A group of grandmothers in Zimbabwe is helping the world reimagine mental health care

Chibanda lost a patient — a young woman with a promising career and a life ahead of her — until she committed suicide after she was unable to access mental health care in her village and could not afford the $15 bus fare to travel 160 miles to see him. After the tragedy, Chibanda decided to dedicate his career to the perplexing question of how to help people who desperately need mental health care but face financial, geographical or cultural barriers to accessing it.

After exploring several ideas for recruiting and training mental health practitioners, Chibanda found that there was indeed a large group of experienced, empathetic, and respectful caregivers who were ready and willing: grandmothers.

Yes, grandmothers.

“The most important resources left behind in most communities are grandmothers, because they are the guardians of local culture and wisdom,” Chibanda said. A global symposium on re-imagining society in 2019.

Chibanda worked with the Ministry of Health and Children’s Welfare and the University of Zimbabwe to develop a pilot program to train older women in a form of evidence-based talk therapy known as problem-solving therapy. The goal was to enhance women’s ability to listen, to make people feel heard and seen, to give patients a sense of belonging, and to help them Gain confidence to find their own solutions.

Consulting with an editorial group of 14 grandmothers in Harare, Chibanda decided that instead of seeing people under fluorescent lights in crowded clinics and hospitals, grandmothers could offer their services in a simple, simple, and accessible place: a park bench.

From the beginning, grandmothers have shaped the programme. When Chibanda initially suggested naming it a “mental health seat,” the women refused. They suggested naming it the Friendship Council as a way to eliminate shame and stigma.

They also advised using local jargon and avoiding excessive clinical language. For example, instead of talking about depression or anxiety, grandmothers often use the nice word shona kufungisisawhich translates as “thinking too much”.

Program participant Suzanne Schally first went to the Friendship Bench when her marriage was in crisis and she was struggling to feed her children and pay school fees. “At first, I thought I wasn’t human anymore because of the problems I had,” Susan told me when we met in July 2020. With few resources and no formal education, she did not feel ready to reach out to anyone. Social service providers.

When Suzanne first met her “grandmother” Sabina Duffy, their bench sessions focused solely on ensuring Suzanne felt loved and respected. Over time, their conversations turned into a practical solution to problems, including how Susan could communicate better with her husband and how she could start earning some income for herself.

Susan told me: “The way Sabina spoke to me, it took away all the pain I was feeling in my heart. I started crying, but in the end I was happy. I felt accepted in society.”

This empowering sense of acceptance and belonging underlies many friendship seat interactions — and it’s mutual. The grandmothers I spoke to mentioned that they gained strength and power from feeling part of a community that extends beyond the bench. “I knew I mattered to others,” said Sabina. “People keep coming to me – it makes me see that I’m doing good in the community.”

Ruth Verhey, a researcher associated with the program, has I studied the effect of the Friendship Seat on grandmothers They found that their participation was associated with a lower incidence of a range of common mental health disorders, such as anxiety and depression.

Part of the strength is camaraderie. The program facilitates social bonding between grandmothers. However, it is also about purpose. Grandma Sabine, who helped Suzanne navigate her challenges, told me, “When I work, I put all my heart and all my effort and energy into doing it. . . . it creates an identity for me. Wherever I go, I carry that identity with me.”

Grandmas feel like they are part of a movement, and this is an antidote to isolation. In America and elsewhere, many psychiatric care professionals are overworked and overwhelmed. An integral part of the challenge of tackling the mental health care crisis is ensuring that workers are supported, recognized and made to feel like they are doing essential work.

There are now nearly 100 Peer review studies For the effectiveness of the Friendship Seat. Find the program published in Journal of the American Medical Association In 2016, he found significant improvement in depressed participants who received treatment from a trained grandmother. At six months, the participants who interacted with these non-specialized health workers – according to the set of indicatorsincluding fear, anger and sleep patterns – fared better than those who received treatment from a community mental health nurse or psychologist.

Last year, the program reached more than 60,000 people in Zimbabwe. Similar projects inspired by grandmothers have been launched in locations from Kenya to Vietnam. The program is a model for Pioneering efforts Around New York City—including in the Bronx, Harlem, and Brooklyn—volunteers work the orange pop-up seats at street fairs and other events.

Last fall, the model was temporarily exported to the FIFA World Cup in Qatar to highlight mental health. In partnership with the World Health Organization, 32 friendship seats have been set up in different locations in Qatar, each representing the competing teams.

The strength of the software is not only in the easily repeatable setup or even in the skill of the service providers. It is about how to enable ordinary people to take responsibility for the psychological well-being of their community.

As policymakers and clinicians propose solutions to address the mental health crisis in the United States, they’d best consider the Friendship Bench as a model. While such a new effort in Massachusetts 24-hour helpline (833-773-2445) and Community clinics Steps in the right direction, the Friendship Bench simplifies access. By overly medicalizing these resources, there is a risk of alienating struggling people, including those from historically marginalized groups who have been Poor service by the health care system.

Charmaine Chitio, the grandmother who works as a trainer, told me. “We feel it really helps destigmatize.”

While the idea of ​​belonging is everywhere these days – from the producer marketing to Speaking Corporate Human Resources The Friendship Bench shows what the word can really mean.

Once a Friendship Bench participant has gone through six sessions, they can be referred to a Circle Kubatana Tose group, a term meaning “hands held together in a circle.” In these meetings, participants pass a stone, and take turns talking about the challenges they face. The group then turns its attention to tackling a societal issue – for example, helping people living with HIV get the right medication or helping single mothers get money to pay their children’s school fees.

The idea is to move the work from therapy to the community. By cultivating a rich connection with others and a sense of common purpose, participants can find the experience of belonging—itself a powerful bulwark against psychological distress.

The Friendship Seat is not a high-tech medical intervention. It’s not a disruptive innovation for healthcare markets. Instead, its potential lies in its simplicity. It’s an effective way to apply what humanity has known for ages: that quality connection is the single most important determinant of good mental health.

Kim Samuel is the author ofAbout Belonging: Finding Connection in an Age of Solitude. She is a founder Samuel Center for Social Communication in Toronto and a visiting research fellow at Green Templeton College, University of Oxford.

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