When you’re down and depressed, how do you seek help for the problems in your life? Probably, you’d turn first to your friends, your relatives, and, if things persist, perhaps a medical professional.  However, what would you do if the nearest psychiatrist was 100 miles away, impossibly expensive, and responsible for over a million other people in your community?

This is the situation for many suffering people living withfrom mental illness in Africa.  Mental health is a cornerstone of overall health, yet on the African continent, serious gaps exist in options for mental health treatment. In Zimbabwe, for example, 13 psychiatrists serve a population of over 13 million people; in Ethiopia, there are only 10 psychiatrists for a population of nearly 61 million people. Not only are the options severely limited and costly, but getting treatment for mental health can is often be intimidating for those who need it the most due to the serious cultural stigma around against mental illness. Traditionally, mental illness in Zimbabwe is considered to be caused by malevolent, supernatural forces, which leads some to seek exorcism by a traditional healer. In traditional frameworks and conventional health systems alike, many people who suffer are often quite reluctant to seek professional help. 

Instead of turning to conventional medical treatment for mental illness, what if you had a support system rooted in your community;, a group of people who you knew, trusted and could confide in? This is the basis of the Friendship Bench, a project initially conceived in 2006 by Dr. Dixon Chibanda, of the University of Zimbabwe. The project was implemented in 2012 through a grant with Grand Challenges Canada, and it uses cognitive behavioral therapy to assist community members manage the symptoms of depression.  Depression in Shona is known as “kunfungisisa”, which is literally translated to “thinking too much.”  

Unlike conventional mental health treatments, the Friendship Bench uses benches in community health clinics to create a safe space for those suffering from kunfungisisa to share their concerns with another community member. Traditionally, mental illness in Zimbabwe is considered to be caused by malevolent, supernatural forces, which leads some to seek exorcism by a traditional healer. Additionally, as in many places, there is a stigma associated with mental illness, and people who suffer are often quite reluctant to seek professional help.  

The Friendship Project presents patients with an option to talk to a member of their community who has been trained in behavioral therapy about their problems. Due to a more informal setting, the Friendship Bench mitigates the shame associated with treatment of mental illness and provides an opportunity to be supported. Participants and local community health workers meet weekly at a bench in the community health clinic to discuss problems and to work through possible solutions. There are also group therapy sessions facilitated at the bench, where several people suffering from depression meet with a community leader to work through different issues that each participant is facing.

Unlike conventional treatment, the Friendship Bench avoids the use of Western terms like “depression” and “anxiety,” which serve to alienate patients. Instead, community health workers, who are often older women who traditionally hold a leadership roles in the community, guide patients through several stages of therapy with the usage of Shona terms that are more resonant and familiar. This approach has proven to be effective, not only in treating mental illness, but also for easing the stigma around mental health in the community. 

Research into the results of the Friendship Bench have demonstrated the effectiveness of the project, and not only in the short term, but also six months after treatment had been completed.  In a study conducted in Harare, participants in conventional and community- based therapy groups were monitored during and after treatment. For those who received conventional treatment, 50 percent experienced a return of symptoms within six months, compared to only 13 percent of participants in the Friendship Bench project.

In addition to the problem-solving aspect of the therapy, there is also an aspect of the project, “Zeebags”, that incorporates peer support groups and income generation. Several participants in the initial phase of the Friendship Bench project came together to work on creating upcycled bags made from old VHS tapes. During the time they worked together, they would discuss their lives and the various challenges they were facing, creating a setting for group therapy as well as a way to generate income for themselves and their families. These bags, “Zeebags,” are marketed locally and internationally, and many of the women who first joined the group are still members some , six years since the group therapy program began.  Other participants went on to start their own mini-lending schemes, and formed their own peer support groups. 

The Friendship Bench initiative is currently based in Harare, but the group plans to eventually reach the nearby cities of Chitungwiza and Gweru through efforts to scale up the project. It will be implemented across 60 health clinics, and will target over 14,000 people.

The success that has already been documented in the Friendship Bench Project sets an innovative example for other public health care providers across the continent. Perhaps this approach, combining traditional community leadership and conventional therapy techniques, could be adopted for an effective, replicable solution to alleviating the burden of mental health across the continent. So, next time when you’re feeling down, grab a friend and head to the nearest park bench for a chat. It might be just what the doctor ordered.  

Useful Links

O. Gureje and A. Alem. “Mental health policy development in Africa.” World Health Organization. 

“The Friendship Bench Project.” The Friendship Bench Project. 

“The Friendship Bench Can Help Chase the Blues Away.” 10, Jan. 2017. National Public Radio. 

“Effect of a Primary Care-Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe: a Randomized Clinical Trial.” 

 

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