The Friendship Bench Project takes mental health to the community

Outside many primary care clinics in Zimbabwe, you can see people sitting, talking on a bench. These aren’t ordinary benches – they are part of the Friendship Bench Project. This project was started by Dr Dixon Chibanda, a senior psychiatrist, and the principal investigator of the project. During his field work for his Masters of Public Health in 2006, Dr Chibanda investigated the prevalence of common mental disorders (depression, anxiety, and post-traumatic stress disorder) in the low-income population around Mbare, and found that 43% of the surveyed group suffered from one or more CMD.

At the time there were no resources available for mental health care – space, staff, or financing. According to the World Health Organization, depression is the greatest contributor to disability in the world. The difficulties faced by Zimbabweans – unemployment, illness, disease, lack of financial security – make for a toxic combination, often causing deterioration of mental health.

With mental health care centres being often viewed with suspicion, people are often reluctant to get professional help. And of course – many people are unable to afford services offered by counsellors or therapists in private practices. There is still a strong reliance of a faith-based approach to dealing with mental health issues, which can create complications as the underlying causes often go unaddressed.

Along with Ruth Verhey and other dedicated professionals, Dr Chibanda conceptualized a model to bring mental health care to the community through therapy on a bench. People who visit primary care centres fill out a mental health questionnaire, tailored for Shona-speakers, using culturally relevant terms. If someone scores below a certain point, they are referred to the Friendship Bench, where grandmothers listen to the patient, and together they come up with a plan of action to start addressing problems underlying their CMD.

These grandmothers have received training from the team to become lay health workers, and are paid by the City Health Department to serve people on these benches. The Friendship Bench Project uses evidence-based intervention therapy in the form of cognitive behavioural therapy (CBT). This method focuses on how thoughts influence feelings and behaviours, and breaks negative cycles using problem solving therapy, behaviour activation, and activity scheduling.

All of the team’s investigations and findings have been recorded and analysed, making sure that the project is backed by solid, scientific evidence. The team carried out a cluster randomized control trial, which showed that the Friendship Bench Project can successfully and reliably provide treatment for depression on a primary care level, in a way that is culturally acceptable in Zimbabwe. The grandmothers on the Friendship Benches did better than anti-depression medication, in a trial that was conducted over six months, in which the grandmother’s referents had improved economic functioning and quality of life. The Friendship Bench Project is unique in that it takes mental health care to the community, through the community. It really works!

Next steps
Since only last year the Friendship Bench lay health workers have seen over 40,000 people. The Friendship Bench has scaled up since it started in 2006, from the initial location in Mbare, to cites all over the country. The next step for the Project is the imminent opening of the Friendship Bench House in Milton Park. The House is designed to be a home for the team, a training centre for the health workers, as well as a resource and counselling centre which uses the Friendship Bench method. At the moment, the House is undergoing renovations. At the moment the Friendship Bench Project generates no income – everything is done on a volunteer basis (except for the grandmothers, who receive a salary).

The team is looking for partners to help create a beautiful and functional home for the Project – please contact them if you would like to get involved. Specifically, they are looking for volunteers to help with the garden, donations of plants, and help with setting up a solar electricity system.

hello@friendshipbenchzimbabwe.com
Dr Dixon Chibanda dichi@zol.co.zw
Ruth Verhey ruth.verhey@zol.co.zw

Zeebags
A group of women suffering from depression have been meeting regularly for the past six years as part of their behavioural activation and income generation component of the Friendship Bench Project. Zeebags are bags that the women make out of recycled plastic, while they share stories and experiences. All proceeds from the bag sales go to the women, to help them feed their families and pay for medication and other expenses. The experience of Zeebags then merged into the Circle Kubatana Tose, used in the Friendship Bench Trial, where long term participants of the Zeebag team were trained to run peer support groups in the intervention clinics and teach others how to make Zeebags. Support this initiative by purchasing Zeebags at the Christmas Fair at The Mustard Seed (27 Ridgeway South) on 1st December.

References:
World Health Organization Depression Fact Sheet: http://www.who.int/mediacentre/factsheets/fs369/en/
World Health Organization, Global Health Observatory, Country Profile, Zimbabwe: http://www.who.int/gho/countries/zwe/country_profiles/en/
The Friendship Bench Zimbabwe: www.friendshipbenchzimbabwe.org