The Friendship Bench
The Zimbabwean Friendship Bench Project is a stepped care approach to depression (commonly expressed as ‘thinking too much’ or ‘Kufungisisa’ in the Shona language) and other common mental disorders in primary care. The Friendship Bench uses a brief psychological approach based on problem-solving therapy and carried out by lay health workers with supervision by higher cadres.
The randomised controlled trial was conducted by the University of Zimbabwe, the London School of Hygiene & Tropical Medicine and King’s College London, and supported by the Government of Canada through Grand Challenges Canada
The Friendship Bench consists of six structured 45-minute one-to-one counselling sessions delivered on a wooden bench in a discreet area within the grounds of a clinic. They are given by supervised lay health workers, known as ‘grandmother health providers’, who have received training in problem solving therapy - a type of cognitive-behavioural therapy (CBT) geared to improve an individual's ability to cope with stressful life experiences.
This study involved more than 550 patients with anxiety or depression, all aged 18 or over, at 24 randomised primary care clinics in Harare. Patients at 12 control group clinics were given standard care while those in the treatment group at 12 other clinics received Friendship Bench. After six months, all participants were then re-assessed using locally validated questionnaires for depression and anxiety; the Shona Symptom Questionnaire (SSQ), the Patient Health Questionnaire (PHQ) and the Generalised Anxiety Disorder scale (GAD).
50 per cent of patients who received standard care still had symptoms of depression compared to 14 per cent who received Friendship Bench (based on PHQ). 48 per cent of patients who received standard care still had symptoms of anxiety compared to 12 per cent who received Friendship Bench (based on the GAD), and 12 per cent of patients who received standard care still had suicidal thoughts compared to 2 per cent who received Friendship Bench (based on SSQ).
With CDN $1 million in funding from Grand Challenges Canada in 2016, the Friendship Bench Programme has since been scaled-up to 72 clinics in the cities of Harare, Gweru and Chitungwiza (total population 1.8 million). To date, over 27,500 people have accessed treatment.