The Friendship Bench Project
Common mental disorders (CMD) such as depression and anxiety are a major cause of disease burden.(1) Especially in low and middle-income countries affected as these mental disorders are hardly recognized and combined with an under resourced medical system, result in a major treatment gap.(2) For sub-Saharan Africa, low cost stepped care treatment packages to address this gap have been recommended.(3)
The HIV epidemic further compounds the prevalence of CMD in the region as people living with HIV (PLWH) have a higher risk of suffering from mental illness.
The Friendship Bench Project aims to reduce the treatment gap by using a cognitive behavioural therapy based approach on primary care level to address kufungisisa. Kufungisisa, the local term for depression, is literally translated into “thinking too much”. Patients visiting the primary care clinics are being screened with a locally validated tool called the Shona Symptom Questionnaire (SSQ). When scoring above the cut off score, they are being referred to the friendship bench where they will receive individual problem solving therapy from a specifically trained lay health worker.
The lay health workers are employed by the city health authorities of Zimbabwe’s capital Harare and therefore represent a sustainable option to provide this task-shifting treatment approach. As other low and middle-income countries, Zimbabwe suffers from a serious lack of mental health specialists.
A recently carried out randomized control trial(4) showed that the Friendship Bench can deliver a successful, culturally acceptable and reliable treatment program for depression on a primary care level.
- World Health Organisation. The Global burden of disease: 2004 update. Geneva: World Health Organisation; 2004.
- Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, Rahman A. No health without mental health. Lancet. 2007;370(9590):859–77.
- Patel V, Simon G, Chowdhary N, Kaaya S, Araya R. Packages of care for depression in low- and middle-income countries. PLoS Med Publ Libr Sci. 2009;6(10):e1000159.
- Chibanda, D, Bowers, T, Verhey, R, Rusakaniko, S, Abas, M, Weiss, H A, Araya, R. The Friendship Bench programme: a cluster randomised controlled trial of a brief psychological intervention for common mental disorders delivered by lay health workers in Zimbabwe. International journal of mental health systems 2015a; 9, 21.