The Friendship Bench: An Innovative Approach To Mental Health

In the field of mental health, innovative approaches that adapt to cultural contexts and local needs are crucial. One such initiative, the Friendship Bench, has shown promising results in supporting rural Zimbabwean women struggling with depression and anxiety. A pilot study published in Global Mental Health in July 2021 explored this intervention among a group of mothers in rural Zimbabwe.

The Friendship Bench is a brief psychological intervention delivered by trained lay health workers through individual problem-solving therapy (PST). This approach equips participants with a step-by-step method to address life challenges, involving identifying and defining a problem, understanding its nature, and generating and implementing solutions. This culturally adapted therapy is particularly relevant in settings where access to professional mental health services is limited.

The pilot study used a mixed methods approach, focusing on a group of mothers in rural Zimbabwe who were identified with depression using standardized assessment tools. A total of 25 women, with an average age of 33, participated in the study. The intervention consisted of six weekly home visits by Village Health Workers trained in problem-solving therapy, complemented by weekly peer support group meetings at local clinics.

The results of the intervention demonstarted that the proportion of women exhibiting depression or suicidal ideation, as measured by the Edinburgh Postnatal Depression Scale (EPDS), dropped from 68% pre-intervention to 12% post-intervention. Similarly, the proportion of women scoring high on the Shona Symptom Questionnaire (SSQ) fell from 52% to 4%. The proportion of women demonstrating clinically significant anxiety, assessed using the Generalized Anxiety Disorder Assessment (GAD), also showed a reduction from 64% to 16%.

Qualitative feedback from participants underscored the positive impact of the program. The women reported no negative effects and expressed a desire for the intervention to continue. An unexpected but noteworthy outcome was that participants felt that the intervention also led to improvement in their income-generating potential, likely related to the skills and confidence gained through the program. Additionally, the peer support groups built upon the individual sessions by encouraging collective problem-solving.

To replicate the success of the Friendship Bench in other contexts, several key elements are important. Firstly, the training of health workers in contextually relevant problem-solving therapy ensures the intervention is inclusive and culturally accessible. Secondly, addressing logistical challenges, such as providing transportation to group sessions, is vital to ensure accessibility for participants.

While the findings are encouraging, the study's small sample size mean that further research with larger groups is necessary to generalize the results. Expanding the scope and scale of the evaluation will provide a more comprehensive understanding of the intervention's long-term effectiveness and potential for broader application.

In the meantime, the success of the Friendship Bench intervention in Zimbabwe has inspired similar initiatives in other parts of the world. A pilot program in Washington, D.C., is adapting this model to support individuals living in low-income areas with historically marginalized populations at greater risk of mental health issues.  Additionally, the Friendship Bench initiative has been introduced on college campuses in Canada to support students' mental health. The University of North Carolina (UNC) has created a partnership with Malawi to explore how the Friendship Bench can fit the scale and needs of a country of 20 million that has only 5 psychiatrists and a handful of mental health professionals.

These adaptations demonstrate the versatility of the Friendship Bench model and its potential to address mental health challenges in diverse settings.  This is particularly relevant as there currently exists a mental health crisis, within the United States and globally. This intervention may play an important role in bridging the gap in community-wide mental health services. 

Resources:

Fernando S, Brown T, Datta K, Chidhanguro D, Tavengwa NV, Chandna J, Munetsi E, Dzapasi L, Nyachowe C, Mutasa B, Chasekwa B, Ntozini R, Chibanda D, Prendergast AJ. The Friendship Bench as a brief psychological intervention with peer support in rural Zimbabwean women: a mixed methods pilot evaluation. Glob Ment Health (Camb). 2021 Aug 26;8:e31. doi: 10.1017/gmh.2021.32. PMID: 34513000; PMCID: PMC8392686.

Pilot Program in DC: https://helpageusa.org/friendshipbench/

Canadian College Campuses: https://thefriendshipbench.org/

UNC - Malawi Program: https://www.unc.edu/discover/friendship-bench-reimagines-mental-health-care/