Mental health issues loom large over the world. There are an estimated 300 million people worldwide with depression and 800,000 people committing suicide every year with the latter more likely to occur in developing countries. So it might be funny to hear that Dixon Chibanda, a psychiatrist and director of the African Mental Health Research Initiative is discouraging the construction of new mental health facilities. Instead, he is advocating for mental health to be taken to the community. His ‘Friendship Bench’ program has already helped over 50,000 Zimbabweans with their mental health issues across 70 communities for free. What is even more surprising is that all of these benches are manned by local grandmothers, not trained professionals.
Chibanda’s initiative for this program began in 2005 following a slum clearance of more than 2 million people. He conducted a survey of those people and was surprised to find how high, the rate of mental health issues were. Despite talking to his superiors and the authorities, he was not afforded any extra funding or staff but instead was given 14 grandmothers. It was with them that the idea of a ‘Friendship Bench’ started and he started training them. However, they would not accept western concepts like ‘depression’ but instead argued to be able to speak the language that patients themselves understand. Thus, concepts from the predominantly spoken language Shona such as ‘strengthening’, ‘opening up the mind’ and ‘uplifting’ formed the basis of the Friendship Bench approach rather than any foreign counterpart.
The program has been found to have exceeded expectations on multiple levels. A randomised study of 573 patients with common mental health issues in 2014-15 found that those in the Friendship Bench had significantly lower symptoms than those receiving conventional treatment. Another intriguing factor in this is that the grandmothers themselves do this daily without burning out and do not cope with high rates of mental health ailments themselves. One emerging explanation is altruism, where they feel they are getting something out of making a difference in other people’s lives. The success of the program has meant that now over 400 grandmothers are participating in the Friendship Bench. Additionally, the program has now been introduced in other countries with their own variations. In Malawi, it is elders of both genders providing advice, Zanzibar uses younger men and women while New York includes individuals of all ages, races and even those from the LGBTQ community.
This new and innovative model has the potential to be replicated around the world with its roots grounded in local language and culture. Perhaps it can even become a global model to take mental health to the public, reducing stigma, discrimination and increasing acceptance and resilience for all.