4 Prison victimization...............................10

2.5 THE LINKAGE BETWEEN MENTAL DISORDERS AND CRIME........11

2.6 FREQUENCY OF MENTAL DISORDES AMONG PRISONERS POPULATION

..........................................................13

CHAPTER 3. RESEARCH METHODOLOGY.............................14

3.1. STUDY AREA...........................................14

3.2 STUDY DESIGN..........................................14

3.3 STUDY POPULATION......................................14

3.5. SAMPLING METHODS.....................................15

3.6. DATA COLLECTION METHODS AND PROCEDURES...............15

3.7 .DATA ANALYSIS........................................16

3.8 PROBLEMS AND LIMITATIONS OF THE STUDY.................16

3.9 ETHICAL CONSIDERATION.................................17

CHAPITER 4.PRESENTATION OF THE RESULTS......................18

4.1. THE PROPORTION OF MENTAL DISORDERS AMONG PRISON

POPULATION OF BUTARE PRISON BY AGE GROUP..................18

ix

LIST OF REFFERENCIES........................................23

WORK PLAN...................................................25

THE GANT CHART..............................................26

BUDGET......................................................27

I. PREPARATION..............................................27

II.THE SURVEY...............................................28

III .THE STUDY SUPPLIES.....................................28

IV.THE PRODUCTION OF THE RAPPORT............................29

V. THE WORKSHOP FOR REPORT VALIDATION......................29

VI. THE BUDGET SUMMARY......................................30

BUDGET JUSTIFICATION........................................30

PROFILE OF APPLICANT AND INSTITUTION........................31

C.PROFILE OF INSTITUTION....................................33

APPENDIX....................................................34

x

xi

LIST OF SYMBOLE AND ABREVIATIONS/ ACRONYMS

%: Percentage

&: And

APA: American Psychiatric association.

BMJ: British medical journal.

DPD: dissocial personality disorder

DSM-IV: Diagnostical and Statistical Manual for mental

disorders Fourth Edition.

e.g: Example

Et al: Et alii or at aliae (and others)

KHI: Kigali Health Institute

Mr.: Mister

Prof: Professor

PTSD: Post traumatic stress disorders.

SHU: Special Housing Unity.

xii

LIST OF TABLES

Table 4.1.a the proportion of mental disorders among prisoners

population aged between 18-24...............................18

Table 4.1.bThe proportion of mental disorder among prison

population aged between 25-31...............................18

Table 4.1.c the proportion of mental disorder among prison

population aged between 32-38...............................19

Table 4.1 d. The proportion of mental disorder among prison

population aged between 39-45...............................19

Table4.1.e The proportion of mental disorder among prison

population aged between 46-52...............................20

Table4.1.f The proportion of mental disorder among prison

population aged between53-59................................20

Table4.1.g The proportion of mental disorder among prison

population aged between 60-66...............................20

Table4.1.h The proportion of mental disorder among prison

population aged between 66-73...............................21

Table 4.2 the proportion of mental disorders among prisoners

population of Butare prison by sex..........................21

Table 4.3 Proportion of prisoner population of Butare prison

without mental disorders by sex.............................22

Table4.4 Prevalence of mental disorders among prisoners

population of Butare Prison according to their categories.. .22

xiii

CHAPITER 1.INTRODUCTION

1.1DEFINITION OF KEY TERMS PERTINENT TO THE STUDY

Prevalence: In an epidemiologic study the prevalence is the

proportion of individuals in a population having disease.

Prevalence is a statistical concept referring to the number of

case of disease that are present in a particular population at

a given time (Medterms, 2010)

Mental disorders: In DSM-IV, each of the mental disorders is

conceptualized as clinical significant behavior or

psychological syndrome or pattern that occurs in an individual

and that associated with present distress (e.g. a painful

symptom) or disability (e.g. impairment in one or more

important areas of functioning) or with significantly

increased risk of suffering death, pain, disability (DSMIV-

2000).

Prison: a correctional institution where persons are confined

while on trial or for punishment. A prison is a place in which

people are confined and deprived of a range of liberties.

Prison is a place in which people are physically confined and,

usually, deprived of a range of personal freedoms (James B, 2004).

Prisoner: One who has been committed to a prison, jail or

penal institution for the purpose of detention until he or she

may be tried for a crime of which he or she is accused, or for

xiv

the purpose of punishment after conviction of such crime. He

is one deprived of freedom of expression or action or one

held in custody, captivity, or a condition of forcible

restraint, especially while on trial or serving a prison

sentence (William H, 2000).

1.2 BACKGROUND OF THE STUDY

Prisoners are particularly vulnerable to developing mental

health problems. Findings from recent studies indicate that

the prevalence of mental illness is higher in prisons than in

the community, and co-morbidity is common. The prison

environment and the rules and regimes governing daily life

inside prison can be seriously detrimental to mental health.

Histories of abuse, deprivation, homelessness, and

unemployment and substance misuse are common. Many prisoners

have numeracy and literacy problems and most prisoners have a

lower than average of intelligent quotient (Singleton et

al ,1998 ).

It is also important to bear in mind that people with mental

disorders are particularly vulnerable to imprisonment, and

initiatives aimed at diverting them from detention are not

always effective (Birmingham, 2001). Women prisoners reported

that imprisonment impacted negatively up on their health. The

initial shock of imprisonment, separation from families and

enforced living with other women suffering drug withdrawal and

xv

serious mental health problems affected their own mental

health (Douglas et al., 2000).

The U.S. prison population, at least as measured by looking at

its largest component, the state prison population,

experiences a prevalence of mental illness very much in line

with that of the general population. Beck and Maruschak in

Mental Health Treatment in State Prisons reported that the

prevalence of mental illness, broadly defined, was between 22%

and 24% in the prison population( Beck &Maruschak, 2000)

The prevalence of psychiatric morbidity among prisoners in

England and Wales were provided by two large-scale point-

prevalence studies carried out in the late 1980s and early

1990s by the Institute of Psychiatry, London (Gunn et al,

1991). Mental disorder (including substance misuse diagnoses)

was found in 37% of sentenced male prisoners, 63% of men on

remand, 57% of sentenced women prisoners and 76% of women

remand prisoners.

In Africa, with reference to Nigeria, Mental health problems

have been observed to be higher among incarcerated inmates

compared to the general population. Common mental health

problems amongst them include substance misuse, personality

disorders and minor (neurotic) symptoms. With these disorders

estimated to be present in 25 to 75% of prisoners, they are

more common than the psychotic disorders, which have been

estimated to account for 2 to 10% of psychiatric morbidityxvi

among them. However, the psychotic disorders have also been

observed to be more common among inmates compared to the

general population. In addition, the frequency of psychosis

tends to be higher in hospital-based studies and the prison

condition has been identified as a potential source of rapid

deterioration in those with preexisting psychosis and

decompensation in vulnerable inmates (Fatoye et al, 2006).

In eastern African with reference to Kenya-Uganda –Tanzania,

95% of criminals in prison were seriously mentally ill. There

was not a single case of psychopathic personality disorder

although this is the one psychiatric disorder that is most

commonly associated with criminal behaviors (Frank, 2002).

Mental health of Rwandan prison population is quit alike of

other prisoners all over the world. The cases of mentally ill

patient received at Neuro-psychiatric Hospitals from different

Central Prisons and some cases of mentally ill prisoners

reported by Prison health services make certain that there are

mental disorders among Rwandan Prison population. Butare

Prison dispensary has reported thirty-two cases of mental ill

prisoners, who were under antipsychotic treatment in March

2010 (Butare prison monthly report, 2010).

1.3PROBLEM STATEMENT

In general, Prison population is more exposed to develop

mental disorders. Their condition of life, deprivation of

liberty, being forced to define themselves as weak, helpless

xvii

and dependent threaten their self concept ,without forgetting

the linking between criminal behaviors and mental disorders.

Even though health care is applied in prisons of Rwanda, there

is an evident lack of data on the prevalence of mental

disorders among prisoners population, while they are more

exposed to stressors which may result in mental disorders.

During our training period at Ndera Neuro-psychiatric Hospital

we have released that there are some cases of mental ill

prisoners who are hospitalized. Skilled mental health

professionals in Rwandan Prisons are still deficient and for

this reason only prisoners who show observable and danger

mental disorders symptoms like agitation, aggressiveness, are

identified as mentally ill and brought to Psychiatric

Hospital, Other patients who do not present stranger symptoms

are ignored. This may lead to further Mental Health problems

to prison population and to all Rwandan society particularly.

With reference to Ndera Neuropsychiatric Hospital, in Rwanda

some kind of mental disorders are more frequent including:

mood disorder, anxiety disorders, psychotic disorders, drugs

and alcohol misuse. This research will determine on which

prevalence the same mental disorders are found in prison

population of Butare prison.

xviii

1.4 OBJECTIVES

1.4.1 Main objective

To evaluate the prevalence of mental disorders within prison

population of Butare Prison. 1.4.2 Specific objective

To identify the more frequent categories of mental disorders

among the prisoner population at Butare prison.

To determine the proportion of mental disorders among

prisoners population of Butare prison by age and sex.

1.5 RESEARCH QUESTIONS

Which categories of mental disorders are more frequent in the

prisoner population of Butare Prison ?

Which is the proportion of mental disorders among prison

population of Butare Prison by age and sex?

1.7 SIGNIFICANCE OF THE STUDY.

a. Scientific interest: The study will help to be aware of

mental health condition and addressing mental health need

among prisoners of Rwandan prisons, as the regained

information will be useful in planning and improving quality

of care for both prisoners with mental disorders and the

prison population as a whole.

b. Professional interest: The presence of prisoners with

unrecognized and untreated mental disorders can complicate and

negatively affect the prison environment, so the study will

help health care givers to promote the mental health care of

xix

prisoners, as well as moral and mental health of prison staff

and should therefore be one of the central objectives of good

prison management.

c. Social interest: Prison health cannot be addressed in

isolation from the health of the general population since

there is a constant inter-change between the prison and the

broader community. This Study will help then Rwandan

community, to avoid and reduce frequent social impairments

caused by some discharged prisoners after the end of their

punishment.

1.8 SUBDIVISION OF THE STUDY

This study is subdivided into 4 main parts: Part one consists

of the introduction which is composed by definition of key

terms, the background, problem statements, objectives,

research questions, research hypothesis and the significance

of the study. Part two consists of the literature review,

which put emphasis on mental health condition, mental

disorders, as well as their causes and their frequency among

prison population, part three consists of methodology, which

also explains the study area, the study designs sampling

strategies, sample size data collection tools, data analysis,

problem and limitation of the study, and the fourth part which

shows how results of the study will be presented.

xx

xxi

CHAPITER2. LITERATURE LIVIEW

2.1. THEORY ABOUT MENTAL DISORDERS

Mental illness, according to American Psychiatric association

[APA], mental disorders is considered as clinically

significant syndrome experienced by a person and marked by

distress, disability or risk of suffering disability or loss

of freedom (Wanda, 2006).

Referring to Pater (2003), Mental illness is any illness

experienced by a person which affect their emotions, thought

or behaviors which is out of keeping with their cultural

believes and personality, and is producing a negative effect

on their life or on the life of their families (Vikram,2003).

DSM-IV-TR Classification of mental disorders

Disorders usually first diagnosed in infancy childhood or

adolescent, Delirium, Dementia, Amnesic and other cognitive

disorders, Mental disorders due to general medical condition

not elsewhere classified, Substance related disorders,

Schizophrenia and other psychotic disorders, Mood disorders,

Anxiety Disorders, Somatoform disorders, Dissociative

disorders, Personality disorder, Sexual and gender identity

disorders ( Katherine et al.,2004).

Brief description of main psychotic disorders

a. Mood disorders: The mood disorders section includes

disorders that have a disturbance in mood as the predominant

xxii

features .The section contains depressive disorders ; manic

and hypo manic episode and bipolar disorders(DSMIV,2000)

b. Anxiety disorders

The anxiety disorders section includes Panic disorders without

agoraphobia; agoraphobia without history of panic disorder;

specific phobia; social phobia; obsessive compulsive disorders

; post traumatic stress disorders, acute stress disorders,

general anxiety disorders; anxiety disorders due to general

medical condition; Substance induced anxiety disorders due to

general medical condition(DSMIV, 2000).

c. Psychotic-disorders: The term psychotic refers to delusion

or prominent hallucinations, with the hallucination occurring

in the absence of insight into their pathological nature. The

disorders in this section include schizophrenia,

schizopreniform Disorders schizoaffective disorders,

delusional disorder, brief psychotic disorders, shared

psychotic disorders, Psychotic disorders due to general

medical condition, and psychotic disorders not otherwise

specified(DSMIV, 2000).

b. Substance –related Disorders: The substance related

disorders include disorders related to the taking of drug of

abuse (including alcohol),to the side effects of medication,

and to the toxin exposure(DSMIV, 2000)

xxiii

2.2. ETIOLOGY OF MENTAL DISORDERS

a. Biological theory

Structural damages to the brain can result from injuries such

as from accidents and from diseases that cause deterioration

(Susan, 2004)

Many of biochemical theories of psychopathology suggest that

too much or too little of certain neurotransmitters in synapse

causes specific types of psychopathology. Psychological

symptoms may be linked to the number of functioning of

receptors for the neurotransmitters on the dendrites. Many

mental illnesses run in families, suggesting that people who

have a family member with a mental illness are more likely to

develop a mental illness. Susceptibility is passed on in

families through genes. Experts believe many mental illnesses

are linked to abnormalities in many genes not just one. That

is why a person inherits a susceptibility to a mental illness

and doesn't necessarily develop the illness. Mental illness

itself occurs from the interaction of multiple genes and other

factors such as stress, abuse, or a traumatic event which can

influence, or trigger, an illness in a person who has an

inherited susceptibility to it (Susan, 2004).

b. Psychological theory.

Psychological theory of abnormality (mental disorders) varies

greatly in factors and processes they say are involved in the

development of abnormal or maladaptive behaviors. Some

theories focus on effect of rewards and punishment in thexxiv

environment, some focus on thought process and some focus on

difficulties human have in striving to realize their full

potentials in capricious world. Others include; severe

psychological trauma suffered as emotional, physical or sexual

abuse. An important early loss, such as the loss of parent,

neglect, poor ability to relate to others, etc...

Psychodynamic theory of mental disorders suggest that all

behaviors, thoughts and emotional whether normal or abnormal

are influenced to a large extend by unconscious process.

(Vakon et al., 2000).

c. Social theory

Psychological theory focus primarily on an individual they

attribute problematic psychological symptoms to unconscious

conflict, negative cognition existential anxiety and other

factors residing largely within the individual. Although these

theories may suggest that the environment plays a great role

in creating these problems.

They still consider the individual as the primary unit of

analysis. These social approaches to abnormality focus more on

the larger social structures within which an individual lives.

Psychological factors that may contribute to mental illness

include: Severe psychological trauma suffered as a child, such

as emotional, physical, or sexual abuse and an important early

loss, such as the loss of a parent or neglect (Vakon, 2000)

xxv

2.3. MENTAL HEALTH OF PRISONERS

According toVikram, mental health of prisoners is important

since some peoples with mental illness get involved in

criminal activities and end in prison. Being in prison can be

stressful experience. The isolation loss of freedom and

anxiety can in some people lead to mental illness. Drug abuse

also may occur in some prisons; thus being in prison can cause

mental disorders. In prison different types of mental

disorders are common. Included are psychotic disorders,

especially in people who are behaving in odd way, speaking to

imaginary people or themselves, restless or agitated. Withdraw

reactions in people with drink or drug problems, very soon

after being put in prison. Depression and anxiety, which are

likely to be the result of imprisonment. Suicide can occur

even in the most highly guarded environment such as prison

(Vikram, 2003).

2.4. FACTORS CONTRIBUTING TO MENTAL DISORDERS AMONG PRISONERS

There are many factors which may contribute to mental disorders

among prisoners, the latter include the treatment prisoners had

in early family life, their community bonding, school

performance, employment history, marital responsibilities,

personality factors, occupational experience, delinquent

activities, psychiatric history, physical health, critical life

events generating stress, and the residual degree of resilience

they retained despite the vicissitudes of life they might have

experienced. The unrelated effects might also include reactivexxvi

mental disturbance from the crimes they committed (Waldron et al.,

2004).

2.4.1 The inmates’ social world

There are a variety of ways to deal with the stress created by

prison life. Some inmates feel they must be active in order to

survive the prison experience. Their activities include

watching television or listening radio or stereo, obtaining

and using a drug, making alcohol beverage, lifting weight or

participating in other activities. Inmates must cope with

physical social and psychological problems that result from

punishment, and the loss of liberty.

The deprivation of goods and services in a society that vary

material procession the deprivation of heterosexual

relationships and result threat to the inmates’

masculinity ,and the deprivation of security in an inmate’s

population that threatens his safety and some time his life

and health.

Everything the inmates do, including the showers they can take

and the hours they can sleep, is regulated by the prison

staff. An individual prison may house up to 2,000 men at a

time, many with violent backgrounds. As of 2004, U.S. prisons

housed over 630,000 inmates who were serving time for a

violent offense (Bureau of Justice Statistics, 2007). Placing

these men together in close quarters may lead to feelings of

hostility, anger, and inevitably violence.xxvii

2.4.2 Prison violence

A common reaction to incarceration is violence including

violence against oneself. Probably the violence among inmates

is underreported; many inmates do not report incidents for

fear of reprisal from other inmates. One way in which inmate

behavior can be explained is the inmates’ criminal tendency or

their inclination to commit crime (Camp et al., 2005).

Prison violence is a product of what Colvin (2000) describes

as dimensions of control. The first type of control seen

in the prison environment is consistent coercion

(intimidation). Consistent coercion occurs when the offender

and victim have an ongoing, highly punitive relationship.

Individuals under this type of control experience high level

of self directed anger and weak social bonds (Colvin, 2000).

Inmates then have a decrease inpro-social behavior and a high

probability of mental health problems.

2.4.3 Isolation

Isolation is the term used when inmates are separated from the

general prison population. There are three situations which

may call for an inmate to be put in isolation. These include

disciplinary segregation, administrative segregation, and

protective custody. According to Singleton et al (1998) , the

level of confinement and isolation experienced by some

prisoners is, in itself, detrimental to their mental health,

but the situation is made worse by the fact that some

prisoners turn to using illicit substances to help them dealxxviii

with long periods of time spent locked up. It is not difficult

to imagine how prisoners with pre-existing psychiatric

problems deteriorate and others who are vulnerable to

developing mental health problems decompensate in these

conditions (Singleton, 1998).Numerous studies have documented

the effects of solitary confinement on prisoners giving them

the name; Special Housing Unit Syndrome or SHU Syndrome. Some

of the many SHU Syndrome symptoms include: visual and auditory

hallucinations, hypersensitivity to noise and touch, insomnia

and paranoia, uncontrollable feelings of rage and fear,

distortions of time and perception, increased risk of suicide,

PTSD. 

2.4.4 Prison victimization

Victimization in prison can take many forms:

physical/assaultive, psychological, and sexual. Byrne and

Hummer (2008b) state that while assault does occur in prison,

the extent and severity is unknown. This may be due to the

differences in definitions of assault among correctional

departments.

For example, some departments may or may not include verbal

threats or attempted

assault when reporting levels of assault in their prisons

(Byrne et al., 2008).

Physical Victimization

The most common form of victimization in prisons is physical

abuse. Another influence on inmate violence is the formalxxix

organization of the prison which may include security,

programs, rehabilitation, staff characteristics, and prison

trains (Gaes et al.,2005).

Psychological victimization: According to South et al.,

(2006), Psychological victimization may include bullying which

includes ridiculing, ostracizing, and rumor spreading.

Victimization may take place because the inmate has not

integrated into a social system

such as a gang which would protect inmates from bullying.

Psychological victimization

may also occur when inmates exhibit higher levels of

maladjustment to prison life.

Inmates who are powerless and feel inferior may experience

this type of victimization if

unable or unwilling to conform to prison life.

Impact of Victimization

Inmates who are victims of another inmate’s aggression and

violence are often placed under immense psychological stress.

Victimized inmates often experience clinical Features similar

to Posttraumatic Stress Disorder (PTSD), a mental disorder

that is caused by a (n) extreme traumatic event(s) that

involved physical harm or the threat of physical harm

(National Institute of Mental Health, 2008)

2.5 THE LINKAGE BETWEEN MENTAL DISORDERS AND CRIME

According to Vikram (2003), certain kinds of mental illness

may influence suffers’ behaviors in different ways, so thatxxx

they do things that break the law. Violent behaviors can occur

in people who are suffering from severe mental disorders like

during a psychotic phase they may wander in public places,

shouting at peoples. Rarely, mentally ill person may threat or

attack someone. Stealing is a crime associated with people who

abuse drugs or alcohol. The reason is simple: these people are

stealing in order to get money to pay their drug habits In

adolescent stealing may be the result of conduct disorder.

Dangerous driving is associated with drinking too much alcohol

and severe disorders. However if we look at the issue of

mental illness and crime by asking question Do most people who

commit crimes suffers from mental illness, the answer is no.

Thus it is important that do not treat people with mental

illness as if they are potentially violent or likely to break

the law. The vast majority of people with mental illness are

not violent (Vikram, 2003).

Personality theory suggest that, emotional conflict and

personality deviation characterize many criminals especially

habitual offenders, leading some theorists to conclude that

such deviation cause criminal behavior. The early studies

emphasized the frequency of an association between mental

disorders and crime. According to Michael.D(2000), Antisocial

Personality Disorder is the most highly correlated mental

disorder with crime. An individual with Antisocial Personality

Disorder has a pervasive pattern of disregard for the rights

of others, and violations of them. The disorder is

xxxi

characterized by a lack of conformity or respect for lawful

behavior. They repeatedly carry out acts that are grounds for

their arrest. Borderline Personality Disorders, which is

possibly the most difficult mental disorder to treat, also can

contribute to criminality (Michael, 2000). Paranoid Personality

Disorder is characterized by a pervasive distrust and

suspiciousness of others. An individual with this disorder

will often interpret another motive as malevolent. When a

person feels someone is motivated to harm them in some manner

it is not surprising that the individual would act in a

violent way to either prevent the acts they expect to have

occur or respond aggressively to those they have seem as

hostile( Michael, 2000)

Intelligence and crime

Closely associated with the mental disorder approach is the

linking of crime and intelligence .It is argued that low

intelligence causes crime, this approach has long historically

roots .As noted ,early studies of family histories that found

many people of lower intelligence in a family line of

criminals concluded that the criminal behavior was caused by

low intelligence.

Howard Professionals through their publication of crime and

human nature, started that there is a clear and consistent

link between criminality and low intelligence and critics’

criminology text book for ignoring the research in this area

(Richard et al., 1985).

xxxii

Cognitive development theory

This approach is based on the belief that the way in which

people organize their thoughts about law result in either

criminal behavior or noncriminal behaviors (Lawrence K, 1958).

Psychologist refers to this organization of thoughts as moral

reasoning. When this reasoning is applied to law, it is termed

legal reasoning, although that term has a different meaning to

person trained in law. The stems from the early works of Jean

Piaget, who believed that there are two in development of

moral reasoning. According to Piaget leave the first stage at

about the age of 13, and the second stage lead to more moral

behavior than the first.The believe that the rules are screed

and immutable and the believe that rules are the products of

humans (Sue, 2000).

Psychiatric approach

The psychoanalytic theories of Sigmund Freud and his

colleagues introduced the concepts of the unconscious, along

with techniques for probing that element of personality and

emphasized that human behavior is motivated and purposive.

According to Freud (1856-1939), human have mental conflicts

because of desire and energy that are repressed into

unconscious. The urges, ideas, desires, and instincts are

basic, but they are repressed because of society’s morality.

Freud saw original human nature as assertive and aggressive.

It is not learned but is rooted deeply in early childhood

experiences. According to Freud we all have criminal

xxxiii

tendencies, but during the socialization process, most of us

learn to control them by developing an ability to control

impulses and acts them out or projects them inward. In the

case of the latter, the child may become neurotic, in the case

of the former, delinquent.

2.6 FREQUENCY OF MENTAL DISORDES AMONG PRISONERS POPULATION

According to Luke Birmingham (2003), mental health problems

are the most significant cause of morbidity in prisons. Over

90% of prisoners have a mental disorder.A recently published

systematic review of serious mental disorder among prisoners

gives some insight into the extent of the problem that exists

in prisons in Western countries today. This review suggests

that typically about one in seven prisoners have psychotic

illnesses or major depression, and about half of all male

prisoners and one in five women prisoners have antisocial

personality disorder. These rates, which are considerably

higher than those found in comparable community samples,

reflect a substantial level of treatment need (Faze et al., 2002).

According to Andersen, several studies have directly compared

females and males in similar or identical study designs.

Except for psychoses and alcohol abuse dependence, females

have overrepresentation of disorders with ration of 2-3 in

relation to males in prison sample (Andersen, 2004). In Fazel &

Danesh’s large review of 62 prison surveys 3.7% among male and

4% among female prisoners had ongoing mental disorders. Fazel

xxxiv

et al., 2002) found an average prevalence of 10%major

depression among male prisoners and 12% among female prisoners

with some differences as to the status of the disorder and

dissocial personality disorder (DPD) has been considered. In

1998, data from Correctional Services Canada found 1,000

inmates, out of 14,000 in the prison population, were

diagnosed with mental-health disorders. In 2004, that number

soared to 1,500 in a prison population of 12,500

(Upswing et al., 2005).

Falissard et al conducted a survey on prevalence of mental

disorders in French prisons for men. Prevalence rates for a

diagnosis given independently by both clinicians and for a

consensual diagnosis were respectively: 3.8% (6.2%) for

schizophrenia, 17.9% (24%) for major depressive disorder,

12.0% (17.7%) for generalized anxiety and 10.8% (14.6%) for

drug dependence. (Falissard et al, 2006).

CHAPTER 3. RESEARCH METHODOLOGY

This part describe the methodology which will be used in this

study, it will contain the description of study area, study

design and study population, sampling methods, sample size and

data collection methods and procedure to be used. Ethical

consideration and limitation of the study are also part of

this chapter.

xxxv

3.1. STUDY AREA

This study will be realized at Butare Prison. This area has

been selected as study site because it is one of the national

reference Prisons of Rwanda and its location is accessible

for the researchers and we have some information about the

state of this prison. The Prison is located at Huye District,

Southern Province.

3.2 STUDY DESIGN

This study will be cross sectional study. the cross-sectional

study is the most appropriate to measure the prevalence of

disease and is called “prevalence study”. This measure the

frequency of disease relation to age, sex, ect. The cross

sectional study is done once in a given period of time to

establish the state of affaires (disease, health state) at

particularly time (Stretch et al., 2006).

3.3 STUDY POPULATION

The study population is a collection of individuals with a

common character which interested the study.

The population of this study will include prisoners of Butare

prison and who will voluntarily accept to participate in the

research. This prison contains 9156 including 8335 men and

801women.This population is composed with members who are 18

to 70 age old. 3.4. SAMPLE SIZE

xxxvi

Graham and cook (2009) defined a sample as small group of

cases down from and used to represent some large group. In

this study the sample size will be calculated using the

following formula:

(3; 1)

n= Expected minimum sample size.

z=is a standard value which correspond to 1.96 (at 95%

confidence internal)

p=proportion /problem magnitude

ε=is the margin of error on p =5%

q=100-p, 100-80= 20

(3; 2)

Researchers prefer to use the half population of the sample

size calculated, because of shortage of time and available

budget. So the study will involve 123 participants from whole

prison population of Butare population)

xxxvii

3.5. SAMPLING METHODS

Sampling refers to the process of selecting a proportion of

the population to represent the entire of population.

Participants who would be selected as a sample of this study

will be selected by systematic random sampling. As we have a

population of 9156 by dividing with sample size of 123 we

obtain 74, randomly we will select any number between 1 and 74

so from that number we will select every 75th name from the

list of prisoners until we reach the last one, number 9156.we

will end up with 123 selected prisoners.

3.6. DATA COLLECTION METHODS AND PROCEDURES

For our study we will use mental status examination as main

tools of identification of the presence of any symptom of

mental disorders trough interview. The following techniques

will be used and we hope this study will have efficient

findings.

3.6.1structured observational method

The purpose of an observation is to try to understand a place,

an event or a behavior by watching (and taking note). After

observing you can reflect (think about what you have

seen).From your observation you can draw inferences about the

place, event, or behavior that might lead you to a large or

more general conclusion (Beck et al., 2005).

xxxviii

In our research we will use mental status examination form.

The selected prisoners will be observed during interview; here

different tools of mental disorders will be identified like

mood disorders, affect disturbance, etc.

3.6.2 Semi-structured interview

According to Beck et al., (2005), semi- structured interviews

are conducted on the basis of a free structure consisting of

open ended questions that define the area to be explored, at

least initially, and from which the interview or interviewee

may diverge in order to purse an idea in more detail. The

researchers prepare in advance a written topic guide is a

list question to be covered with each respondent .For our

research, we will prepare an interview guide to be used and

completed while we will be interviewing prisoners concerned

buy this study.

3.7 .DATA ANALYSIS

The data will be collected, entered in the computer from data

capture sheet and will be analyzed using computer software

SPSS (Statistical Package for Social Sciences). Demographic

data will be analyzed with frequencies means and standards

deviations, prevalence will be given in frequencies and

percentages.

xxxix

3.8 PROBLEMS AND LIMITATIONS OF THE STUDY

3.8.1. The problems of the study

a. Financial resources

b. Difficulty in obtaining information on sensitive and/or

private matters.

3.8.2. Limitations

The study population is too large so as limitation the sample

size will be large.

The risk of getting false information.

Communication problem considering the condition of prisoners.

3.9 ETHICAL CONSIDERATIONThe research will be carried out after obtaining permission

from KHI authorities and the Direction of Butare Prison.

The prisoners will participate voluntarily and freely in this

study after clearly explaining to them the significance of the

study in order to obtain their informed consent. The interview

will be done in a safe environment and the interviewers will

respond to all participants’ enquires and show acceptance of

their comments. The confidentiality will be assured to the

prisoners who will participate in the research as they will be

named by using the codes. During the study, the researcher

will consider various rights of the participants, such as

right to privacy, right to information and informed consent,

right to appropriate treatment and care, right to choices,

right to respect, and right to complain.

xl

xli

CHAPITER 4.PRESENTATION OF THE RESULTS

4.1. THE PROPORTION OF MENTAL DISORDERS AMONG PRISON

POPULATION OF BUTARE PRISON BY AGE GROUP

Table 4.1.a the proportion of mental disorders among prisonerspopulation aged between 18-24

Age

Group

Categories of

mental disorders

Frequencies Percentages

18-24 Mood disorders Anxiety disorders Psychotic

disorders Drugs and alcohol

misuse Others

Table 4.1.bThe proportion of mental disorder among prison populationaged between 25-31Age

Group

Categories of

mental disorders

Frequencies Percentages

25-31 Mood disorders Anxiety

disorders Psychotic

disorders Drugs and

alcohol misuse

xlii

Others

xliii

Table 4.1.c the proportion of mental disorder among prison

population aged between 32-38

Age

Group

Categories of

mental disorders

Frequencies Percentages

32-38 Mood disorders Anxiety

disorders Psychotic

disorders Drugs and

alcohol misuse Others

Table 4.1 d. The proportion of mental disorder among prisonpopulation aged between 39-45Age

Group

Categories of

mental disorders

Frequencies Percentages

39-45 Mood disorders Anxiety disorders Psychotic

disorders Drugs and alcohol

misuse Others

xliv

xlv

Table4.1.e The proportion of mental disorder among prison populationaged between 46-52Age

Group

Categories of

mental disorders

Frequencies Percentages

46-52 Mood disorders Anxiety disorders Psychotic

disorders Drugs and alcohol

misuse Others

Table4.1.f The proportion of mental disorder among prison population

aged between53-59

Age

Group

Categories of

mental disorders

Frequencies Percentages

53-59 Mood disorders Anxiety disorders Psychotic

disorders Drugs and alcohol

misuse Others

Table4.1.g The proportion of mental disorder among prison populationaged between 60-66

Age

Group

Categories of

mental disorders

Frequencies Percentages

xlvi

60-66 Mood disorders Anxiety disorders Psychotic

disorders Drugs and alcohol

misuse Others

xlvii

Table4.1.h The proportion of mental disorder among prison populationaged between 66-73

Age

Group

Categories of

mental disorders

Frequencies Percentages

67-73 Mood

disorders Anxiet

y disorders Psycho

tic disorders Drugs and

alcohol misuse Others

Table 4.2 theproportion ofmentaldisorders amongprisonerspopulation ofButare prisonby sex.

xlviii

Sex Categories of

Mental Disorders

Frequency

Male

Mood disorders Mood disorders Anxiety disorders Psychotic

disorders Drugs and

alcohol misuseOthers

Female Mood disorders Mood disorders Anxiety disorders Psychotic

disorders Drugs and

alcohol misuseOthersTotalPercentage

xlix

Table 4.3 Proportion of prisoner population of Butare prison

without mental disorders by sex.

Table4.4 Prevalence of mental disorders among prisoners populationof Butare Prison according to their categories.

l

Sex Freque

ncy Male Female Total Percentage

Mental disorders

detected

frequenc

y

Perce

ntage Mood disorders Anxiety

disorders Psychotic

disorders Drugs and

alcohol misuse Others total

LIST OF REFFERENCIES

African Medical Journal, Vol. 83 No. 10

American Psychiatric Association, 2000. Diagnostic and statistical of

mental disorders, fourth edition.p19

Birmingham L, (2004) Mental disorder and prisons, Psychiatric

Bulletin, p393-397

Butare Prison Dispensary monthly report, March, 2010.

Coid J., Petruckevitch A., Bebbington P. ,et al (2003b)

Psychiatric morbidity in prisoners and solitary cellular

confinement, II: special (‘strip’) cell. Journal of Forensic

Psychiatry and Psychology, 14,320-304.

Commission on Safety and Abuse in America’s Prisons, 2006, p23

Her Majesty’s Inspectorate of Prison, 1997b, 2000a

(http://byprcpch.org/cgi/content/full/9/9)

Hochstetler & Delisi, 2005, Health Services Research Unit,

University of Oxford, UK Department of Public Health, p258

li

Isherwood S. & Parrott, J. (2002) Audit of transfers under the

Mental Health Act from prison the impact of organizational

change. Psychiatric Bulletin, p 368-370

James.B (2004) life inside a supermax security prison,

voyageur press, hardcover p.192

Johnson, 1997, Psychiatric mental health nursing., fouth edition

Johnson,1997, Psychiatric mental health nursing ,fourth edition , p5.

Journal (Advances in Psychiatric Treatment (2003), p 191-199

Kathrine M. F&Patrician A.Holoday worret, 2004, psychiatric mental

health nursing, third edition, page646-652)

L.keltner& L. Schwecke,2003, Psychiatric Nursing,Fourth Edition ,

p188-190

Michael D. (2000), Mental Disorders and Crime: Personality Disorders

Nurse J., Woodcock P. & Ormsby J. (2003) Influence of

environmental factors on mental health within prisons:

focus group study. BMJ, p 480 -485

Rhodes, L. (2005) Psychological effects of the supermax

prison. American Journal of Public Health, 95, 10, 1692-1695.

Routledge, Liebling, 1992, Studies in Prison A., London

scandinavica,volume 110,issues s424,p5-59

lii

Singleton, N., Meltzer, H. & Gatward, R. (1998)Psychiatric Morbidity

among Prisoners in England and Wales(Office for National Statistics),

London: Stationery Office.)

Steve Taylor&David field(2003),Sociology of Health and health care.

ThirdEdition,Blacwell pag42-56

Sue Titus,Reid,2000,Crime and Criminology, 9TH edition. United

States, Mccraw-Hill Higher Education. Pag419-434.

Susan Nolen H.2004, Abnormal psychology 3rd edition, p34-36

The British Journal of Psychiatry (2002) ,p 354-359

(http://byprcpsychorg/misc/terms.shttml)

Upswing: report, Paul Hunter reports, 2005

Vikram P. 2003, Where there is no psychiatrist, p3-5; p 195-197

Wanda K. 2006, Psychiatric Mental Health Nursing, University of

medicine and Detistery of New Jery, Lippincott&Wilkins , 6th

edition p8

TASKS TO BE

PERFORMED

DATES TO BE

COMPLETED

PERSONNEL

ASSIGNED TO

TASK

PERSON DAYS

REQUIRED

1.Finalizing

the research

proposal and

submission

Week 1-9

20th June-26th

August

2

Researchers

+1Superviso

r

3persons×67days

=221

2.Ethical

clearance

Week 10-11

27th Aug-3rd

2

researchers

2

persons×7days=1

liii

permission Sept 43.Prisoners

population

contact to

orient members

on project.

Week12-15

4th Sept -

25sept

1

researcher

1person×21days=

21

4.

Pretesting ,rev

iew and

finalizing

research

instruments.

Week12-15

4th Sept -

25sept

2

researcher

2persons×21days

=42

5.Data

collection.

Week 16-23

26th Sept.-22th

Oct.

2researcher

s

1supervisor

3persons×56days

=168

6.Data coding

and entry into

computer

Week24-27

23st Oct. -14th

Nov.

2

researchers

1statician

3persons

×21days=63

7.Data analysis Week28-29

15-31st ,Nov

2

researchers

1

supervisors

3

personsx14days=

42

8.Report

presentation

Week34

29th Dec.-5th

Jan,2011

2researcher

s

2persons×7days=

14

liv

9.Report

writing (final

draft)

Week35

6th,Jan-

12th,Jan,2011

2researcher

s

2persons×7days=

14

10.Submission

of final report

Week 36

13th Jan-19th

Jan

2

researchers

2personsx7days=

14

11.feed back to

Butare Prison

staff.

Week 37

20th -26th

,Jan,2010

2

researchers

persons×7days=1

4

WORK PLAN

THE GANT CHART

TASK TO BE PERFORMED Year 2010-2011Jun Jul Aug Sep

t

Oc

t

Nov Dec Ja

n1.Finalize project for

submission

xx xxxx xxx

2. Ethical clearance

and permission to do

the work

x x

3.Community contact to

orient the members on

project

xxx

4.Pre-testing and

finalizing research

instruments ( e.g.

xxx

lv

questionnaire)5.Data

collection(flied work)

x xx

x6.Data coding and

entry into computer

x xx

7.Data analysis xx8.Report writing(first

draft)

xxx

9. Report

presentation(workshop

x

10. Report writing

(final writing)

x

11.Submission of final

report

x

12.Feed-back to Butare

Prison Staff.

x

lvi

BUDGET

I. PREPARATION

No Item No of

person

No of

days

No of

Perso

n

Days

No

of

unit

Cost/

Unit

(RWF)

Total

RWF

1 Realm of paper - - - 2 3000 6,0002 Purchased of

flash disk

- - - 2 20000 40,000

3 Photocopies of

different

documents in use

- - - 200 20 4,000

4Printing

300 50 1,5000

5Rent of lap-top

2 25000 5,0000

6Communication

3 233 699 699 300 20,9700

7Transport

3 12o 360 360 1000 360,000

8Accommodation and

restaurant

3 120 360 360 1000 360,000

9Covering of the

documents

- - - 9 1000 9,000

Sub-total1 1,0537

00

lvii

II.THE SURVEY

Nº Item Person

s/

Materi

als

No.

of

days

Person

-Days

Unit

Cost

(RWF)

Total

(RWF)

1 Authorization

request and

transportation

2 7 14 5,000 70,000

2 Prison population

contact

2 21 42 5,000 210,000

3 Pretesting and

finalize research

instrument.

2 21 42 5000 210,000

4Data collection

3 14 42 10,000 420,000

Sub-total 2910,000

lviii

III .THE STUDY SUPPLIES

lix

Nº Item Quantit

y

Unit Price

RWF

Total RWF

1 Note Books A4 3 3000 90002 Identification

Cards

3 3000 9000

3 Clipboards 2 1000 20004 Pencil 1

parquet

1000 1000

5 Pens 1box 2000 20006 Rubber eraser 3 200 6007 Blanco 2 1500 30008 Files 2 1000 20009 Ruler 2 200 400

Sub – total 329000

IV.THE PRODUCTION OF THE RAPPORT

.

V.

THE

WORKSHOP FOR REPORT VALIDATION

NºItem Quant

ity

NO./

Days

Pers-

days

Unit

Price

RWF

Total

RWF

1 Report

presentation

3 1 3 10000 30,000

2 Projector 1 1 1 10,000 10,0003 Submission of 2 7 14 5000 70,000

lx

N

º

Item Quantit

y

No. of

days

Pers.-

days

Unit

Price

RWF

Total

RWF

1 Crosscheck &

Verification

of data

3 7 21 1,000

0

210,000

2 Entering

Data

2 21 42 5000 210,000

3 Analysis of

Data

3 14 42 5000 210,000

4 Report

(Draft 1-3)

2 21 42 5000 210,000

5 ICT

Technician

1 14 14 5000 70,000

Sub – total

4

910000

final report4 Feedback to

Butare Prison

staff

2 7 14 5000 70,000

Sub–total 5180000

VI. THE BUDGET SUMMARY

.

lxi

Nº DESCRIPTIONTOTAL

1 Preparation for the Study 1,0537002. The survey 910,0003 Study supplies 290004. Production of the Report 9100005 Workshop for report

validation

180000

TOTAL BUDGET 3082700

BUDGET JUSTIFICATION

One of the factors for success of this survey is financial

availability, our budget is proportional with the following

activities: preparation of the research project requiring

1,053,700; 910,000 for survey;29000 for study

supplies;910,000for production of the study;180,000 for work

shop for report validation and 399,100 for unforeseen.

The total sum will be 3481800 rwfs including all needs for

this study and unforeseen cases which can appear during

implementation of this project.

A.CURRICULUM VITAE OF APPLICANT

I. Identity

Surname: KANGABE Date of

birth: March the 20th ,1987

lxii

Nationality: Rwandese

Fist name: Valentine

II. Academic profile : Qualification; School or

University ;Year

1994-1999:Primary school at Rango Primary school

2000-2006: Secondary school:1-3rd year at Group Scolaire

Notre Dame de Lourdes Byimana

4-6th year at ESI

Rwamagana

2008-2010: Higher education at Kigali Health Institute in

Mental Health Nursing DepartmentIII.Post held: Work experience2006-2007:Served as a nurse at Ruhuha health centerIV.LanguageKinyarwanda : Very good

French : Very good

English : Good

PROFILE OF APPLICANT AND INSTITUTION

lxiii

B.CURRICULUM VITAE OF APPLICANT

I. Identity

Surname: HABYARIMANA Date of

birth: 1st January,1980

Fist name: Charles

Nationality: RwandeseI. Academic profile : Qualification; School or

University ;Year

a. Primary school at Rutonde

b. Secondary school:1-3rd year at Group Scolaire Ste Bernadette

4-6th year at Group Scolaire

official Butare

c.2008-2010 :Higher education at Kigali Health Institute in

Mental Health Nursing DepartmentIII.Post held: Work experience2005-2007:Served as a nurse at Ruhuha health center.IV.LanguageKinyarwanda : Very good

French : Very good

English : Good

Swahili : Good

lxiv

lxv

C.PROFILE OF INSTITUTION

A. Name: Kigali Health Institute (KHI)

B. Address: Po.Box: 3286 Kigali-Rwanda

phone :( +250) 572172 / 571788

Fax: (+250) 571787

e-mail:rector@khi.ac.rw

C. Campuses: KHI has two campuses in different places namely

Kigali and Nyamishaba

D. Faculties: KHI has three faculties: Allied Health Sciences,

General Nursing and Community health sciences.

D.1.Nursing has: General Nursing, Mental Health and Midwifery

departments.

D.2. Allied Health Sciences has: Medical Imaging Sciences,

Dentistry, Physiotherapy, Ophthalmology and Anesthesia

departments, Biomedical Laboratory Sciences.

D.3. Community Health sciences has: Environmental Health

Department

E. Vision of KHI: To be centre of excellence in training and

development of health professionals

G. Mission: “To train and improve the capacity of health

workers”lxvi

In order to realize the above vision and mission, Kigali

Health Institute will have to put special emphasis on the

goals identified in KHI Strategic Plan 2007 - 2012.

H. Budget and resources

H. Administration department.

-Rector: Dr. Ndushabandi Desire

-v/rector in charge of academic affairs and research: Dr.

Kabagabo Chantal

-v/ rector in charge of administration and finance: Mr.Kazige

Eugène

 

lxvii

APPENDIX

lxviii

1. INFORMED CONSENT LETTER

We, HABYARIMANA Charles and KANGABE Valentine, have the

pleasure to introduce ourselves to you and invite you to

participate in this study: ‘Prevalence of mental disorders

among prisoners of Butare prison’.

The work will be conducted by the researchers and those who

have been chosen to participate will contribute in the

following manner:

They will be observed and interviewed by researchers.

They will also have to respond to some oral questions.

The information gathered during this study will remain

confidential. You do not have to identify your names.

Thank you for your good understanding.

2. INTERVIEW GUIDE (English Version)

2. a. Identification

i. Age distribution

18 to 24 years old

25 to 31 years old

32 to 38 years old

39to 45 years old

46 to 52 years old

53to 59 years old

60 to66 years oldlxix

67 o 73 years old

ii. Gender Male

Female

2. b. Questionnaires for assessment of mental disorders

symptoms trough interview and observation

I. MOOD DISORDERS

Have you ever had the following symptoms for a period of two

weeks?

Depressed mood

Apathy

Pessimism

Sense of loneliness

Suicide ideation

Fatigue/loss of drive

Hypersomnia

Insomnia

Psychomotor retardation

grandiosity

Aggressiveness more

talkative than usual

lxx

Fright of ideas

increase in goal directed activity

Impairment in occupational functioning or in usual social

activities without a known

cause (e.g. drug abuse, a medication or a general medical

condition

Others (specify)

……………. ………….

…………….

…………..

II. PSYCHOTIC DISORDERS

Have you ever had two or more of the following symptoms?

Illusion

Disorganized speech

Hallucination

Affective flattening

Delusion

Other thought disorders

Others (specify)

……………. ………….

…………….

…………..

lxxi

III. ANXIETY DISORDERS

Have you ever had some of the following symptoms?

Restlessness or feeling keyed up or on edge

Being easily fatigued

Difficulty concentrating or mind going blank

Being Irritable

Sleep disturbance

A fear of that you are going mad

Felling of panic

Being detached from oneself

Feeling not in control of your action or detached from your

surrounding

Repeated thoughts or flashbacks of traumatic experiences

Trembling or shaking

Others (specify)

……………. ………….

…………….

…………..

IV. ALCOHOL AND DRUG MISUSE

a. Do you regularly take one or more drugs and/or alcohol

to change or to manage:

lxxii

Your mood

Your emotion

The state of your conscious

b have you ever had the following problems during a period

of 12 months?

Taking a large amount of drug

Physical hazardous

Withdraw syndrome

Failure to fulfill major role obligation because

alcohol or drug

Others ( specify)

……………. ………….

…………….

…………..

UMUGEREKA (Version Kinyarwanda)

1. Amabwiriza

Twebwe HABYARIMANA Charles na KANGABE Valentine, dushimishijwe

no kubibwira tukanabashishikariza kwitabira ubu bushakashatsi

bugamije kugaragaza ubwiganze bw’indwara zo mu mutwe muri

gereza ya Butare. Iki gikorwa tuzagikorana n’abazaba bemeye

kwitabira ubu butumire, kandi bizakorwa mu buryo bukurikira :

Abitabiriye, hari ibibazo bazasubiza imbonankubone.

Amakuru yose azaturuka muri ubu bushakashatsi ni ibanga, niyo

mpamvu udasabwa kugaragaza amzina yawe.

Tubashimiye ubufatanye bwanyu.

2. INTERVIEW GUIDE (Kinyarwanda Version)

lxxiii

a. Irangamimerere

Imyaka

18 - 24

25 - 31

32 - 38

39- 45

46 - 52

53- 59

60 -66

67-73

Igitsina Gabo

Gore

2. b. Ibigaragaza ko umugororwa afite ibibazo byo mu mutwe

binyuze mu kiganiro.

Indwara z’agahinda /ibyishimo birenze.

Waba warigeze ugaragaza bimwe mu bimenyetso bikurikira?

Agahinda

yego oya

lxxiv

Gucika intege

yego oya

Guta icyizere

yego oya

Kumva uri wenyine

yego oya

Gushaka kwiyahura

yego oya

Kunanirwa no kubura ubushake yego

oya

Gusinzira cyane

yego oya

Kudasinzira

yego oya

Kubura intege yego

oya

Kubura amahwemo

yego oya

Kugira amahane

yego oya

Kumva uri umuntu ukomeye Yego

oya

Kugira amagambo menshi bidasanzwe Yego

oya

Kugira ibitekerezo byinshi byisukiranya Yego

oya

lxxv

Kugira ibyishimo birenze urugero Yego o

oya

Gukorana ingufu nyinshi kandi utananirwa Yego

oya

Kutuzuza inshingano zawe no kunanirwa kubana

n’abandi

Yego oya

Ibindi

……………. ………….

…………….

…………..

b. Indwara z’imitekerereze n’ibyumviro.

Waba warigeze ugaragaza bimwe mu bimenyetso bikurikira ?

Kumva (ibyumviro ) bidasanzwe yego

oya

Kumva (ibyumviro ) ibitariho yego

oya

Imitekerereze idasanzwe yego

oya

Izindi ndwara zimitekerereze yego

oya

Kugira amagambo atajyanye yego

oya

Guhindagurika mumaranga mutima yego

oya

lxxvi

Ibindi

……………. ………….

…………….

…………..

c.Indwara z’ ubwoba

Waba warigeze ugaragaza bimwe mu bimenyetso bikurikira ?

Guhorana impungenge

yego oya

Kunanirwa vuba

yego oya

Kumva ufite umushiha

yego oya

Kudasinzira neza

yego oya

Kumva ugiye guta umutwe

yego oya

kunanirwa gufata gahunda

yego oya

Guhorana igihunga

yego oya

lxxvii

Kugarukirana kw’amashusho y’ibyakubayeho.

Yego oya

Ibindi

……………. ………….

…………….

…………..

d. Inzoga n’ibiyobyabwenge

a.Waba ukunze gukoresha inzoga cyangwa ibiyobya bwenge kugira

ngo bigufashe kugenzura:

Ibyishimo cyangwa agahinda

yego oya

Amarangamutima

yego oya

Imitekerereze

yego oya

b.Waba warigeze uhura n’iki kibazo kubera gukoresha inzoga

cyangwa ibiyobyabwenge mu gihe kingana n’umwaka?

Kungero urugero rw’ ikiyobyabwenge wafataga yego

oya

lxxviii

Kubura amahwemo igihe utabonye ikiyobya bwenge yego

oya Kunanirwa kuzuza inshingano zawe zaburi

munsi yego oya

Ibindi

……………. ………….

…………….

…………..

APPLICATION LETTER FOR CARRYING OUT RESEARCH

lxxix

Kigali Health Institute

Faculty of Nursing Sciences

Department of Mental Health

September, the 7th, 2010

To: The General Director Butare Prison

RE: Request for permission to carry out a research

Dear Sir/ Madam,

We would like to conduct a research on “prevalence of mental

disorders among prisoners at Butare prison.”

We humbly request your authorization to carry out our proposed

research study.

We look forward to your favorable response.

Faithfully yours,

lxxx

Students,

Charles HABYARIMANA

And

Valentine KANGABE

Kigali Health Institute

Department of Mental Health

PO.BO 3286

September, the 7th, 2010

To: The President of the KHI research committee.

Re: Requesting for the authorization for conducting a

research.

lxxxi

Dear Sir,

We humbly wish to request your authorization to conduct the

study. In fact, we are finalist students at KHI Department of

Mental Health our study will evaluate “the prevalence of

Mental Disorders among prisoners population at Butare prison”

Your favorable response shall be highly appreciated.

Faithfully yours,

Students,

Charles HABYARIMANA

And

Valentine KANGABE

lxxxii