the friendship bench
The Friendship Bench has been developed over a 20-year period from community research. The intervention is based on problem-solving therapy, in which the patient identifies a problem (eg, unemployment) rather than a diagnosis, symptom or label.
The psychological approach of problem-solving therapy works through enabling a more positive orientation toward resolving problems and empowering people to have a sense of greater coping and control over their lives.
The Friendship Bench Project aims to reduce the mental health treatment gap by using a cognitive behavioural therapy based approach at primary care level to address mild to moderate mental health problems such as depression and anxiety.
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.
In practical terms, participants are taught a structured approach to identifying problems and find workable solutions. Lay health workers follow a detailed script contained in a manual to conduct 6 sessions on a bench located in a discreet area outside the clinic.
OPENING THE MIND Kuvhura Pfungwa
This phrase refers to the therapeutic process by which, through asking questions, clients are encouraged to open their minds to identify their problems, choose one to work on, identify a feasible solution, and agree on an action plan guided by the lay health workers.
THE PROCESS OF GETTING TO WHERE WE ARE TODAY...
The Scale up of the Friendship Bench intervention after a successful trial was planned in various stages:
1. Needs assessment and sensitization of all stakeholders
Team members visited all clinics and spoke to clinic staff and patients following an interview guideline
2. Devising and adjusting training material
The existing Friendship Bench trainings manual was reviewed and extended considerably to cater for a wider patient load presenting with additional disorders as defined by mental, neurological and substance use disorders. A facilitators’ handbook was written to ensure a structured teaching approach. Parts of the manual were translated into the local language Shona. (resources page> manual)
3. Training of facilitators and future supervisors
The clinical team consisting of psychologists and social workers of the Friendship Bench was extended, the group of facilitators and assistants were trained.
4. Training of lay health workers and evaluation
The training has just begun. Groups of 30 lay health workers are trained in three different venues in Harare: Harare Hospital Psychiatric Unit, Wilkins Hospital for infectious diseases and MRCZ offices.
5. Roll out and evaluation
In cooperation with Harare’s City Health Department, the intervention will be rolled out and evaluated scientifically with full approval of local medical research authorities (MRCZ).