A BENCH WITH A HIGHER PURPOSE
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The Friendship Bench is a multi-component intervention designed to address common mental health problems, including symptoms of depression, anxiety, and trauma. It utilises talk therapy delivered by a trained lay health worker and peer support. The programme applies problem-solving therapy to encourage a positive and structured approach to identifying and addressing problems that negatively impact mental health. Because poor mental health is a significant risk factor for experiencing and perpetrating intimate partner violence (IPV), mental health interventions have the potential to prevent or reduce violence by improving mental health outcomes.
The programme includes four to six one-on-one sessions, six group sessions, and weekly supportive text messages. Lay health workers, called Ambuya Utano, or community “grandmothers,” guide recipients to identify solvable problems, brainstorm solutions, create action plans, and implement them. They use local concepts, such as kufungisisia or “thinking too much” and mwoyo unorwadza or “heavy heart,” instead of anxiety or depression. Participants join local peer groups for social activities such as singing and prayer, income-generating activities such as crocheting items for sale, and mutual aid activities.
In a cluster-randomised controlled trial in Harare, Zimbabwe, recipients were over 70 percent less likely to report depression, anxiety, or disability after six months. They also reported improved quality of life than those receiving usual care. Also, those reporting IPV experienced mental health improvements.
Zimbabwe Health Trust, Zimbabwe Health Training Support, and Grand Challenges Canada initially funded the programme. It was a collaborative effort coordinated by the Medical Research Council of Zimbabwe and the London School of Hygiene & Tropical Medicine in partnership with the Harare City Health Department. If you want to adapt the programme, we recommend contacting the Friendship Bench Consortium first.
- Effective features for promoting mental health AND reducing IPV include positive coping strategies, normalising mental health problems, supportive peer networks, and activities that alleviate poverty.
- With large gaps in mental health care and services, this programme benefits those with severe mental health problems and other high-risk populations, such as those with HIV, post-partum women, and youth.
- Additional content or adaptations, such as adding medication adherence modules for those with HIV and involving caregivers in children’s treatment, could improve programme effectiveness for special populations.
- About 80 percent of Friendship Bench recipients are women, but there is limited documentation of efforts to increase acceptability or evaluate effectiveness for men.
- Engagement with stakeholders and the community, as well as infrastructure to support ongoing training and supervision of lay health workers, are critical for the programme’s success and sustainability.
“… I know that, if i do these things, I can solve my problems… I used to get stressed asking myself about who will give me money to buy vegetables, but now I can do it for myself.”
CURRENT PARTICIPANT, 2021, HARARE, ZIMBABWE
