StrongMinds: Taking an innovative therapy to an unprecedented scale
This September marks the first-ever mental health panel of the SOCAP14 conference, featuring speakers from around the world invited to discuss “innovative approaches to improving health outcomes through low-cost interventions” as part of this year’s Health theme. Sean Mayberry, Executive Director of StrongMinds, was invited to represent an implementer’s perspective on solutions from low- and middle-income countries with the potential to transform mental health at an “unprecedented scale and impact”.
Here, we’d like to share StrongMinds’ story of transforming an innovative therapeutic approach to the treatment of depression in Uganda, into an ambitious program with the aim of treating 2 million people across Africa by 2020. Key to this story is the ongoing consideration of culture and context that can make or break program scale-up.
What makes StrongMinds unique: Striving for scale
Scale is what sets StrongMinds apart from most other organizations implementing mental health programs in Africa. We respect and are immensely thankful for the amazing work of these other organizations, but none of them have yet scaled their work to reach the millions of people who are afflicted with mental illness. While StrongMinds is still very small, our ultimate goal is something much, much bigger. Success for us will be measured in the millions of people in Africa accessing much-needed treatment…anything less will not suffice.
Since approximately 90% of Africans with mental illness do not have access to quality treatment services, any significant solution needs to be able to scale—to expand and cover millions of people. For the most common mental illness in Africa (and indeed the world), depression, there are roughly 90 million Africans afflicted. StrongMinds has an organizational goal of treating 2 million Africans with depression by the year 2020—which is a great first step. But it is just a first step as we plan to scale our model of intervention. While we are still in the pilot phase of operation, and will only treat 500 Africans in Uganda in 2014, we have our eye set on much greater growth, and indeed we understand the need to adapt and scale the intervention quickly, so that the millions of people suffering from depression in Africa can benefit.
How do we approach this task of reaching scale? Looking at the enormous task before us and factoring in the resource constraints we face (for example, limited availability and access to pharmaceuticals), as well as the unique sociocultural context, we ensure that our therapeutic approach is not only culturally-appropriate and effective, but also that it addresses these constraints.
Understanding the context allows us to address the need for scale
Collaboration within groups is the typical way that many people in Africa live and work. A one-to-one therapy approach can be helpful in some contexts, but here, we can leverage local preferences for group activities to work with greater populations and fewer human resource inputs, in a manner that is culturally appropriate and effective– through Group Interpersonal Psychotherapy (G-IPT).
G-IPT is a proven, simple, and cost-effective community-based intervention to treat depression. G-IPT focuses on interpersonal relationships of depressed group members and is led by a local community facilitator who uses a structured model over a period of 16-weeks to help group members identify and understand the root causes and triggers of their depression, and then to formulate strategies to overcome those triggers. Since depression is episodic and will continue to recur throughout most sufferers’ lives, these newly acquired skills have both an immediate impact and long-term preventative impact.
StrongMinds relies on locally-trained
facilitators to deliver an acceptable,
effective intervention that can be
scaled up even in low-resource settings
G-IPT was first tested in Uganda by Johns Hopkins University in a randomized controlled trial in 2002 following extensive formative research. Using lay community workers with only a high school education, the researchers found that G-IPT was successful in reducing depression symptoms in 93% of the 224 patients treated. Review the JAMA article on the resources page of StrongMinds' website for more information.
Research has also demonstrated that, in addition to experiencing relief from depression, G-IPT group members also experience gains in productivity and health. In addition, their families and communities also become stronger from the social support system created through the G-IPT approach.
Having an intimate knowledge of the community is fundamental to providing treatment to those most at risk. StrongMinds uses a locally tested therapeutic intervention delivered by locally trained mental health facilitators to treat those affected with depression, so we know we are using the best and most feasible method available to reach our patient population in Africa at scale.
You can read more about StrongMinds’ work in Uganda on their website and Innovation page. Visit their resources page for articles on the G-IPT approach. You can also learn about John Drain and Sean Mayberry on their profile pages.
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