the friendship bench
CREDIT: Rainer Kwiotek
264 million people suffer from depression globally.
• Depression is the leading cause of disability worldwide.
• In under-resourced communities, there is 1 mental health professional for every 1.5 million people.
• Suicide is the second leading cause of death among people aged 15 - 28 and the most common cause is depression.
• Close to 800 000 people die due to suicide every year. That's one suicide every 40 seconds.
• 79% of global suicides occur in low- and middle-income countries.
• 76% to 85% of people in under-resourced settings who need treatment do not get or cannot access care.
• By 2030, mental health problems will cost the global economy US$16 trillion in lost productivity per year!
REimagining the delivery of evidence-based mental healthcare.
we envision a world where a friendship bench is within walking distance for all.
The mission of the Friendship Bench is to create safe spaces and a sense of belonging in communities, to enhance mental wellbeing and improve peoples’ quality of life. Guided by our values of empathy and connection, and anchored in over a decade of rigorous research (including a RCT published in the Journal of American Medical Association, JAMA) we have re-imagined the delivery of evidence-based mental healthcare.
The Friendship Bench clinical team trains community health workers (also known as lay health workers) to provide basic Cognitive Behavioural Therapy with an emphasis on Problem Solving Therapy, activity scheduling and peer led group support. This task shifting approach means we can deliver an effective, affordable and sustainable solution to bridge the mental health treatment gap at a primary care level.
We deliver the talk therapy intervention to people with mild to moderate level common mental health disorders, such as anxiety and depression, known locally as ‘kufungisisa’- thinking too much. When people visit the Friendship Bench they are screened with a locally validated tool called the Shona Symptom Questionnaire (SSQ-14). If a person scores above the cut off point, they are suggested to stay and receive the one-on-one problem solving therapy. In practical terms, participants are taught a structured approach to identifying problems and find workable solutions.
We are not conventional, our trained CHWs sit with their clients outdoors, under the trees on wooden park benches in discreet safe spaces in the community. During training, a referral pathway is established for cases which are considered ‘red flags’ where a higher level of care is needed.
After the one-on-one talk therapy, Friendship Bench clients are introduced to a peer led support group known as Circle Kubatana Tose (CKT), meaning ‘holding hands together’. In these groups clients are connected to others who have sat on the Friendship Bench, received PST and became empowered to solve their own problems. Group members can relate to one another because they tend to come from the same community and have learned about the benefit of empathic listening. This safe space to talk in and be heard contributes to clients’ sense of belonging and reduces stigma surrounding mental health and sharing of personal issues.
In the CKT groups, clients are engaged in revenue generating opportunities, learning to crochet items out of recycled plastic bags and old VHS tape ribbon! Some items commonly made and then sold in the community are bags, hats and mats. So beyond the group being a form of ongoing support and behavioural activation, it becomes a vital part of the intervention due to the need for income generation in a country going through socio-economic distress.
REACH & IMPACT TO DATE
Friendship Bench Reach
• Trained over 700 lay health workers
• Seen more than 50 000 clients
• Is active in 5 countries; Zimbabwe, Malawi, Zanzibar, Kenya & New York City
Friendship Bench Impat, published in JAMA
• Showed 80% reduction in depression and suicide ideation, and
• 60% improvement in quality of life
SCALE UP PROCESS
The Scale up of the Friendship Bench intervention after a successful trial was planned in various stages as outlined below;