Friendship bench

Operation

The Friendship Bench aims to enhance mental well-being and improve quality of life through the use of trained community health workers (CHWs) who deliver individual problem-solving therapy sessions to people struggling with mild to moderate mental health problems such as anxiety and depression. The CHWs are trained in a cognitive behavioural therapy-based approach with a strong emphasis on problem-solving therapy (PST) and behavioural activation at primary health care (PHC) level to address kufungisisa, a local Shona concept which literally translates into "thinking too much" and whose symptoms resemble depression and anxiety. When clients come to the Friendship Bench seeking mental health support, they are screened with a Shona Symptoms Questionnaire-14 (SSQ-14), an indigenous measure of common mental disorders.

The talk therapy sessions take place on wooden park benches, which are usually placed in quiet, discreet spaces under shady trees at primary health care clinics or community rooms.

Grandmothers

Uniquely, Friendship Bench uses "Grandmothers", more fondly known as Ambuya Utano or Gogos, to deliver the problem-solving therapy intervention. The FB Grandmothers are rooted in their community and are the custodians of local wisdom and knowledge.

Without any prior medical or mental health experience, each Grandmother or equivalent CHW goes through eight days of training in a structured problem-solving based approach which emphasizes listening skills, empathy, connection and a non-judgemental attitude along with steps to generating a SMART action plan and delivery of a screening tool. After the training, each CHW has a 30-day clinic internship. In this way, as described in the Friendship Bench Randomized Control Trial published in JAMA in 2016:

Support groups

After the one-on-one talk therapy, Friendship Bench clients are introduced to a peer led support group known as Circle Kubatana Tose (CKT), meaning "holding hands together". In these groups clients are connected to others who have also gone through mental health problems and found solutions on the Friendship Bench. Group members tend to come from the same community and so can relate to each other's struggles. CKT groups contribute to clients' sense of belonging and reduces stigma surrounding mental health.

References

References

1. (2015-03-30). "The Friendship Bench Training Manual".
2. (2011-10-26). "Problem-solving therapy for depression and common mental disorders in Zimbabwe: piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV". BMC Public Health.
3. (2015-05-23). "The Friendship Bench programme: a cluster randomised controlled trial of a brief psychological intervention for common mental disorders delivered by lay health workers in Zimbabwe". International Journal of Mental Health Systems.
4. (2016-05-11). "'Opening up the mind': problem-solving therapy delivered by female lay health workers to improve access to evidence-based care for depression and other common mental disorders through the Friendship Bench Project in Zimbabwe". International Journal of Mental Health Systems.
5. Kotifani, Aislinn. (2018-12-26). "A Friendship Bench in Zimbabwe is Starting a Revolution in Mental Health".
6. (June 1997). "The Shona Symptom Questionnaire: the development of an indigenous measure of common mental disorders in Harare". Acta Psychiatrica Scandinavica.
7. (2016-12-27). "Effect of a Primary Care–Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe: A Randomized Clinical Trial". JAMA.
8. "The Shona Symptom Questionnaire – FPR Global Database".