Innovation summary

Depression is the leading cause of disability worldwide. In Africa, 66 million women live with this debilitating illness, and 85% have no access to treatment. Women are affected at twice the rate of men, and African governments typically devote less than 1% of their budgets to providing mental health services. StrongMinds has identified an innovative solution that is both effective and scalable using group interpersonal psychotherapy (IPT-G) to treat depression in response to this crisis. IPT-G is a proven, simple, and cost effective community-based model to treat depression. This cost-effective model is enabling us to rapidly treat tens of thousands of individuals for depression each year.

Utilizing therapy delivered in person or by phone, group members are led through an 8–12-week program that teaches them how to identify their unique triggers, manage their current depression, and prevent future episodes. Together members support one another forming strong social bonds in the process. Following treatment, impact assessments show that more than 80% of clients are depression-free and remain so six months after therapy. These women thrive, economies grow stronger, and communities become more resilient as a result.

Impact summary

  • Since first initiating fieldwork in 2014, StrongMinds has treated more than 120,000 women and adolescents for depression in Africa.
  • More than 80% of those treated remain depression-free post-therapy.
  • These results are sustained six months after the conclusion of treatment

Innovation details

StrongMinds provides free, group talk therapy to low-income and marginalized women and adolescents in Africa using group interpersonal psychotherapy (IPT-G). IPT-G is a form of talk therapy that emphasizes relationships as the root of – and source of recovery for – depression. IPT-G is well-studied in low- and middle-income countries and is recommended by the World Health Organization (WHO) as the first-line depression intervention in resource-poor settings.
 
Our group therapy is available in person or by phone. In groups, members find safe spaces to open up with peers about their worries and struggles. Over 8-12 sessions, counselors guide structured discussions to help participants identify the underlying triggers of their depression and examine how their current relationships and depression are linked. Together, they strategize solutions to their problems, learn coping mechanisms, practice interpersonal skills, and identify support structures that they can continue to lean on after therapy ends.
 
 
Members work together to form solutions for overcoming their challenges, developing strong social bonds in the process. Since depression is episodic and recurrent throughout most people’s lives, these newly acquired skills have immediate and long-term impacts on the individual.
 
IPT-G sessions are divided into three phases, each with distinct objectives:
 
 
1. Initial Phase: This phase focuses on building trust and rapport among group members, so they feel comfortable opening up with one another.
2. Middle Phase: This phase ensures that all members are actively engaged in discussion and collective problem-solving. Participants learn to fully understand the symptoms and triggers of depression.
3. Termination Phase: By this stage, most participants have experienced a substantial reduction in the severity of their depression symptoms. As they prepare for the end of formal sessions, each will form a plan to identify and mitigate triggers in the future to prevent recurring depressive episodes.
 
The innovation does not require the use of modern-day medications to treat depression –a fact that is quite important since access to such medication is limited and costly for most of the African population. Instead, our treatment uses an evidence-based, cost-effective, culturally adept, scalable, self-sustaining model to treat one of Africa’s most underprioritized illnesses.
    
StrongMinds achieves sustainability by identifying and training former clients and local health workers to facilitate StrongMinds therapy groups in their communities to further spread the seeds of good mental health. We also work with governments and NGOs to layer mental health services into existing livelihood, food security, healthcare, and education programs to scale our reach and enhance outcomes for program participants.

Key drivers

  • Lay community health workers who could be trained to deliver services

  • Depth of knowledge pertaining to the regions and populations being served

  • Expertise in delivering programmatic therapy in a variety of development settings

  • A core set of partners with a strategic understanding of program potential

Challenges

  • Limited funding
  • Lack of awareness of depression as a treatable medical condition
  • Dispersed local population

Continuation

StrongMinds seeks to partner strategically with other NGOs to share knowledge and build awareness and ultimately reach underserved populations.  We do this by building bridges between Ministries of Health, NGOs, and regional experts to expand our program services.

Partners

StrongMinds works through partners to layer mental health services into existing livelihood, food security, healthcare, and education programs to scale our reach and enhance outcomes for program participants.

StrongMinds is thankful to have generous supporters helping us treat women and adolescents in Africa. Some examples include:

 
  • Butabika National Hospital: Dr. Dorothy Kizza, based at Butabika, provides field expertise to StrongMinds Mental Health Facilitators
  • Columbia University: Dr. Helena Verdeli, Associate Professor of Clinical Psychology & Director of the Global Mental Health Lab, is a key partner and advisor
  • Medic Mobile: Medic Mobile’s SMS technology cost-effectively improves StrongMinds’ data collection/analysis and improves patient communication
  • FXB Uganda: StrongMinds treats depressed women in eastern Uganda before they enter FXB’s poverty alleviation programs
  • IRC: A joint pilot to provide depression treatment to refugee women with the goal of scaling the partnership throughout Uganda to treat tens of thousands of female refugees

Evaluation methods

The project is evaluated internally through routine monitoring and evaluation activities, and externally through an independent impact evaluation. The impact evaluation includes a controlled longitudinal cohort study comparing outcomes of women and adolescents with depression receiving treatment in a StrongMinds Therapy Group, with outcomes of women and adolescents with depression who have received no treatment. 

StrongMinds uses the Patient Health Questionnaire (PHQ-9) to evaluate individuals with depression immediately pre- and post-intervention, as well as at a 6 month follow-up. The PHQ-9 is contained within the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and is endorsed by the World Health Organization for use in the developing world.

Impact details

StrongMinds has treated more than 120,000 women and adolescents in Africa for depression since 2014 and more than 80% of those treated remain free of depression six months post-therapy. Results from assessments conducted after therapy suggest that the well-being of participants and their families also improved in the following ways:
 
13% of clients report an increase in food security.
30% identify a rise in their children’s school attendance.
16% report an increase in work attendance.
28% describe feelings of being more socially connected.


 
Similarly, a large majority of women and adolescents who recovered from depression became powerful change agents in their communities, by supporting others and removing stigma around the subject of mental health


 

References

1. WHO (2012). Depression Fact Sheet. Geneva: World Health Organisation, Accessed 28 August 2014.

2. WFMH (2012). Depression: a Global Crisis. Occoquan, VA: World Federation for Mental Health.

3. Weissman M, Markowitz J, Klerman G (2000). Comprehensive Guide to Interpersonal Psychotherapy. New York, NY: Basic Books.

4. Bolton P et al. (2003). Group Interpersonal Psychotherapy for Depression in Rural Uganda: A Randomized Controlled Trial. JAMA, 289(23):3117-3124.

5. StrongMinds (2016). Our Impact. Accessed 6 April 2016.

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Uganda, Zambia, United States of America

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