Training the Elderly to Fill Mental Health Worker Gap

friendship bench

On a quiet wooden bench on the grounds of a small local clinic on the edge of Zimbabwe’s capital, Harare, a young woman sits down with an Ambuya Utano, a lay health worker often referred to as ‘grandmother,’ who uses talk therapy to help her work through her severe depression and anxiety.

It’s a lifeline the woman would have not been able to access through the country’s strained medical system and, although seemingly unsophisticated in its approach, this rudimentary therapy couch (called a Friendship Bench) provides critical access to support for thousands of vulnerable Zimbabweans in the same position.

The World Health Organization (WHO) estimates that one in four people will suffer from mental health problems at some point in their lives – for Africa those numbers could run into the hundreds of millions. In Zimbabwe, with a population of around 15 million, around a quarter of the country’s primary care patients suffer from depression, anxiety, and other mental disorders, yet there are only 10 psychiatrists and 15 clinical psychologists in the entire country available to treat them.

Add to this the stigma of mental illness that is still prevalent in many communities throughout Africa, and the likelihood of not receiving or even seeking treatment.

friendship bench

The Friendship Bench project is an innovative solution that tackles this complicated problem with a unique, community-oriented approach. It’s really a network of community-based volunteers, specialists, and health workers who are trained in various intensive talk therapy techniques to provide treatment to those suffering with mental health problems.

The lynchpin of the therapy are the grandmothers who work to provide a safe and comfortable environment for patients to relax on these wooden benches and speak freely about their problems. Each patient is referred by a clinician and can receive up to six 45-minute counselling sessions which can include a home visit from the grandmother too, and in some cases, a referral to other health and social services. In certain instances, the grandmother can also refer the patient to income-generating activities to help alleviate stress and anxiety in their everyday lives. These low-impact cognitive therapy techniques are designed to help each patient get to the root of their problem and work with the grandmother to develop coping mechanisms for their mental illness.

The initiative is more than just a panacea, it’s already seeing significant results. In just two years, the project has already expanded to reach more than 10,000 vulnerable Zimbabweans. The goal is to boost that up to around 50,000 people a month once the initiative expands nationwide. Given the success the project, which is already scaling up to 60 clinics in three cities, this target already seems well within reach.

Funded by the Canadian Government through Grand Challenges Canada, a trial gauging the efficacy of the Friendship Bench project was conducted in Zimbabwe through King’s College London, the London School of Hygiene & Tropical Medicine, and the University of Zimbabwe. Patients were randomly selected and monitored over a period of six months where they participated in six weekly Friendship Bench session with their ‘grandmother’ therapists. The results were impressive. After only a few weeks the majority of the participants showed significant improvement in the severity of their depression, anxiety, and suicidal thoughts. Add to this, after receiving the problem-solving therapy for six months (and compared to patients who only received standard care), Friendship Bench patients with depression or anxiety were now three times less likely to experience these symptoms and five times less likely to have suicidal thoughts when measured against a control group.

friendship bench

This year the Friendship Bench initiative has been expanded to reach other vulnerable populations including the disenfranchised youth and refugees; partnering with the Swedish NGO SolidarMed, the Friendship Bench project is also working to extend its model to the Masvingo province, and after that throughout refugee centers of the eastern highlands on the border with Mozambique.

Photo credit: Grand Challenges Canada/Friendship Bench