Summary
Dixon Chibanda, a professor of psychiatry in Zimbabwe, has implemented a mental health program in which trained grandmothers provide free mental health care assistance to people in need. Sitting at the Friendship Bench, grandmothers and participants develop a relationship based on trust, which promotes feelings of belonging and connectedness, and helps relieve some of the symptoms of depression.
A successful case study, the program has been exported to several other countries as a way to improve mental wellbeing and quality of life.
Story
Two decades ago, a severe shortage of mental health professionals was already a rather concerning issue – not only in Europe and America, but also in Africa. In Zimbabwe, a country of 16 million people, there were only 15 psychiatrists.
Young and talented, Dixon Chibanda was one of them.
One of his patients, lacking access to mental health care in her village and unable to afford the $15 bus fare to travel 160 miles to see him, ended up taking her own life.
The tragic loss of a patient to suicide was a turning point in Chibanda’s career. In that moment, he decided to devote his career to solving the problem of how to help people who most need mental health care but face financial, geographical or cultural barriers to accessing it.
In his research, while exploring several ideas for recruiting and training mental health care practitioners, Chibanda found there was already a large cohort of experienced, empathetic, respected caregivers who were ready and willing to help: grandmothers.
Chibanda strongly believes that “the most important resource that is left in most communities are grandmothers, because they are custodians of local culture and wisdom.”
In order to put his idea into practice, Chibanda worked with the Ministry of Health and Child Care, as well as the University of Zimbabwe, to develop a pilot program to train older women in a mode of evidence-based talk therapy known as “problem-solving therapy.” The aim was to reinforce the women’s capacity to listen, to make people feel heard and seen, to give patients a feeling of belonging, and to help them gain the confidence to find their own solutions.
From the beginning, Chibanda discussed the idea with a group of grandmothers, who were actively involved in shaping the free program. Together, they decided it would be better to provide the service in an informal location – a park bench (instead of an intimidating clinical setting). As a way of eliminating shame and stigma, the grandmothers suggested calling it the Friendship Bench (instead of the “Mental Health Bench”).
They also advised the use of local idioms, as well as the avoidance of overly clinical language. For example, rather than talking about depression or anxiety, the grandmothers often use the gentler Shona word kufungisisa, which really translates as “thinking too much.”
An empowering sense of acceptance and belonging underlies many of the Friendship Bench interactions – and it is reciprocal. Not only do participants report a reassuring feeling of connectedness, but grandmothers also acknowledge gaining strength and sustenance from feeling part of a community that extends way beyond the bench:
“I learned that I am important to other people,” Grandmother Sabinah said. “People keep coming to me – it makes me see that I’m doing a good job in the community.”
The Friendship Bench has been so successful in Zimbabwe, it has sparked international curiosity. There are already almost 100 peer-reviewed studies on different aspects of the Friendship Bench, including its effectiveness. Significant improvement was observed in participants with depression who received therapy from a trained grandmother. At six months, participants who interacted with these lay health workers (LHWs) were, according to a range of indicators including fear, anger, and sleep patterns, better off than those who received therapy from a community mental health nurse or psychologist.
In 2022, the program reached over 60,000 people in Zimbabwe. Similar projects have been launched in other countries. A pilot project is being instigated in New York and the model was showcased at the Qatar World Cup.
The Friendship Bench is now registered as an NGO in Zimbabwe. Guided by their values of compassion and connection, and anchored in over a decade of research, the team has “re-imagined the delivery of evidence-based mental healthcare.” They envision a world where a Friendship Bench is within walking distance for all.
This story was originally published by The Boston Globe.
