Friendship Bench: A Scalable Model of Community Mental Health Care

“Let’s be the first ones to go there and tell them depression is real, depression is normal and it’s something that you can pull out from if we work together.”

Friendship Bench counselor (“grandmother”)¹ 

What are you to do if you are living with depression in a country with only 12 psychiatrists and 16 psychologists for a population of 13 million? This is the conundrum the Friendship Bench project in Zimbabwe seeks to address, using an innovative model for delivering psychological interventions.² People can visit a bench located in a discrete area outside a primary care facility to speak with a “grandmother.” These grandmothers are lay health workers trained and supervised by clinical psychologists and psychiatrists to deliver problem-solving therapy.^2–4 

 

“I now have a friend, hope, and the will to live.”

Person who used the Friendship Bench service.⁵

A community-based model that works

Founded in 2006, Friendship Bench has treated over 279,913 people both in person and online. The number of locations is expanding, and the team has a vision of a Friendship Bench within walking distance for all.⁵ A randomized clinical trial reported that the intervention group had significantly fewer symptoms at 6 months compared with a control group.³ Tracking metrics collected as part of the Friendship Bench revealed that 82% of people engaging with the program showed a significant decrease in symptoms of depression after 6 weeks.⁵ This inspiring project demonstrates how we can try to tackle access issues and other barriers to mental health care with novel solutions.

“By training local buddies and community members as interventionists, the Friendship Bench enhances the capacity of the community to address mental health issues effectively. This helps to reduce the stigma associated with mental health.”

Tarisai Bere, Senior Clinical Psychologist 

 

“Seeing individuals healing, gaining coping skills, and improving their mental well-being through the support offered by the Friendship Bench is incredibly gratifying.”

Tarisai Bere, Senior Clinical Psychologist

Tailoring the approach to suit the individual

People can benefit from the Friendship Bench project both in person as well as virtually on a messaging app. Following an assessment and screening, the structured program branches into several pathways, including follow-up and the offer of additional services. Pathway one is a discussion with the lay health worker who provides advice before discharging them, pathway two is the offer of up to six free, confidential problem-solving therapy sessions, and pathway three is referral to a supervisor for initiation of specialist care.⁴ People can choose to attend group follow-up sessions to facilitate community discussion or take part in activities such as self-directed care and workplace training.^2,4

“Improving mental health care in Zimbabwe is an ongoing process that involves several key efforts [including] digital platforms that assist in providing therapy sessions and self-care resources. The Friendship Bench has scaled up to all provinces in Zimbabwe, and several technologies have been implemented to support this.”

Providence Tsungai Jongwedzvuku, Strategic Information and Evaluation Officer 

Embedding regional knowledge and social structures into care

The project leverages the traditional role of “grandmothers” as community leaders (although project participants are not always actual grandmothers or even women). This approach fosters a family feel and enables the lay health workers to understand patients as individuals, driving change at a community level.⁴ The concept was developed in collaboration with the community, incorporating accessible language and local idioms, such as the term “kufungisisa,” which is used to describe emotional distress and literally translates as “thinking too much.” This collaborative approach was used to validate and translate the screening tools and was designed to maximize community engagement with the program.⁴ The problem-solving therapy approach was chosen to minimize the influence of stigma around certain types of discussions about emotions. The approach incorporates key elements of kuvhura pfungwa (opening of the mind), kusimudzira (uplifting), and kusimbisa (strengthening).²

“I have gained practical skills and knowledge that have positively impacted my life and my work at the Friendship Bench. I realised there is so much to learn.”

Providence Tsungai Jongwedzvuku, Strategic Information and Evaluation Officer 

A scalable model that weaves in digital and in-person approaches 

Friendship Benches can now be found across 23 districts of Zimbabwe, with additional benches in neighboring countries. Ongoing projects are incorporating and furthering the use of digital approaches to maximize the benefits for people living with mental health conditions.⁵ Members of the project team have been further expanding the reach of the program by supporting adaptation of the idea to different settings, locations, and cultures. This includes a pilot program of pop-up benches in New York City in the United States and adaption of the program to address mental health disorders in members of a vulnerable population people in Vietnam.^1,6 Access to mental health care and stigmatization of people seeking help is a global problem requiring understanding of patients as individuals and open-mindedness to novel approaches.

“I really like it when I see our efforts being recognized and our intervention being taken up, but more so I really get excited when I hear the testimonies of healing.”

Tarisai Bere, Senior Clinical Psychologist 

Cite this piece as Friendship Bench: A Scalable Model Connecting Psychiatry. Published March 2024. Accessed [month day, year]. [URL]

SC-US-76704

SC-CRP-14916

December 2023