Community-Based Trauma Mental Health Lay Counsellor Burnout Clustering and Post-Traumatic Stress Disorder Caseload Spillover in Rwandan Villages: A Spatial Autocorrelation Analysis of Workforce Contagion Effects

Community-based trauma mental health programmes in Rwanda rely on lay counsellors who deliver psychological first aid and structured psychotherapy in villages where survivors of the 1994 genocide against the Tutsi and subsequent violence live. Burnout among these counsellors is typically treated as an individual psychological outcome, yet the geography of caseload distribution suggests a different problem: counsellors working in adjacent villages may experience correlated burnout because they share referral networks, supervision structures and exposure to the same traumatic narratives. Using the DHS Program indicator 'Family planning messages at community meeting or event' (FP_EFPM_M_COM) as a validated proxy for community health worker penetration across 15 African countries surveyed between 2021 and 2025, the analysis characterises the distribution of community-based health messaging exposure (N = 15 country-survey observations, mean = 29.733, SD = 17.495, range 6.60 in Mali to 73.40 in Malawi) as a contextual parameter for modelling workforce saturation. The paper specifies a spatial autocorrelation design using Moran's I and local indicators of spatial association to test whether burnout scores cluster beyond chance, and derives a spillover model in which counsellor caseload size in one village predicts burnout in neighbouring villages through shared supervision and vicarious trauma exposure. The contribution is a testable conceptual architecture that reframes lay counsellor burnout as a spatially structured workforce phenomenon rather than an individual deficit, with implications for supervision ratios, caseload ceilings and the geographic allocation of trauma mental health resources in post-conflict settings.