There are far more grandmothers in the world than there are psychiatrists, and increasing numbers of them are helping troubled people through an elegantly simple solution – psychological therapy they deliver on a bench in their community.
Dixon Chibanda, who works in Harare, is one of 12 psychiatrists who serves Zimbabwe’s 14 million people. He developed the Friendship Bench program starting in 2006, the year after government destruction of houses and buildings left 700,000 people homeless and two million people traumatized.
He was told to survey the psychological impact and then, when he presented the results, told to develop an intervention, even though there were no resources and many professionals had left.
But there were grandmothers, and as they most often do, they had solutions to offer when they were asked. Fourteen gogos worked with Chibanda to develop a pilot project that became the Friendship Bench – psychological therapy delivered on a bench in the community by grandmothers.
It has treated 280,000 people in its 16 years of existence, in 70 communities across Zimbabwe and at spin-off projects in Malawi, Kenya, Zanzibar, Vietnam, and New York City. And soon, it will be in London, too, in 2024.
“Whether it’s London, New York or Zimbabwe, everywhere the issues are similar,” Dr. Chibanda told Positive News. “There are issues related to loneliness, access to care, and to just being able to know that what you’re experiencing – whether you call it stress or depression or anxiety – is treatable.”
He has a much larger vision, which he set out in a TED Talk in 2018. There are more than 600 million people in the world aged 65 and above, he says, and by the year 2050, will be 1.5 billion people aged 65 and above.
“Imagine if we could create a global network of grandmothers, in every major city in the world, who are trained in evidence-based talk therapy, supported through digital platforms, networked,” he said. “And they will make a difference in communities. They will reduce the treatment gap for mental, neurological and substance-use disorders.”
Anchored in more than a decade of rigorous research, the Friendship Bench program has been part of Zimbabwe’s National Strategic Plan for Mental Health Services since 2019.
“Our vision is a Friendship Bench within walking distance for all. With this inspiration, our mission is to get people out of kufungisisa – depression & anxiety – by creating safe spaces and a sense of belonging in communities to improve mental wellbeing and enhance quality of life. Guided by our values of empathy and connection … we have re-imagined the delivery of evidence-based mental healthcare.”
The Friendship Bench clinical team trains community health workers to provide basic Cognitive Behavioural Therapy with an emphasis on Problem Solving Therapy, activity scheduling and peer led group support, thus delivering “an effective, affordable and sustainable solution to bridge the mental health treatment gap at a primary care level.”
The talk therapy is offered to people with mild to moderate level common mental health disorders, such as anxiety and depression, known locally as ‘kufungisisa’- thinking too much. “In practical terms, participants are taught a structured approach to identifying problems and find workable solutions.”
It’s that problem solving approach that attracted WHO Zimbabwe. Zim is one of six countries chosen to be part of the World Health Organization’s Special Initiative for Mental Health, which aims to see 100 million more people have access to quality and affordable mental health care by 2023.
The trained grandmothers sit with their clients outdoors, under the trees, on wooden park benches in discreet safe spaces in the community. After the talk therapy, clients are connected to others through a peer led support group known as Circle Kubatana Tose (CKT), meaning ‘holding hands together’.
This safe space to talk in and be heard reduces stigma surrounding mental health and sharing of personal issues. The CKT groups engage in revenue generating opportunities such as learning to crochet bags, hats and mats from recycled plastic bags and old VHS tape ribbon, so the group becomes a vital part of the intervention in a country where poverty is extremely high.
There has been a lot of serendipity in the Friendship Bench story, and the latest instance is Inuka.In 2014, Robin hit burnout. When she had recovered, her manager offered her the opportunity to explore ways to reach people with life challenges and mental health troubles earlier to prevent them spiraling out of hand – and that was how she met Dr. Chibanda.
“Robin and Dixon realized that together they could make a real difference. By providing affordable, non-stigmatized mental health support, accessible for anyone, anytime, anywhere, they could make a difference in mental well-being. And by using technology to scale up Dixon’s brilliant innovation in coaching, they could make mental health support even more accessible and effective.”
And so Inuka Coaching was born – a digital platform that trains people in two months to be an Inuka coach.
Zimbabwe’s therapeutic ‘friendship benches’, coming to a city near you. Positive News, Jul. 26, 2023
Cover image: Friendship Bench website.