'Friendship Bench' tackles Zim's mental health crisis

HARARE - Friendship Benches — located in the grounds of health clinics around Harare and in Gweru and Chitungwiza — are helping patients with depression or anxiety with problem-solving therapy.

The practitioners, who operate from simple wooden seats, are lay health workers known as “Community Grandmothers,” or “Mbuya Utano”, trained to listen to and support patients living with anxiety, depression and other common mental disorders.

But the impact, measured in a ground-breaking study, shows that this innovative approach holds the potential to significantly improve the lives of millions of people with moderate and severe mental health problems in countries where access to treatment is limited or nonexistent.

Six months after undergoing six weekly “problem solving therapy” sessions on the Friendship Benches, participants showed significant differences in severity of depression, anxiety, and suicidal thoughts.

At least 30 000 people have received mental health  care through the Friendship Benches, in the last six months, a figure that shows the extent of mental illness problems in Zimbabwe.

With only 13 psychiatrists and 12 clinical psychologists in the country, it is the health grannies, who are leading the fight against depression.

Depression, according to psychiatrist and founder of the Friendship Bench project, Dixon Chibanda, is a condition referred to in the Shona language as chirwere chekufungisisa or a disease triggered by thinking too much.

“When we think of increased access to mental health services, we need to focus on taking mental health to the community. There are a lot of people who still believe that we need to build more mental health institutions, which is an outdated line of thinking. We really should be taking mental health to the community with simple interventions like the Friendship Bench.

“If we strengthen communities by empowering members of the community such as these grandmothers with mental health skills, we will improve the collective community’s capacity to problem solve.”

Where the grannies are unable to cope, they refer clients to the next level, which is the district health promoting officer. If the district health promoting officers (DHPOs) cannot handle it, they go to the clinical psychologist or the psychiatrists.

“But we have learnt that they are extremely efficient,” Chibanda said of the grannies.

But how rampant is this problem in Zimbabwe?

Government statistics show that one in every four Zimbabweans suffer from mental illness. But Chibanda said people needed to be careful with the classification of the statistics.

“Often when people talk about one in four, they are talking about depression. A lot of people are suffering from depression or kufungisisa which is characterised by low self-esteem, lack of motivation, sleep disturbances, poor functioning and at times feeling suicidal or wanting to harm yourself.

“The rate of suicide or deliberate self-harm is high in Zimbabwe and this is largely due to kufungisisa or depression.

“Obviously the socio-economic environment is not encouraging; it’s very difficult for a lot of people,” he said. 

“So as we say one in four, we have to be careful because we cannot take rates that are unique to clinics and generalise them to the community. If 30 percent of people coming to the clinic have mental illness, it does not mean that 30 percent of people in the community have mental illness. Having said that, it’s still quite high in the community,” he said.

Chibanda said people who suffered from other chronic illnesses such as diabetes, hypertension and HIV often suffered from depression as well.

“So today in Hatcliffe, we are actually piloting an HIV component of the Friendship Bench because a lot of people living with HIV suffer from depression and if depression is not treated among people who are HIV positive, the outcome of the HIV itself can be worse because  depression can hasten HIV disease progression, that is why it’s important to treat it.

“We have also found that people with hypertension or diabetes for instance, when they have depression and you don’t treat the depression, the hypertension and diabetes can get worse.”

He said the prevalence of depression among people living with HIV was very high, above 30 percent and this is not just in Zimbabwe but across the region.

“If you look at the post-natal period as well, studies locally have shown that 33 percent of mothers attending the six weeks post-natal clinic suffer from post-natal depression. That is a big problem and it’s not being addressed,” he said.

The other issue is substance abuse.

“Bronco, mbanje (marijuana) and all sorts of cough syrups, and now we also have cocaine, and a wide range of substances which are being brought in illegally are abundant in our communities, this is why you need these Friendship Benches,” Chibanda said.

Mbuya Utano Gogo Dzukwa, 52, who has been running friendship benches for the past three years, said the intervention has become instrumental in helping people deal with their issues.

“Where we are sitting here, we call it Bhenji Rehushamwari, talking to people who have problems. For example, the one I am sitting with had issues of acquiring birth certificates for her children for them to be admitted into school, as she herself does not have an identification card (ID). 

“We are also coming across issues of domestic violence , and those who are living with HIV and others who are unemployed and feel they have no way to get money,” she said.

“These problems can lead to serious kufungisisa, sometimes even driving people to suicide if they are not addressed.

“We are talking to these people to open their minds, uplift them and strengthen them as we were taught by the Friendship Bench team and our DHPOs.

“And most of the people are finding it helpful like the one I am sitting with, was able to find someone to help her get the birth certificates, after we went through these components.

“People are opening up — kuvhura pfungwa — because they also know that they are telling us their issues in confidence. We are now doing this every day because the number of people scoring high on our screening tool the SSQ-14 is increasing.”

For Rudo Muchemwa, a 28-year-old mother of two, the Friendship Bench intervention came at the time she was thinking of ending her life.

“I came here crying because I was depressed and questioning what would become of my kids in this world. It got me depressed and stuck to a point where I wanted to end my life and throw myself in the road. But I got counselling from mbuya (granny) and it helped me,” Muchemwa said.

Other countries have now shown interest in the Friendship bench project. According to Chibanda, there has been interest from Malawi, Botswana, Ghana, Ecuador, as well as New York City, which has started piloting aspects of the Friendship Bench using Zimbabwe’s training materials. In July 2017, New York City will be launching the Friendship Bench program.

Comments (1)

How do i join our sessions

Mitchelle - 27 October 2017

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