The Friendship Bench therapy- why has it been so successful?

The recently published paper of The Friendship Bench project in Zimbabwe, with principal investigator Dr Dixon Chibanda, is making waves. Published in the Journal of the American Medical Association (JAMA), this project tackles mental health like never before. 

How the Friendship Bench works

The Friendship Bench project uses benches as a form of therapy for people who are struggling with mental health or emotional problems. These benches are located on the grounds of medical clinics around Harare and other major cities in Zimbabwe, and each bench (one in each clinic) has a trained community member who counsels people struggling with depression. Depression in the local language is called kufungisisa. When a person gets to a point where they cannot take kufungisa (thinking too much in English) anymore, they visit the nearest clinic where a trained lay health worker will sit with the troubled patient in the safe place called the Friendship Bench. The counsellors intentionally avoid the use of Western terms such as‘depression’ or 'anxiety' which to many, sound unrelatable.

While completing his Master's in public health, Dr Chibanda was looking for a solution. After speaking with various community leaders and health workers he discovered that generally, people tend to be embarrassed of going to see a therapist when they are depressed or needing someone to talk to because of the stigma attached to depression and ‘madness.’ But in Zimbabwe it seems like the bench idea is proving beneficial as the lay health workers are from the same communities and speak the same language as the patients. Dr Chibanda noted that though people loathe heading to a mental clinic and speaking with a lab-coated medical professional about their mental health, they were generally willing to sit on a park bench and share their worries with someone within their own community.

Contributors to the success rate of the Friendship Bench

• Frequency of the sessions - At these benches, community counselors and patients meet weekly to discuss intimate issues.
• The project is solution-based – “It's all about empowering people to go and solve their own problems," says Chibanda.
• The project is communal - There are group therapy sessions where patients gather and sit around the bench and tell others in the group about their own stories and testimonies.
• Local language - The lay health workers speak the local language, Shona, which makes it easy to communicate between the patient and the lay health worker.

Currently there are 13 psychiatrists in Zimbabwe who serve a population of 13 million. As a psychiatrist at the University of Zimbabwe, Dr Dixon Chibanda came up with the name chigaro che hushamwari in Shona (Friendship Bench) in 2006. 

"It's all about empowering people to go and solve their own problems."

 

- Dr Dixon Chibanda

​Praises for The Friendship Bench Project

Since publication of this study, the Friendship Bench project has appeared in several online outlets. To list a few, those are:

• NPR - Stories of life website describes this project as “chasing the blues away”.
• A Plus - Wellness website cited that “People in Zimbabwe are using friendship benches to improve their mental health — and it's working.”
• Voa News - Health and Science website said the same thing that “Zimbabwe Tackles Mental Health With 'Friendship Benches'.
• Psych Central - Friendship Bench Therapy Proves Effective in Treating Mental Illness.
• LSHTM Press - 'Friendship Bench' therapy significantly reduced anxiety and depression in Zimbabwe.

There are 573 anxiety and depression patients in total that took part in this study for a period of 6 months. Half of these patients received treatment from the nurses and half of them took part in the Friendship Bench project. After six months, half of those who were treated at the clinic by the nurses still showed symptoms of depression and only 13% of those who participated in The Friendship Bench program still had symptoms.

"This is really one of the few examples where treatments for common mental health problems have been delivered by people who actually live and work in the community."

 

- Dr. Melanie Abas, psychiatrist at King's College London and one of the study's co-authors.

The study was conducted from September 2014 to June 2015 and has since been scaled-up to 72 clinics in the cities of Harare, Gweru and Chitungwiza (total population 1.8 million) with over 27,500 people having accessed treatment. 

Sources disclaimer: Parts of this article were extracted from the online publications listed above.

For more resources and information on The Friendship Bench please click here.