No practice rooms, no upholstered couches, no highly qualified therapists.
No practice rooms, no upholstered couches, no highly qualified therapists. Instead, patients sit on a simple wooden bench in the shade of banana trees. “Grandmother” is what they call the older women who sit there and listen to the problems, worries and fears of their neighbors. “Friendship Bench” is the name of the alternative – and extremely successful – therapy concept that has established itself in Zimbabwe. Hundreds of grandmothers sit on wooden benches across the country and listen to anyone who needs someone to talk to. Studies have shown that the therapeutic approach to mild to moderate anxiety and depression can have more beneficial effects than traditional talking therapies and medical treatments.
According to the Born This Way Foundation, about 25 percent of Zimbabwe’s entire population suffers from depression, known in the country as “kufungisisa.” The word from the language of the Shona people literally translated means “too much thinking”. According to a report by the portal “Positive News”, the high rate of depression is based on several traumas at the national level, including the Gukurahundi genocide, an HIV pandemic and dictator Robert Mugabe’s campaign in 2005 to forcibly clear slums that k!lled 700,000 people made Zimbabweans homeless.
Currently, illnesses and unemployment in particular – 70 percent of the population live below the poverty line – are driving people to despair. However, depression is often inadequately recognized and treated. In Zimbabwe’s highly superstitious and religious society, the mentally ill are marginalized, stigmatized and sometimes even viewed as possessed, the Guardian writes.
Poorer people in particular have little access to medical treatment. There are only 13 psychiatrists in Zimbabwe for a population of 16 million. dr Dixon Chibanda, Director of the African Mental Health Research Initiative and Professor of Psychiatry at the University of Zimbabwe and the London School of Hygiene and Tropical Medicine, is one of them. In 2004, one of his patients committed suicide after being unable to get psychiatric support in her village and unable to afford a $15 bus ride to the capital, Harare. “That’s when I knew I had to move psychiatry out of the hospital and into the community,” Chibanda told Positive News. He asked her how to reach the people most in need of help; how to break down the financial, geographic and cultural barriers. The solution: old ladies.
“The most important resource left in most communities is grandmothers, because they are the custodians of local culture and wisdom,” the Boston Globe quoted the psychiatrist as saying. Also known as “Gogos” (“elderly women”) or “Ambuya Utano” (“community grandmas”), the women traditionally play the role of counselors in Zimbabwean society. As experienced and sensitive ladies, they enjoy a high reputation, which is why the grandmothers are perfect in Chibanda’s eyes as amateur therapists.
Although the women usually have no medical or psychological background knowledge, they are trained in the basics of behavioral therapy before they are assigned a park bench in their community. There, according to the mission of the “Friendship Bench”, they are to “create safe spaces and a sense of belonging in the community to improve psychological well-being and improve the quality of life”.
The grandmothers decide who can be treated on the “Friendship Bench” using the “Shona Symptom Questionnaire”, a questionnaire based on Zimbabwean concepts of mental illness. Severe cases are forwarded to a clinical facility, all others are allowed to receive therapy from the grandmothers.
The grandmothers not only listen, but also help with practical advice. “My work is about changing lives and changing the way people see their lives,” a grandmother named Felistas Gasa told Positive News. Her client Elton Mudzingwa, an alcoholic street vendor grieving the loss of his wife, managed to quit drinking thanks to her support. “I had the feeling that she would take care of me,” says the 47-year-old. Since he already knew the friendly woman from the neighborhood, he felt encouraged to disclose his condition. A step known in the Shona language as “Kuvhura Pfungwa” (“opening the mind”).
A step that is elementary for the entire concept that works with the so-called “problem-solving therapy”. The grandmothers should “make people feel seen and heard and help them find the confidence to solve problems themselves,” writes the Boston Globe. This should happen in talk therapy, which, according to the “Global Center for Mental Health”, usually includes six sessions of 45 minutes each.
After the sessions are complete, patients can become part of a support group called Circle Kubatana Tose, which means “holding hands in a circle” in English. Participants can talk about the challenges they face; about “how they’re coping with life or how they feel when they’re not coping with life,” according to the Friendship Bench website. The group is intended to provide ongoing support and further integrate therapy into the community.
In addition, the group members are taught “sales-generating skills”, reports the “Positive News” portal: They learn, for example, how to make jam, crochet bags from old VHS cassette tapes and build bread ovens. According to a 2021 study published in the Global Mental Health Journal, 67 percent of female group members maintain or even expand on these projects.
According to “Positive News”, around 280,000 people have already sat on a “Friendship Bench”. Chibanda and his team have also trained more than 600 grandmothers to become health workers offering their services free of charge in more than 70 communities in Zimbabwe, reports the Center for Global Mental Health. The model’s success is largely due to the grandmothers themselves: the tradition of respect for African matriarchs, their advisory role and their notoriety in the neighborhood – they are perceived much more as friends than as doctors.
And they gave the whole project a local flavor from the start, which Chibanda also valued. “We use a language that resonates with the community. A language that is culturally appropriate, even though we offer a clinical service,” explains the psychiatrist in an interview with the news portal “Bloomberg”. The “Opening of the Mind” is an example of this. The same applies to words like “Kusimudzira” (“uplifting”) and “Kusimbisa” (“strengthening”), as well as the name “Friendship Bench”.
Mental problems are not named by professional medical diagnoses, but are described by local cultural concepts. “We used those words to wrap up a scientific intervention, so it’s acceptable,” Chibanda told The Guardian. This in turn should contribute to the destigmatization of mental health problems. “If you advertise the program in the local language, it’s more acceptable and people understand it better and relate to it,” said Charmaine Chitiyo, one of the grandmothers, in the Boston Globe.
In conservative Zimbabwe, getting people to think about their mental health is a victory in itself, Joyce Ncube, another grandmother, told the Guardian. “In our culture, if you talk about your mental health, you get ridiculed,” confirms a 49-year-old unemployed mother of three who found support on a Friendship Bench. She really wanted to talk about her problems and when she spoke to the grandmothers she “felt a load lifted from my heart.”
The positive experiences of clients have now also been confirmed by dozens of studies. A 2016 study by Chibanda and colleagues from Zimbabwe and England, published in the Journal of the American Medical Association, divided 573 people with depression into two groups. It found that those who attended the Friendship Bench had significantly fewer symptoms after the sessions than those who received conventional treatment. On average, symptoms decrease by 85 percent, Chibanda summarizes the research in the “Born This Way Foundation” article.
Another study from the “Global Mental Health Journal” came to the conclusion that the proportion of women with depression or suicidal thoughts fell from 68 to 12 percent. In the conversation with the grandmothers, the study participants particularly appreciated the “established and trusting relationship that guaranteed confidentiality”. The feeling of acceptance and belonging is mutual. “People keep coming back to me – it shows me that I’m doing a good job in the community,” a grandmother named Sainah Dovi told the Boston Globe.
Although the older women come from the same communities as their patients and have often experienced the same social trauma, Chibanda notes that they have “amazing resilience”: They rarely suffer from post-traumatic stress disorder and other mental illnesses. “There seems to be a developing concept of altruism where grandmothers really feel like they’re getting something out of making a difference in the lives of others,” the BBC psychiatrist says.
Another study from the “International Journal of Mental Health Systems” concludes that the use of trained laypersons can help to close the treatment gap for mental illnesses – and not just in Zimbabwe. dr Nilofer Naqvi, a psychologist working in sub-Saharan Africa, told Positive News that the project has “lessons to expand access to mental health care for marginalized communities” around the world.
It’s basically a “simple approach, but it’s very powerful when it comes to empowering people who are showing symptoms of depression,” Chibanda explains in a video from the African Academy of Science. His idea enables people without much background knowledge to take responsibility for the psychological well-being of their community. It’s an effective way to put into practice what mankind has always known: that a good connection is the most important factor in good mental health, according to the Boston Globe.
Because the model is easy to replicate, it has now spread to other countries, such as Malawi, Kenya, Zanzibar and Vietnam. The “Friendship Benches” also started successfully in New York City. As “Deutschlandfunk” reports, in 2019 around 60,000 patients sat on one of the bright orange benches in the Bronx and Harlem districts. However, the project had to be scrapped when funding fell away.
The World Health Organization (WHO) exported the “Friendship Benches” to Qatar last year for the World Cup. 32 benches, each representing one of the participating teams, were temporarily placed in Doha. The “Friendship Benches” are described by the WHO as “safe places where people can talk to each other”. The organization emphasizes that talk therapy can help people who suffer from conditions such as anxiety and depression.
A first pilot project with the “Friendship Benches” is to start next year in London. “Whether it’s London, New York or Zimbabwe, the problems are similar everywhere,” Chibanda told the BBC. Therefore, he believes the program is appropriate for any community interested in providing affordable, accessible, and effective help to residents.