Rosemary Choga, a community healthcare worker, compassionately and attentively listened as a client narrated her problems.
The intimate exchange between the two, who were seated on a wooden bench, went on for more than 30 minutes as the client offloaded her emotional baggage that she could not carry alone anymore.
After the brief session, the visibly relieved patient thanked Choga and went her way, with her invisible mental weight no longer holding her back.
Choga is a member of the Friendship Bench, an organization that trains grandmothers who work as community health promoters for the city health department to provide mental health support to people suffering from common mental issues such as anxiety and depression.
The 63-year-old grandmother from Budiriro, a high-density, low-income township south-west of the capital Harare, has been trained to administer problem-solving therapy to patients, and she performs her duties with passion.
“Out of 10 patients, studies have shown that three suffers from mental health-related issues,” Choga told Xinhua shortly after a session with a client.
She said psychological interventions through the Friendship Bench are helping address mental health issues such as depression, or known in the local Shona language as “kufungingisisa” — an idiom for non-psychotic mental illness which can be loosely translated as “thinking too much.”
“When some people are on the verge of committing suicide, if we speak to them, those thoughts might disappear,” said Choga. “Many of our members were suicidal, but through talk therapy, support and monitoring, they recovered.”
As the name “Friendship Bench” suggests, sessions often take place on wooden benches, which are usually placed at community health centers where clients can confidentially speak with grandmothers about their problems.
When clients come to the benches seeking mental health services, they are screened with a Symptoms Questionnaire of 14 questions to determine the state of their mental health.
This way insures that the grandmothers can help their patients to identify their problems and find their own solutions.
Clients are usually offered about six counseling sessions that last for about 30 minutes each.
Chengetai Nyamukapa, the country coordinator for the Friendship Bench, said the program came from the necessity to find a space to offer mental health assistance, which was not widely available at primary healthcare centers before.
“So what we do is we train cadres, mostly our grandmothers in terms of delivering this problem-solving therapy so that as they are in their communities they come across people with issues to do with mental health challenges,” she said. “When we train them on the problem-solving therapy, they are able to sit with their clients on the friendship bench, and on the friendship bench what they do is they create a safe space for the client and the client is able to verbalize or talk about whatever is affecting him or her.”
HOME-GROWN SOLUTIONS FOR LOCAL CHALLENGES
In a country where clinical services for mental health care are extremely limited, the Friendship Bench’s thoroughly vetted sustainable community-based psychosocial interventions have proved to be helpful in tackling mental health challenges.
With fewer than one psychiatrist per 1 million people and a similarly small number of psychologists, the Friendship Bench is there to plug the shortage of mental health support.
As an organization anchored in research, the Friendship Bench offers all the intervention programs based on empirical research that has been carried out and proven to be effective.
Unlike conventional therapy in which the patient is diagnosed with an issue and is then treated based on the finding of the diagnosis, Friendship Bench’s psychological interventions aim at empowering clients to find their own solutions to their problems, Nyamukapa said.
“We do this via various sessions. A client can actually have from 2 to 3, or 6 sessions, depending on how they are able to find solutions to their own problems,” she said.
To make the intervention more accessible to the public, the therapy is conducted in the local Shona language and is adapted to local cultural concepts.
The non-use of medical terminology prevents stigma and encourages more people to openly seek assistance without fear of discrimination.
On why grandmothers make good psychological support providers, Nyamukapa said research has shown that working with grandmothers helps to alleviate problems related to depression.
“In terms of grandmothers, we are saying our grandmothers have got experiences, our grandmothers have got the wisdom and our grandmothers have been there and they are there within our communities, they are not going anywhere,” she said.
Grandmothers are often best equipped to provide care because they have the patience to listen and guide their clients toward a solution bit by bit, unlike other relatives who tend to prescribe their patients what to do, Nyamukapa said,.
In addition, the grandmothers involved in the project not only provide a safe space to share problems but also empower their patients through solution-oriented discussions and guidelines. They ensure that clients graduate from that face-to-face intervention by encouraging them to join income-generating projects, Nyamukapa said.
Clients are invited to take part in the income generation component of the Friendship Bench, the peer support group called “Circle Kubatana Tose,” where they are taught to make bags out of recycled material and learn to share their stories with others.
“Why? Because we are saying they are in this environment where they understand each other. And as they make the bags, as they make the cakes, or as they are in the garden, you know, it’s a safe space for them that takes them away from the problems that they have been facing,” Nyamukapa said.
COUNTERACTING MENTAL HEALTH STIGMA
By promoting open communication, the initiative encourages people to open up about mental health issues thereby counteracting the stigma of mental illness.
Since its formation in 2006 by Dixon Chibanda, a Zimbabwean psychiatrist, the program has trained more than 700 grandmothers to lend a supportive ear and to those dealing with mental illness.
There are now more than 120 Friendship Benches, dotted across healthcare centers in Harare, the neighboring town of Chitungwiza and in Gweru, and to date, more than 80,000 people have accessed treatment free of charge.
The concept has now been expanded to other countries, providing a blueprint for alleviating challenges of mental health. The idea is being implemented in Malawi and Tanzania, and has been adopted even in developed countries such as the United States.
Nyamukapa said the Friendship Bench aims to have a bench within walking distance of every community.
There’s also work being done to train young people to offer therapy to their peers as a means of making the benches accessible to the young in colleges and universities.
THERAPEUTIC CARE SERVICE AMID PANDEMIC
The COVID-19 pandemic and the resulting economic fallout have negatively affected the state of many people’s mental health and created additional challenges for people already suffering from mental health illness.
During the COVID-19 pandemic, demand for psychotherapeutic services has gone up significantly, Choga said, and the Friendship Bench is providing much-needed therapeutic care at a time when it’s needed the most.
Despite the risks posed by the pandemic, some grandmothers, who are at a larger risk of getting infected by the virus, still choose to continue providing health services to their local communities.
Some services have moved to virtual platforms due to mobility and safety concerns.