Friendship Bench grandmother and community member

The Friendship Bench

Describe The Friendship Bench

The Friendship Bench program is an evidence-based intervention developed in Zimbabwe to bridge the mental health treatment gap. Our mission is to create safe spaces and a sense of belonging in communities so as to enhance mental well-being and improve quality of life through the use of problem-solving therapy delivered by trained lay health workers, known as Ambuya Utano - Community Grandmothers.

Guided by our values of empathy and connection, and anchored in over a decade of rigorous research (including a RCT published in the Journal of American Medical Association, JAMA) we have re-imagined the delivery of evidence-based mental healthcare.

We deliver the talk therapy and behavioral activation intervention to people with mild to moderate levels of common mental health disorders, such as anxiety and depression, known locally as ‘kufungisisa’- thinking too much. When people visit the Friendship Bench they are screened with a locally validated tool called the Shona Symptom Questionnaire (SSQ-14). If a person scores above the cut-off point, they are advised to stay and receive one-on-one problem-solving therapy.

In practical terms, participants are taught a structured approach to identify problems and finding workable solutions. Once they have had their one-on-one sessions, they are then referred to a peer-led support group, known as Circle Kubatana Tose in Shona, which translates as 'Holding Hands Together'.

Why does the world need The Friendship Bench?

264 million people suffer from depression globally. Depression is the leading cause of disability worldwide. In under-resourced communities, there is 1 mental health professional for every 1.5 million people.

Suicide is the second leading cause of death among people aged 15 - 28 and the most common cause is depression. Close to 800 000 people die due to suicide every year. That's one suicide every 40 seconds. 79% of global suicides occur in low- and middle-income countries.

76% to 85% of people in under-resourced settings who need treatment do not get or cannot access care.

By 2030, mental health problems will cost the global economy US$16 trillion in lost productivity per year!

What is unique about The Friendship Bench?

We are not conventional. Our therapy rooms are outdoors under trees and our therapists are elderly Zimbabwean women. These women are city lay health workers who have become known as Community grandmothers.

What inspired you to start?

In 2005 the Zimbabwean government launched a large-scale campaign called Operation Murambatsvina (“remove the filth”), also officially known as Operation Restore Order. The campaign was set to forcibly clear slums across the country. According to the United Nations, it directly affected 700,000 people by leaving them homeless or taking away their livelihood and indirectly affected about 2.4 million people.

In 2006, I (Dixon Chibanda) was one of only eleven psychiatrists in Zimbabwe, and at the time the only one in the country working in the public health space where we were struggling to provide care to the 12 million-strong population. Carrying out my fieldwork for a Master’s in public health, I found “extremely high” rates of common mental disorders (CMD) such as depression, anxiety, and stress-related disorders as well as substance use disorders. When I approached my supervisors with these findings I was told there were no resources. Not long after that one of my patients, Erica, took her own life.

Erica hadn't come for her follow-up session and then her mother called me to say that she had hung herself from a mango tree. When I asked why they hadn’t come for review, her response was: ‘We couldn’t come because I didn’t have the bus fare’. They did not have the $10 needed to come to Harare.

Lacking any other options, I decided to go back to what the supervisors had to offer me.... 14 Grandmothers (Lay Health Workers) and space outdoors at the clinic grounds.

What have you learned from the experience?

I am always inspired and motivated by the Friendship Bench Grandmothers. Their lived experience and subsequent accumulation of wisdom combined with their ability to empathically connect with people in their communities is something we can all learn from.

What's the one piece of advice you'd give an aspiring change maker?

Initially, I thought: how could this possibly work, with these grandmothers? They are not educated. I was thinking, in a very Western, biomedical kind of sense that you would need psychologists or psychiatrists. to run such a project So my advice would be: Don't rely on the textbook!

What have you achieved so far?

The Friendship Bench has:

• Trained over 700 lay/community health workers

• Seen more than 60 000 clients

• Is active in 5 countries; Zimbabwe, Malawi, Zanzibar, Kenya & New York City ​

The Friendship Bench Impact, published in the Journal of American Medical Association:

• Showed an 80% reduction in depression and suicide ideation

• 60% improvement in quality of life

What are your plans for the future?

The Friendship Bench is currently running a Digital Mental Health Trial, it's essentially a virtual Friendship Bench, it was planned before the Covid-19 pandemic but it is needed now more than ever, as we continue to make evidence-based mental health care accessible and affordable for all.

We are also developing the Friendship Bench for University campuses within our Youth Bench program, and that too is being trialed right now.

To mention a few things, we have a lot going on - you will have to follow our links to keep up!

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