I was on a bus in Central America in a country I had never been before and my poor Spanish had gotten me lost. I had taken the wrong bus and was headed in the wrong direction…not just to the opposite side of town, but so far off that I was headed to the border of yet another country!
The bus wouldn’t stop until we got there and I felt lost, out of control, and unable to think clearly about how to solve my mistakes. As I was mentally beating myself up for how stupid I was, a man who noticed me came and sat next to me.
A calm came over me as he started to ask me questions, tell me where I was, and what I needed to do to get back to my place. My problems quickly shrivelled and I received practical directions home. “It’s all going to be ok,” I thought. I think we could all use that kind of support from time to time.
In Harare, Zimbabwe, an initiative called the Friendship Bench is doing similar support for those who are in need of mental support — and it’s all done by volunteers. In the study, Effect of a Primary Care–Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe, they reported that there were only 10 psychiatrists for the 13 million people in the area.
To address the staggering need for mental health support in the primary care system, they turned to LHWs to fill the gap. What is an LHW? Well, they are lay health workers supervised and trained to give care for a range of common mental disorders. In just a few days of training, these local women (mean age of 53 years; an average of 10 years of education; able to use a mobile phone and resided near their respective clinic) become the game-changer in the uphill battle against common mental health disorders.
The study involved 24 clinics and 573 participants: 286 in the intervention group and 287 in the control group. They were assessed for common mental disorders (CMD) using the Shona Symptom Questionnaire (SSQ-14). The innovative SSQ-14 is the first indigenous measure in sub-Saharan Africa to include localized idioms in their native language when assessing for CMDs. Participants were selected by their SSQ-14 assessment scores being greater than 9 with the average being 10.4. The participants in the intervention group were mostly women (86.4%), and had a median age of 33 years. The control group, on the other hand, received a nurse-led evaluation, brief support counselling, optional medication, and further mental health information.
When the intervention group visited the clinic, they were later sent to a discreet bench where an LHW would be waiting to meet with them. LHWs followed a detailed script outlined in their manual for the 6 sessions. In the session, participants were encouraged to identify problems, then choose one to work on. Together, they would identify a workable solution and then agree on an action plan.
This is an approach used in problem-solving therapy that focuses on resolving problems which results in empowerment. It encourages participants to make steps to better cope with difficulty and take more control over their lives. For example, rather than focusing on, “You are depressed,” and now need to work on this intangible concept of depression, they focus on causes of depression. The person may be unemployed, for instance, and so the LHW and client identify that as problem. Then they find steps to take to solve it. The next time on the bench, they will start from there.
The results from The Friendship Bench have been extremely encouraging. The intervention group experienced an SSQ-14 score drop to an average of 3.81 verses the average 8.90 for the control group. The intervention group also had fewer people exhibiting symptoms of depression (13.7% verses 49.9%) compared to the control group.
When I felt stupid, out of control, and headed in the wrong direction (literally), I needed a friend. I needed someone with a little more life experience than me to come and sit on the bench with me. I am very grateful to that man who gave me some practical actions I could do to get out of my predicament. While common mental health disorders are different than taking the wrong bus, experiencing depression or anxiety can sure feel like it at times. This Friendship Bench brings community volunteers to meet with others living with CMDs in a simple and beautiful way.
I marvel at how some aunties and grannies can be made into the frontline force aiding in mental health treatments. I dream of a day where there is abundant professional mental health support for all, but also community support available along the way. It seems like the countries that are rich in one (professional support), are lacking in the other (community support). The Friendship Bench is an encouraging strategy that can help bring those two together.
At Nurau, we see managers as key influencers who can enable mental health support at the work place. We deliver 15-minute mental health experiences with the latest research. We equip managers to affect change within their work communities. Not only do we bring mental health education and equipping to the workplace, but we envision whole communities blossoming within companies and between managers nation-wide. Imagine managers who can share with other managers going through similar challenges.
This is what the Friendship Bench has shown to work and what Nurau wants to make possible.
Chibanda, D. et al. Effect of a primary care-based psychological intervention on symptoms of common mental disorders in Zimbabwe: A randomized clinical trial. JAMA - J. Am. Med. Assoc.316, 2618–2626 (2016).