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‘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
Open accessAbstract
BACKGROUND: There are few accounts of evidence-based interventions for depression and other common mental disorders (CMDs) in primary care in low-income countries. The Friendship Bench Project is a collaborative care mental health intervention in primary care in Harare for CMDs which began as a pilot in 2006. CASE PRESENTATION: We employed a mixture of quantitative and qualitative approaches to investigate the project's acceptability and implementation, 4-8 years after the initial pilot study. We carried out basic descriptive analyses of routine data on attendance collected between 2010 and 2014. We also conducted five focus group discussions (FGDs) with LHWs in 2013 and 12 in-depth interviews, six with staff and six with patients, to explore experiences of the intervention, which we analysed using grounded theory. Results show that the intervention appears highly acceptable as evidenced by a consistent number of visits between 2010 and 2014 (mean 505 per year, SD 132); by the finding that the same team of female community LHWs employed as government health promoters continue to deliver assessment and problem-solving therapy, and the perceived positive benefits expressed by those interviewed. Clients described feeling 'relieved and relaxed' after therapy, and having their 'mind opened', and LHWs describing satisfaction from being agents of change. Characteristics of the LHWs (status in the community, maturity, trustworthiness), and of the intervention (use of locally validated symptom screen, perceived relevance of problem-solving therapy) and continuity of the LHW team appeared crucial. Challenges to implementation included the LHWs ongoing need for weekly supervision despite years of experience; the supervisors need for supervision for herself; training needs in managing suicidal and hostile clients; poor documentation; lack of follow-up of depressed clients; and poor access to antidepressants. CONCLUSIONS: This case study shows that a collaborative care intervention for CMDs is positively received by patients, rewarding for LHWs to deliver, and can be sustained over time at low cost. Next steps include evaluation of the impact of the intervention through a randomised trial, and testing of a technological platform for supporting supervision and monitoring clients' attendance.
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“One example of this culturally responsive practice is the use of familial terms between clients and task-sharing providers, which helped establish older adult task-sharing providers as trusted confidants with whom community members could discuss their mental health concerns [57].”
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Self-citation
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“One example of this culturally responsive practice is the use of familial terms between clients and task-sharing providers, which helped establish older adult task-sharing providers as trusted confidants with whom community members could discuss their mental health concerns [57].”
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“Some studies mentioned demandside financing as a barrier to improved mental health delivery, citing the ability to pay for basic mental health services from the patient’s perspective (Neuner et al. 2008; Nimgaonkar & Menon, 2015; Abas et al. 2016).”
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Metadata
- Authors
- Abas, M., Bowers, T., Manda, E., Cooper, S., Machando, D., Verhey, R., Lamech, N., Araya, R., & Chibanda, D.
- Affiliations
- King's College London (GB)
- University of Zimbabwe (ZW)
- University of Cape Town (ZA)
- Women's University in Africa (ZW)
- Schizophrenia Research Foundation (IN)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Bowers, Tarryn
- Venue
- International Journal of Mental Health Systems
- Published
- 2016-05-11
- Volume
- 10
- Issue
- 1
- Pages
- 39-39
- ISSN
- 1752-4458 (ISSN-L)
- PMC
- PMC4865009
- OpenAlex
- W2391003650
- Cited by
- 114
- References
- 20
- Citations by year
- 2026: 12 · 2025: 11 · 2024: 8 · 2023: 7 · 2022: 20 · 2021: 24 · 2020: 9 · 2019: 14 · 2018: 5 · 2017: 3 · 2016: 1
- FWCI
- 12.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- International Journal of Mental Health Systems (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Open University of Cape Town (University of Cape Town) (submittedVersion)
- Greater South Information System
- Funders
- Grand Challenges Canada (09/31/2012 – 09/30/2015)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- problem-solving therapy, lay health workers, community mental health workers, depression, common mental disorders, collaborative care, primary care mental health, treatment acceptability, implementation barriers, supervision, Zimbabwe
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