Lessons From Zimbabwe on Mental Health Treatment

Zimbabwe rarely makes it into the news, except in regards to its venal autocratic regime and sensational rate of hyperinflation. But for all its woes — and perhaps because of them — the country’s citizens have proven to be creative, resilient, and resourceful, as evidenced in part by their fascinating idea of “friendship benches” –nondescript park benches located throughout major cities that help facilitate therapy and mental health services. As NPR reports:

Dr. Dixon Chibanda, a psychiatrist at the University of Zimbabwe, came up with the name Friendship Bench — or chigaro che hushamwari in Shona — back in 2006. In Zimbabwe, as in most places, there’s a lot of stigma around mental illness. Patients may feel uncomfortable with the idea of going to a mental health clinic. Traditionally, Zimbabweans with depression may see a healer about an exorcism — many view mental illness as a curse. And there is a shortage of professional help: 13 psychiatrists serve a population of 13 million.

While completing his master’s in public health, Chibanda was looking for a solution. After speaking with various community leaders and health workers, he figured out that while people were loathe to head to a mental clinic and speak with a lab-coated medical professional about their mental health, they were generally willing to sit on a park bench and share their worries with someone within their own community.

At these benches, community counselors and patients meet weekly to discuss intimate issues — and develop a plan to overcome difficulties. As part of the treatment, there are also group therapy sessions, when patients gather and sit around the bench. “It’s all about empowering people to go and solve their own problems,” Chibanda says.

A recent study published in JAMA validated this unique approach: it followed 573 patients with anxiety or depression for a six-month period, half of whom received standard treatment (speaking with a nurse about their problems and being given medication if applicable) while the other half went a Friendship Bench to meet with trained community members. By the end of the study, half of those who received basic treatment continued to struggle with depression, compared to 13 percent of those who used the Friendship Bench.

The key to the program’s success lies in the fact that most of the counselors are older women who are respected members  of their communities. This makes it easier for locals to open up about their problems, admit that they have a mental health issue, and accept pychiatric help. The community counselors also undergo continuous training and supervision under the auspicious of formally trained professionals.

Friendship Benches also take into account cultural attitudes, eschewing foreign or clinical terms that may be unrelatable or even off-putting:

 

The counselors avoid the Western terms “depression” and “anxiety,” which to many might sound foreign and unrelatable. Instead, the counselors may suggest that someone has been “thinking a bit too much” and guide them through the different stages of talk therapy, which in Shona are called kuvhura pfungwa (“opening of the mind”), kusimudzira (“uplifting”), and kusimbisa (“strengthening”). “We use indigenous terms,” Chibanda says. “These are words that people in the community can identify with.”

This initiative has already helped 27,000 people suffering from mental health problems, and is now expanding through Zimbabwe, although it will need more funding to continue growing (something that will be difficult in the country’s repressive and economically unstable environment).

 

Still, many outside observers believe the Friendship Benches have tremendous potential well beyond Zimbabwe:

“It’s just a great model, and it’s impressive,” says Brandon Kohrt, an assistant professor of psychiatry at Duke University who wasn’t involved in the development of the Friendship Bench program or in the recent study.

“It’s often very stigmatizing to have to go to a mental health professional,” Kohrt says. “So it’s great that their approach didn’t require people to go to a location — like a psychiatric hospital — that was seen as somewhere only really ill incurable people went.”

The program also attests to the power of community, says Kohrt, and harnessing the community to support those suffering mental illness. He believes that “the lessons from this can be applied globally, even in high income countries.”

Given the near-universal stigma towards mental illness, the program’s ability to bridge the discomfort and shame experienced by most sufferers will no doubt prove invaluable if applied elsewhere in the world.

What are your thoughts?

 

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