1 00:00:15,076 --> 00:00:21,316 Speaker 1: Pushkin. I'm a Higgins and this is Solvable Interviews with 2 00:00:21,356 --> 00:00:25,036 Speaker 1: the world's most innovative thinkers working to solve the world's 3 00:00:25,076 --> 00:00:29,676 Speaker 1: biggest problems. My name is Dixon Shibanda and my solvable 4 00:00:30,076 --> 00:00:34,556 Speaker 1: is breaking the wall of depression by training grandmothers all 5 00:00:34,556 --> 00:00:39,516 Speaker 1: over the world in basic cognitive behavioral therapy so they 6 00:00:39,556 --> 00:00:45,396 Speaker 1: can provide care in their communities. Dixon Shabanda is an 7 00:00:45,436 --> 00:00:49,316 Speaker 1: associate professor at the University of Zimbabwe and he's the 8 00:00:49,316 --> 00:00:53,636 Speaker 1: director of the African Mental Health Research Initiative. He's also 9 00:00:53,716 --> 00:00:57,476 Speaker 1: one of only sixteen psychiatrists in the whole of Zimbabwe. 10 00:00:57,876 --> 00:01:00,996 Speaker 1: Now that country has a population of thirteen million people. 11 00:01:01,676 --> 00:01:05,516 Speaker 1: So Dixon Shabandah created the Friendship Bench that's a place 12 00:01:05,556 --> 00:01:09,116 Speaker 1: for people to seek and access therapy for mental healths. 13 00:01:09,956 --> 00:01:13,716 Speaker 1: These friendship benches are run by women in the community. 14 00:01:14,076 --> 00:01:17,316 Speaker 1: They're fondly referred to as grandmothers, and their work is 15 00:01:17,396 --> 00:01:21,356 Speaker 1: proving hugely successful. It's even beginning to catch on around 16 00:01:21,356 --> 00:01:24,036 Speaker 1: the world with a bench popping up here in New 17 00:01:24,116 --> 00:01:28,436 Speaker 1: York and also throughout Kenya. We certainly need solvables like 18 00:01:28,516 --> 00:01:32,756 Speaker 1: this because mental health is a global issue today and 19 00:01:32,916 --> 00:01:36,236 Speaker 1: estimated three hundred and twenty two million people around the 20 00:01:36,276 --> 00:01:40,556 Speaker 1: world live with depression, and the majority of those people 21 00:01:40,596 --> 00:01:45,476 Speaker 1: are in non Western nations. Now, mental health is fundamental 22 00:01:45,596 --> 00:01:51,356 Speaker 1: to our collective and our individual ability as humans to think, 23 00:01:51,436 --> 00:01:55,156 Speaker 1: to experience emotions, to interact with each other, to earn 24 00:01:55,196 --> 00:01:59,276 Speaker 1: a living, and really just to enjoy life. In low 25 00:01:59,276 --> 00:02:02,316 Speaker 1: income countries likes and bad Way, where seventy two percent 26 00:02:02,356 --> 00:02:05,956 Speaker 1: of the population live below the poverty line, you can 27 00:02:05,996 --> 00:02:09,436 Speaker 1: imagine that getting access to really any form of mental 28 00:02:09,436 --> 00:02:14,076 Speaker 1: health therapy, it's not only difficult, it's nearly impossible. But 29 00:02:14,396 --> 00:02:18,436 Speaker 1: that's changing thanks to today's guest Dicks in Shabandah. You'll 30 00:02:18,436 --> 00:02:22,516 Speaker 1: hear how in this conversation with Jacob Weisberg, I wanted 31 00:02:22,516 --> 00:02:26,476 Speaker 1: to ask you what brought you to this problem? Well, 32 00:02:26,516 --> 00:02:30,436 Speaker 1: the problem that I experienced, you know, as a junior 33 00:02:30,476 --> 00:02:35,596 Speaker 1: psychiatrist in Zimbabwe, where I first started my work was 34 00:02:35,676 --> 00:02:39,436 Speaker 1: just you know, quite huge, you know, just the sheer 35 00:02:39,476 --> 00:02:43,396 Speaker 1: amount of work and the need for professionals. And I 36 00:02:43,476 --> 00:02:47,876 Speaker 1: realized from a very early stage that working from a 37 00:02:48,036 --> 00:02:52,076 Speaker 1: hospital which just wasn't going to enable me to reach 38 00:02:52,116 --> 00:02:55,596 Speaker 1: out to the thousands of people that needed care, particularly 39 00:02:55,596 --> 00:02:58,916 Speaker 1: for depression. And when I lost a client of mine 40 00:02:59,516 --> 00:03:05,756 Speaker 1: Erica through suicide, I realized the need to actually take 41 00:03:06,196 --> 00:03:09,396 Speaker 1: mental health to the community, and this is how this 42 00:03:09,516 --> 00:03:13,796 Speaker 1: whole concept of working with grandmothers started. You know, a 43 00:03:13,956 --> 00:03:17,196 Speaker 1: need to take evidence based mental health to the community 44 00:03:17,476 --> 00:03:21,876 Speaker 1: and not just provided within health facilities or clinics. It's 45 00:03:21,876 --> 00:03:24,396 Speaker 1: been a real struggle in this country, and I'm sure 46 00:03:24,876 --> 00:03:27,996 Speaker 1: there's a different version of it Zimbabwe that you live through. 47 00:03:28,116 --> 00:03:32,276 Speaker 1: But to put mental health on a par with physical health, 48 00:03:32,316 --> 00:03:35,996 Speaker 1: people who will readily concede that everyone should have access 49 00:03:36,076 --> 00:03:40,956 Speaker 1: to healthcare sometimes think that mental healthcare is secondary or 50 00:03:40,956 --> 00:03:44,756 Speaker 1: a luxury of some kind. Yeah, that is unfortunately a 51 00:03:44,796 --> 00:03:49,316 Speaker 1: problem which is a global problem. A lot of people 52 00:03:49,356 --> 00:03:54,476 Speaker 1: do not realize that by sidelining mental health you inevitably 53 00:03:54,676 --> 00:04:00,716 Speaker 1: have challenges in addressing the physical health issues because coal 54 00:04:00,796 --> 00:04:03,316 Speaker 1: morbidity is kind of the norm in a lot of 55 00:04:03,436 --> 00:04:07,436 Speaker 1: chronic diseases. If you think of things like hypotension or diabetes, 56 00:04:07,756 --> 00:04:10,076 Speaker 1: you know a lot of people who from these chronic 57 00:04:10,156 --> 00:04:14,756 Speaker 1: diseases do have core morbid mental health issues. And when 58 00:04:14,796 --> 00:04:18,116 Speaker 1: you tackle just the physical and not tackle the mental 59 00:04:18,196 --> 00:04:21,396 Speaker 1: health or the emotional well being or a person, you 60 00:04:21,516 --> 00:04:25,316 Speaker 1: actually do not improve the outcomes or the physical aspect 61 00:04:25,356 --> 00:04:27,356 Speaker 1: as well. So it's very important to have a very 62 00:04:27,396 --> 00:04:29,956 Speaker 1: holistic approach. This is what the work that I do 63 00:04:30,076 --> 00:04:32,556 Speaker 1: is all about. You know, it's not really just about 64 00:04:32,636 --> 00:04:36,396 Speaker 1: mental health, but it's ensuring that mental health results in 65 00:04:36,796 --> 00:04:42,156 Speaker 1: improved outcomes of other conditions that people may have and functionality, 66 00:04:42,236 --> 00:04:45,236 Speaker 1: for instance, the number of people who struggle in the 67 00:04:45,236 --> 00:04:48,516 Speaker 1: workplace as a result of mental health issues. You know. Again, 68 00:04:48,596 --> 00:04:52,196 Speaker 1: if you address the mental health issues, you improve people's functionality. 69 00:04:52,596 --> 00:04:56,436 Speaker 1: Organizations function better, companies produce better results, you know. So 70 00:04:56,956 --> 00:04:59,996 Speaker 1: it's kind of endless if you think of the link 71 00:05:00,076 --> 00:05:02,636 Speaker 1: of mental health with the challenges that are out there 72 00:05:02,676 --> 00:05:05,476 Speaker 1: that the world is trying to address. What type of 73 00:05:05,516 --> 00:05:08,796 Speaker 1: mental and emotional issues are you dealing with? How serious? 74 00:05:09,716 --> 00:05:12,476 Speaker 1: So when we first started, our focus was on what 75 00:05:12,516 --> 00:05:16,596 Speaker 1: we call common mental disorders, which in essence include things 76 00:05:16,636 --> 00:05:22,396 Speaker 1: like depression anxiety disorders PDSD. And we use an algorithm 77 00:05:22,716 --> 00:05:27,156 Speaker 1: to enable us to determine the severity of the symptoms 78 00:05:27,156 --> 00:05:30,796 Speaker 1: that a person presents with. And so if someone is, 79 00:05:30,876 --> 00:05:34,996 Speaker 1: for instance, a red flag, someone is for instance, suicidal, 80 00:05:35,476 --> 00:05:38,316 Speaker 1: the grandmothers on the bench will refer that person to 81 00:05:38,396 --> 00:05:41,956 Speaker 1: the next level. So we have these algorithms that enable 82 00:05:42,116 --> 00:05:45,236 Speaker 1: us to address the needs of pretty much everyone who 83 00:05:45,236 --> 00:05:48,116 Speaker 1: comes to the bench, either directly on the bench or 84 00:05:48,156 --> 00:05:51,236 Speaker 1: by referring them to the next level, depending on what 85 00:05:51,356 --> 00:05:54,276 Speaker 1: it is they present with, Jackson, How did you come 86 00:05:54,356 --> 00:05:57,676 Speaker 1: up with this idea of the bench? So when I 87 00:05:57,716 --> 00:06:01,716 Speaker 1: first made the decision to introduce something at community level, 88 00:06:02,076 --> 00:06:04,916 Speaker 1: a lot had been happening in my country. In two 89 00:06:04,916 --> 00:06:08,716 Speaker 1: thousand and five, the country went through a lot of 90 00:06:08,756 --> 00:06:13,196 Speaker 1: social or economic upheavals, and it was against the background 91 00:06:13,436 --> 00:06:18,076 Speaker 1: of these upheavals that a need to introduce something at 92 00:06:18,156 --> 00:06:25,876 Speaker 1: community level came. And unfortunately, because there were no psychiatrists 93 00:06:25,996 --> 00:06:30,036 Speaker 1: or doctors available, I was instructed to try and come 94 00:06:30,116 --> 00:06:35,236 Speaker 1: up with a solution using community grandmothers. And because we 95 00:06:35,236 --> 00:06:38,636 Speaker 1: couldn't use any of the buildings, we were also told, well, 96 00:06:38,796 --> 00:06:41,316 Speaker 1: try and come up with something outside of the building. 97 00:06:41,396 --> 00:06:44,116 Speaker 1: So it was really more of necessity, you know, and 98 00:06:44,196 --> 00:06:49,396 Speaker 1: through an iterative process with the grandmothers, we eventually came 99 00:06:49,476 --> 00:06:53,076 Speaker 1: up with the idea of actually delivering therapy on a bench. 100 00:06:53,156 --> 00:06:56,436 Speaker 1: It was really necessitated by the fact that there was nothing, 101 00:06:56,476 --> 00:07:00,316 Speaker 1: absolutely nothing, and so all I had with these grandmothers 102 00:07:00,796 --> 00:07:04,356 Speaker 1: and the idea of doing something on a bench. So, Dickson, 103 00:07:04,396 --> 00:07:07,196 Speaker 1: you've seen the effectiveness of the friendship bench. Can you 104 00:07:07,236 --> 00:07:09,876 Speaker 1: give us an example. Sure, let me give you an 105 00:07:09,876 --> 00:07:14,836 Speaker 1: example of Derek. Derek was a young man who was 106 00:07:14,916 --> 00:07:20,116 Speaker 1: employed in the tea industry in Zimbabwe and he was 107 00:07:20,236 --> 00:07:25,916 Speaker 1: referred to the friendship bench after a third unsuccessful attempt 108 00:07:26,316 --> 00:07:30,036 Speaker 1: to kill himself. And this was the first time really 109 00:07:30,476 --> 00:07:35,276 Speaker 1: he had the opportunity to tell his story. And when 110 00:07:35,276 --> 00:07:40,676 Speaker 1: the grandmother invited him to share his story, he suddenly 111 00:07:40,796 --> 00:07:46,556 Speaker 1: had this overwhelming sense of relief because he could really 112 00:07:46,596 --> 00:07:49,556 Speaker 1: then share his story with the grandmother and that was, 113 00:07:49,636 --> 00:07:54,196 Speaker 1: in essence, the beginning of his healing. Often it's simply 114 00:07:54,236 --> 00:07:58,796 Speaker 1: about letting people share their stories. And after he shared 115 00:07:58,836 --> 00:08:03,996 Speaker 1: his story, the grandmother worked through and enabled him to 116 00:08:04,116 --> 00:08:07,516 Speaker 1: prioritize the things that needed to be done in order 117 00:08:07,796 --> 00:08:12,516 Speaker 1: to help him through the challenges that he was facing. See, 118 00:08:12,556 --> 00:08:16,236 Speaker 1: Derek was living with HIV and he was struggling to 119 00:08:16,276 --> 00:08:19,356 Speaker 1: get his medication. He was struggling to come to terms 120 00:08:19,356 --> 00:08:22,956 Speaker 1: with being HIV positive. And that was his story. And 121 00:08:23,116 --> 00:08:29,916 Speaker 1: today Derek is still functional and he's kept his job. Yeah, 122 00:08:30,036 --> 00:08:33,876 Speaker 1: that is a great story. The grandmothers can't prescribe drugs. 123 00:08:33,916 --> 00:08:38,156 Speaker 1: I'm assuming what do they do with patients who are 124 00:08:38,196 --> 00:08:42,356 Speaker 1: in need of some medical and intervention. Well, they refer 125 00:08:42,556 --> 00:08:45,596 Speaker 1: so as I said earlier on, we have this algorithm 126 00:08:45,956 --> 00:08:49,396 Speaker 1: and based on the severity of symptoms that a client 127 00:08:49,876 --> 00:08:54,316 Speaker 1: presents with, they will then refer to the next level, 128 00:08:54,356 --> 00:08:58,236 Speaker 1: and the next level will establish whether there's need for medication. 129 00:08:58,316 --> 00:09:02,756 Speaker 1: If there's need for medication, the clinic nurse will prescribe 130 00:09:02,756 --> 00:09:07,236 Speaker 1: the medication, not the grandmother or the psychiatrist will prescribe 131 00:09:07,276 --> 00:09:11,556 Speaker 1: the medication. So the entry point into Friendship Bench is 132 00:09:11,556 --> 00:09:17,756 Speaker 1: a screening of basic symptoms for common mental disorders. For instance, 133 00:09:17,756 --> 00:09:21,356 Speaker 1: the questionnaire will include questions related to sleep. You know, 134 00:09:21,436 --> 00:09:23,836 Speaker 1: how have you been sleeping in the last week, and 135 00:09:23,956 --> 00:09:26,916 Speaker 1: have you found it difficult to cope in the last week? 136 00:09:26,996 --> 00:09:30,516 Speaker 1: Have you found yourself feeling tearful in the last week? 137 00:09:30,596 --> 00:09:34,676 Speaker 1: Have you had thoughts of ending your life? Those kind 138 00:09:34,676 --> 00:09:37,956 Speaker 1: of questions, And depending on the number of yes responses 139 00:09:37,996 --> 00:09:42,076 Speaker 1: that the grandmother gets, she will then know where to 140 00:09:42,276 --> 00:09:46,116 Speaker 1: place a client. You know, whether this is a client 141 00:09:46,436 --> 00:09:50,236 Speaker 1: that should receive the full Friendship Bench or they should 142 00:09:50,236 --> 00:09:53,756 Speaker 1: immediately be referred because it's a red flag, So we 143 00:09:53,836 --> 00:09:57,356 Speaker 1: try to use those categories to ensure that we really 144 00:09:57,596 --> 00:10:01,516 Speaker 1: don't cause any harm to anyone through this intervention. So 145 00:10:01,596 --> 00:10:04,876 Speaker 1: it's really an essence as stepped care kind of approach 146 00:10:05,156 --> 00:10:08,396 Speaker 1: to addressing the treatment gap with a bulk of the 147 00:10:08,796 --> 00:10:11,596 Speaker 1: client and so are taken care of by grandmothers and 148 00:10:11,756 --> 00:10:15,556 Speaker 1: those that they can't help go to the next level. Dickson, 149 00:10:15,596 --> 00:10:18,316 Speaker 1: you said it's evidence based. What is the evidence that 150 00:10:18,396 --> 00:10:22,716 Speaker 1: you have about how the effectiveness of this compares to 151 00:10:23,076 --> 00:10:26,996 Speaker 1: other more conventional forms of initial treatment. Yeah, that's a 152 00:10:27,036 --> 00:10:30,276 Speaker 1: great question, you know. So in the world of research, 153 00:10:30,876 --> 00:10:36,156 Speaker 1: the gold standard for effectiveness is what we call the 154 00:10:36,156 --> 00:10:40,236 Speaker 1: the randomized trial, and so we carried out a cluster 155 00:10:40,396 --> 00:10:45,036 Speaker 1: randomized controlled trial of the Friendship Bench, which is actually 156 00:10:45,076 --> 00:10:49,116 Speaker 1: published in the Journal of the American Medical Association. And 157 00:10:49,236 --> 00:10:53,236 Speaker 1: in this cluster randomized controlled trial, we had twenty four 158 00:10:53,276 --> 00:10:58,716 Speaker 1: clinics that we're randomized into intervention arm, which was the 159 00:10:58,756 --> 00:11:03,956 Speaker 1: Friendship bench or usual care, which essentially is being seen 160 00:11:03,996 --> 00:11:09,516 Speaker 1: by a clinic nurse or a psychiatrist or receiving rozac 161 00:11:09,676 --> 00:11:13,116 Speaker 1: for depression. So that was one arm and we compared 162 00:11:13,556 --> 00:11:17,196 Speaker 1: the primary outcome was HQ nine, which is a measure 163 00:11:17,316 --> 00:11:20,996 Speaker 1: for depression symptoms, and we followed our clients over a 164 00:11:21,116 --> 00:11:26,116 Speaker 1: six month period and after six months, our results showed 165 00:11:26,156 --> 00:11:33,076 Speaker 1: that grandmothers were statistically much better than usual care, which 166 00:11:33,116 --> 00:11:38,996 Speaker 1: include nurses and psychiatrists in alleviating symptoms of depression on 167 00:11:39,036 --> 00:11:42,516 Speaker 1: the bench, you know, and so that evidence is published, 168 00:11:42,556 --> 00:11:45,516 Speaker 1: it's out there and people can look at it. But 169 00:11:45,716 --> 00:11:49,476 Speaker 1: not only that, we have well over fifty peer reviewed 170 00:11:49,516 --> 00:11:53,156 Speaker 1: publications about the Friendship Bench, how it works and why 171 00:11:53,156 --> 00:11:58,916 Speaker 1: it works, both quantitative publications and qualitative publications which describe, 172 00:11:58,996 --> 00:12:02,436 Speaker 1: you know, the process, which describe the experience of both 173 00:12:02,436 --> 00:12:05,876 Speaker 1: the grandmothers and the experience of the clients. So the 174 00:12:05,916 --> 00:12:09,596 Speaker 1: evidence is quite rigorous that we have managed to together 175 00:12:09,756 --> 00:12:12,516 Speaker 1: and publish over the past couple of years. There's often 176 00:12:12,596 --> 00:12:16,756 Speaker 1: stigma attached to depression, and the stigma is different in 177 00:12:16,916 --> 00:12:20,916 Speaker 1: different cultures. What's it like in Zimbabwe and how do 178 00:12:20,956 --> 00:12:25,156 Speaker 1: you deal with that? So there's no difference in Zimbabwe 179 00:12:25,196 --> 00:12:29,396 Speaker 1: with regards to stigma attached to different forms of mental illness. 180 00:12:30,476 --> 00:12:33,156 Speaker 1: But the way we've dealt with it on the Friendship 181 00:12:33,156 --> 00:12:39,356 Speaker 1: Bench is we have avoided the medicalization or the use 182 00:12:39,436 --> 00:12:45,476 Speaker 1: of clinical terms to describe clients that come to the bench. 183 00:12:45,916 --> 00:12:48,476 Speaker 1: The first thing that we emphasize on the Friendship bench, 184 00:12:48,516 --> 00:12:53,276 Speaker 1: for instance, is the desire for our team to improve 185 00:12:53,356 --> 00:12:56,636 Speaker 1: a person's quality of life, and we do not refer 186 00:12:56,756 --> 00:13:01,236 Speaker 1: to clients based on their diagnosis. And the other thing 187 00:13:01,316 --> 00:13:06,596 Speaker 1: is we use local indigenous terms to describe what they're 188 00:13:06,636 --> 00:13:09,476 Speaker 1: going through, like for instance, we would never use the 189 00:13:09,476 --> 00:13:13,396 Speaker 1: word depression. The term that is used on the Friendship 190 00:13:13,396 --> 00:13:17,196 Speaker 1: bench in my language is kufungi sisa, which literally means 191 00:13:17,396 --> 00:13:21,676 Speaker 1: thinking too much, and that often resonates with people when 192 00:13:21,716 --> 00:13:24,996 Speaker 1: it comes to depression. When you think of the actual 193 00:13:25,156 --> 00:13:29,476 Speaker 1: intervention itself on the bench, the different sessions we use 194 00:13:29,676 --> 00:13:33,916 Speaker 1: language again which resonates with the community. We talk about 195 00:13:34,036 --> 00:13:38,676 Speaker 1: kuvurap funga, which literally means opening up the mind. We 196 00:13:38,716 --> 00:13:43,116 Speaker 1: talk about kusimud zera, which literally means uplifting, and then 197 00:13:43,156 --> 00:13:46,876 Speaker 1: we talk about kusimbisa, which is strengthening. You know, none 198 00:13:46,916 --> 00:13:50,396 Speaker 1: of those terms are medical in whatever way you look 199 00:13:50,436 --> 00:13:54,596 Speaker 1: at them, but they are very powerful and communities resonate 200 00:13:54,676 --> 00:13:59,276 Speaker 1: with those words. They can identify with kuvapunga or opening 201 00:13:59,356 --> 00:14:01,996 Speaker 1: up of the mind, because that's really what people want 202 00:14:01,996 --> 00:14:04,916 Speaker 1: when they present their story. They want to open up 203 00:14:04,996 --> 00:14:07,516 Speaker 1: their minds so they can see how through that story 204 00:14:07,836 --> 00:14:10,716 Speaker 1: they can get healing. Through that story, they can get 205 00:14:10,716 --> 00:14:13,196 Speaker 1: a sense of direction in terms of what needs to 206 00:14:13,236 --> 00:14:16,396 Speaker 1: happen in their lives. And again, if you look at 207 00:14:16,436 --> 00:14:19,436 Speaker 1: New York City, they are pretty much doing the same thing. 208 00:14:19,476 --> 00:14:23,036 Speaker 1: They are not labeling people, they are creating an opportunity 209 00:14:23,116 --> 00:14:26,596 Speaker 1: for people to tell their stories. That's wonderful. And do 210 00:14:26,636 --> 00:14:30,156 Speaker 1: you think that would apply as well in the developed 211 00:14:30,196 --> 00:14:33,596 Speaker 1: world or is there something about traditional culture of the 212 00:14:33,676 --> 00:14:36,356 Speaker 1: kind you were operating in a Zimbabwe and the role 213 00:14:36,396 --> 00:14:40,916 Speaker 1: of grandmothers there that makes it specially effective. I think 214 00:14:40,956 --> 00:14:44,236 Speaker 1: it would apply in the developed world as well. What 215 00:14:44,356 --> 00:14:47,116 Speaker 1: we've learned from Friendship Bench is that grandmothers are the 216 00:14:47,196 --> 00:14:53,356 Speaker 1: custodians of local culture and wisdom, and using grandmothers in 217 00:14:53,396 --> 00:14:58,396 Speaker 1: any culture is a great way of connecting people and 218 00:14:58,476 --> 00:15:03,916 Speaker 1: really addressing some of the issues around, for instance, loneliness. 219 00:15:04,716 --> 00:15:06,836 Speaker 1: You know, so, I think, as I said earlier on, 220 00:15:06,916 --> 00:15:10,756 Speaker 1: this model works and it's kind of universal. I think 221 00:15:10,956 --> 00:15:13,076 Speaker 1: from what we're seeing in terms of, you know, the 222 00:15:13,156 --> 00:15:17,076 Speaker 1: different places in the world that are using Friendship Bench. 223 00:15:17,436 --> 00:15:21,596 Speaker 1: I also wonder, Dickson, is there something about doing this 224 00:15:21,796 --> 00:15:25,476 Speaker 1: therapy out of doors as opposed to in a closed room. 225 00:15:25,556 --> 00:15:28,636 Speaker 1: That makes a difference to the patients. See from the 226 00:15:28,676 --> 00:15:31,996 Speaker 1: feedback that we get from patients doing this kind of therapy, 227 00:15:32,036 --> 00:15:36,236 Speaker 1: Outdoors almost kind of takes away the stigma that is 228 00:15:36,276 --> 00:15:40,996 Speaker 1: associated with being indoors and seeing a therapist who is 229 00:15:41,036 --> 00:15:45,596 Speaker 1: formally dressed or a psychiatrist. In fact, the name itself, 230 00:15:45,636 --> 00:15:49,116 Speaker 1: you know, the Friendship Bench, just takes away the stigma. 231 00:15:49,316 --> 00:15:52,156 Speaker 1: When we first started, you know, we actually called it 232 00:15:52,196 --> 00:15:55,636 Speaker 1: the mental health bench. And guess what, no one wanted 233 00:15:55,676 --> 00:15:59,476 Speaker 1: to come to the mental health bench and the grandmothers, 234 00:15:59,516 --> 00:16:03,276 Speaker 1: the grandmothers advised that I changed the name, change the 235 00:16:03,356 --> 00:16:06,516 Speaker 1: name to Friendship Bench, because that's what really was happening. Yet, 236 00:16:06,556 --> 00:16:10,236 Speaker 1: this was about creating friendship through stories. And when we 237 00:16:10,316 --> 00:16:13,756 Speaker 1: change the name, you know, again it's it took away 238 00:16:13,836 --> 00:16:19,116 Speaker 1: that that clinical aspect or clinical connotations, and it just 239 00:16:19,276 --> 00:16:22,596 Speaker 1: became a lot more acceptable. I think that one of 240 00:16:22,636 --> 00:16:25,196 Speaker 1: the powers of Friendship Bench, whether you look at Friendship 241 00:16:25,196 --> 00:16:27,836 Speaker 1: Bench in New York City, it's it's that it's outdoors, 242 00:16:27,916 --> 00:16:31,276 Speaker 1: which gives people that freedom to express themselves. What's it 243 00:16:31,356 --> 00:16:33,876 Speaker 1: like for the grandmothers? First of all, do they get 244 00:16:33,876 --> 00:16:37,556 Speaker 1: paid and second of all, do they all take to 245 00:16:37,596 --> 00:16:39,556 Speaker 1: it in the same way. I mean, I imagine that 246 00:16:39,556 --> 00:16:41,676 Speaker 1: this is the kind of work that is on the 247 00:16:41,716 --> 00:16:45,316 Speaker 1: one hand, very fulfilling, but on the other hand, very difficult, 248 00:16:45,756 --> 00:16:50,396 Speaker 1: including emotionally. For that. Yeah, it was one of our concerns, 249 00:16:50,596 --> 00:16:53,556 Speaker 1: you know, a few years ago and a colleague of mine, Ruth, 250 00:16:54,276 --> 00:16:57,316 Speaker 1: who is a clinical psychologist working on the friendship bench, 251 00:16:58,036 --> 00:17:02,596 Speaker 1: she actually took it upon herself to try and look 252 00:17:02,836 --> 00:17:07,316 Speaker 1: into how the grandmothers, you know, we're coping with doing 253 00:17:07,356 --> 00:17:10,836 Speaker 1: all these work. So that was really her PhD topic 254 00:17:10,996 --> 00:17:14,716 Speaker 1: to really look into how the grandmothers were managing to 255 00:17:14,756 --> 00:17:17,756 Speaker 1: do all this. Our hypothesis was, you know, we're probably 256 00:17:17,796 --> 00:17:21,796 Speaker 1: going to see a lot of these grandmothers stressed, burned out, 257 00:17:21,916 --> 00:17:25,036 Speaker 1: and they will they will themselves have very high rates 258 00:17:25,076 --> 00:17:29,876 Speaker 1: of common mental disorders. But surprisingly, out of a random 259 00:17:29,956 --> 00:17:34,436 Speaker 1: sample of hundreds of grandmothers, we found that the actual 260 00:17:34,676 --> 00:17:38,716 Speaker 1: rates of common mental disorders amongst the grandmothers who were 261 00:17:38,756 --> 00:17:42,276 Speaker 1: working on the friendship bench who was much lower than 262 00:17:42,316 --> 00:17:45,156 Speaker 1: the community of people who were not working on the 263 00:17:45,236 --> 00:17:48,876 Speaker 1: friendship bench. And we then went deeper into it to 264 00:17:48,916 --> 00:17:53,636 Speaker 1: find out how this was possible, and the themes that 265 00:17:53,836 --> 00:17:56,916 Speaker 1: kept emerging from their grandmothers, you know, had a lot 266 00:17:56,956 --> 00:17:59,996 Speaker 1: to do with altruism. Working on the bench for the 267 00:18:00,076 --> 00:18:04,596 Speaker 1: grandmothers in their communities gave them a sense of purpose 268 00:18:05,436 --> 00:18:08,676 Speaker 1: and over the years that sense of purpose, you know, 269 00:18:08,876 --> 00:18:14,156 Speaker 1: resulted in mastery of a skill to really empower others 270 00:18:14,156 --> 00:18:16,916 Speaker 1: in the community and help others in the community. And 271 00:18:16,996 --> 00:18:20,076 Speaker 1: it also gave the grandmothers a sense of autonomy which 272 00:18:20,116 --> 00:18:25,396 Speaker 1: is very empowering. So in essence, the grandmothers are benefiting 273 00:18:25,476 --> 00:18:30,076 Speaker 1: from this work while they help people. And are they 274 00:18:30,276 --> 00:18:33,156 Speaker 1: paid and does that matter? So they do get an 275 00:18:33,156 --> 00:18:37,556 Speaker 1: allowance from the city Health Department. I must say recently, 276 00:18:37,636 --> 00:18:42,356 Speaker 1: the government of Zimbabwe this year finally after a long time, 277 00:18:42,796 --> 00:18:47,596 Speaker 1: it decided to endorse Friendship Bench as a national program 278 00:18:48,076 --> 00:18:52,596 Speaker 1: which is now integrated in the health system of the country. 279 00:18:52,996 --> 00:18:55,316 Speaker 1: So they do get an allowance. But we also get 280 00:18:55,356 --> 00:18:57,956 Speaker 1: a lot of people who do Friendship Bench for free, 281 00:18:58,036 --> 00:19:02,076 Speaker 1: who volunteer. For instance, we've taken Friendship Bench to schools. 282 00:19:02,516 --> 00:19:06,396 Speaker 1: As you know, mental health issues are quite topical with 283 00:19:07,276 --> 00:19:09,956 Speaker 1: young people. In fact, young people at the most affected 284 00:19:10,276 --> 00:19:12,876 Speaker 1: by depression. If you look at some of the statistics 285 00:19:12,916 --> 00:19:16,116 Speaker 1: coming out of the world Health organization, and so we've 286 00:19:16,116 --> 00:19:20,836 Speaker 1: been taking Friendship Bench to universities where we're introducing a 287 00:19:20,996 --> 00:19:25,716 Speaker 1: peer driven Friendship bench where university students are trained to 288 00:19:25,756 --> 00:19:28,516 Speaker 1: sit on the bench to provide the service to other 289 00:19:29,076 --> 00:19:33,076 Speaker 1: students because Zimbabwe has one of the highest suicide rates 290 00:19:33,076 --> 00:19:35,636 Speaker 1: in that part of Africa, and so we see this 291 00:19:35,796 --> 00:19:39,396 Speaker 1: as an effective intervention where young people are reaching out 292 00:19:39,796 --> 00:19:44,556 Speaker 1: to provide support to other young people. And again it's 293 00:19:44,676 --> 00:19:50,076 Speaker 1: all rooted in storytelling. You referred a little obliquely to 294 00:19:50,396 --> 00:19:55,036 Speaker 1: what's happened in Zimbabwe, but obviously you have this devastating 295 00:19:55,076 --> 00:20:02,476 Speaker 1: combination of long term political repression with economic collapse. Has 296 00:20:02,556 --> 00:20:07,396 Speaker 1: that produced special circumstances or a larger number of people 297 00:20:07,996 --> 00:20:12,796 Speaker 1: in need of this kind of cognitive therapy. So, while 298 00:20:12,876 --> 00:20:16,036 Speaker 1: Zimbabwe is unique in the sense that it has a 299 00:20:16,116 --> 00:20:21,196 Speaker 1: lot of problems, when you look at the global burden 300 00:20:21,836 --> 00:20:27,156 Speaker 1: of common mental disorders, it's not unique to Zimbabwe. The 301 00:20:27,276 --> 00:20:33,076 Speaker 1: whole world is desperately in need of evidence based interventions 302 00:20:33,236 --> 00:20:38,076 Speaker 1: such as Friendship Bench that really seek to narrow or 303 00:20:38,116 --> 00:20:41,836 Speaker 1: reduce the treatment gap for these conditions so that everyone 304 00:20:41,876 --> 00:20:46,196 Speaker 1: everywhere has access to this much needed help. So, yes, 305 00:20:46,476 --> 00:20:49,836 Speaker 1: Zimbabwe has a whole lot of challenges. I mean historically, 306 00:20:50,276 --> 00:20:52,756 Speaker 1: you know, if you look at Zimbabwe, it's a country 307 00:20:52,796 --> 00:20:57,796 Speaker 1: that is characterized by several generations of trauma. When you 308 00:20:58,556 --> 00:21:03,076 Speaker 1: think of the right in the eighteenth century, the Pioneer Column, 309 00:21:03,116 --> 00:21:06,316 Speaker 1: and then you had the Rhodesian Bush War, and then 310 00:21:06,476 --> 00:21:10,196 Speaker 1: you had the massacre of more than twenty thousand debility 311 00:21:10,236 --> 00:21:13,596 Speaker 1: speaking people. You know, the farm invasions where white folks 312 00:21:13,636 --> 00:21:16,196 Speaker 1: were kicked off their farms and a lot of them killed. 313 00:21:16,916 --> 00:21:20,956 Speaker 1: It's just a history of tragedy and with that history 314 00:21:21,636 --> 00:21:25,756 Speaker 1: comes a need for healing. And I see the Friendship 315 00:21:25,796 --> 00:21:32,196 Speaker 1: Bench as a platform providing an opportunity for healing, not 316 00:21:32,276 --> 00:21:35,436 Speaker 1: only for Zimbabwe, but for the world. And as I 317 00:21:35,476 --> 00:21:40,316 Speaker 1: said earlier on, people thrive through storytelling, and we all 318 00:21:40,356 --> 00:21:45,156 Speaker 1: have a story to tell. And if we can leverage 319 00:21:45,236 --> 00:21:52,596 Speaker 1: our ability to use these stories to facilitate healing, I 320 00:21:52,716 --> 00:21:55,516 Speaker 1: believe that we could be moving in a direction where 321 00:21:56,236 --> 00:21:58,556 Speaker 1: the world becomes a better place for all of us. 322 00:21:58,916 --> 00:22:01,236 Speaker 1: And so, in a small way, that's what I believe in, 323 00:22:01,356 --> 00:22:03,636 Speaker 1: you know, and that's why I keep carrying on doing 324 00:22:03,636 --> 00:22:06,716 Speaker 1: this work on Friendship Bench. It's not just about mental health, 325 00:22:06,756 --> 00:22:09,356 Speaker 1: it's about the big picture takes a news say in 326 00:22:09,396 --> 00:22:12,236 Speaker 1: a small way, but not that small anymore. What's the 327 00:22:12,356 --> 00:22:17,796 Speaker 1: scale of friendship Bench now in Zimbabwe and then everywhere else? 328 00:22:18,276 --> 00:22:22,316 Speaker 1: So in Zimbabwe we are seeing thousands of people every month. 329 00:22:22,396 --> 00:22:24,636 Speaker 1: I mean in the last two years we reached out 330 00:22:24,716 --> 00:22:30,076 Speaker 1: to over sixty thousand people, and we don't have accurate 331 00:22:30,156 --> 00:22:35,156 Speaker 1: figures for places like Malawi, Zanzibar and Kenya where we've 332 00:22:35,196 --> 00:22:38,996 Speaker 1: recently introduced. What we do know is friendship Bench New 333 00:22:39,076 --> 00:22:42,316 Speaker 1: York City in the Bronx and Harlem is doing extremely 334 00:22:42,356 --> 00:22:45,636 Speaker 1: well and they managed to reach out to over eighty 335 00:22:45,676 --> 00:22:49,916 Speaker 1: thousand people a year ago, and so I guess the 336 00:22:50,036 --> 00:22:53,636 Speaker 1: numbers are growing exponentially. But what I really would like 337 00:22:53,716 --> 00:22:57,516 Speaker 1: to see is a situation where friendship Bench is reaching 338 00:22:57,556 --> 00:23:02,396 Speaker 1: out to millions of people across the world and also 339 00:23:03,156 --> 00:23:07,636 Speaker 1: friendship Bench being recognized as a platform that really can 340 00:23:07,876 --> 00:23:13,116 Speaker 1: enable people to open up and tell their stories in 341 00:23:13,156 --> 00:23:17,756 Speaker 1: a safe environment, telling their stories so that we have healing. 342 00:23:18,316 --> 00:23:21,676 Speaker 1: It's clear the idea of spreading around the world, But 343 00:23:21,756 --> 00:23:26,076 Speaker 1: what's next for the bench as a project. So as 344 00:23:26,076 --> 00:23:29,796 Speaker 1: a project, we are now really looking at how we 345 00:23:29,876 --> 00:23:34,516 Speaker 1: can reach our first million clients, not just you know, 346 00:23:34,556 --> 00:23:37,676 Speaker 1: in Zimbabwe, but in the different parts of the world 347 00:23:37,716 --> 00:23:41,716 Speaker 1: where we've introduced friendship Bench. We are about to introduce 348 00:23:41,756 --> 00:23:46,516 Speaker 1: friendship Bench in Rwanda, we are planning to go to Liberia, 349 00:23:46,636 --> 00:23:49,876 Speaker 1: you know, we've just started in Kenya. And so what 350 00:23:49,916 --> 00:23:53,876 Speaker 1: we're really working on is how to bring on board 351 00:23:54,196 --> 00:23:58,796 Speaker 1: a digital component to enhance the work that the Grandmothers 352 00:23:58,796 --> 00:24:02,036 Speaker 1: are doing because now we're really dealing with big data, 353 00:24:02,236 --> 00:24:06,156 Speaker 1: and with big data, we need to really look at 354 00:24:06,196 --> 00:24:08,756 Speaker 1: how best we can learn from the data that is 355 00:24:08,796 --> 00:24:12,236 Speaker 1: being collected. How can we improve friendship Bench. How can 356 00:24:12,276 --> 00:24:16,396 Speaker 1: friendship Bench continue to serve communities, How can friendship Bench 357 00:24:16,476 --> 00:24:20,156 Speaker 1: continue to improve lives across the world. So that's really 358 00:24:20,196 --> 00:24:23,116 Speaker 1: our next big challenge. And for all of that, obviously 359 00:24:23,156 --> 00:24:27,236 Speaker 1: we need support and we are we are looking for 360 00:24:27,356 --> 00:24:31,316 Speaker 1: partners who can help us to really reach every corner 361 00:24:31,396 --> 00:24:34,436 Speaker 1: of the world and make mental health, you know, evidence 362 00:24:34,476 --> 00:24:37,236 Speaker 1: based mental health accessible for all. Well, that brings me 363 00:24:37,276 --> 00:24:39,636 Speaker 1: to the last question I always like to ask, which 364 00:24:39,716 --> 00:24:44,396 Speaker 1: is how can listeners advance this? How can they get involved? 365 00:24:44,436 --> 00:24:48,196 Speaker 1: How can they help? If you want to help friendship Bench, 366 00:24:48,276 --> 00:24:52,676 Speaker 1: people can do is really within themselves in their communities, 367 00:24:53,556 --> 00:24:58,836 Speaker 1: try to create space for healing. The world today is 368 00:24:58,916 --> 00:25:04,076 Speaker 1: facing numerous challenges, numerous problems. You know, on the one hand, 369 00:25:04,836 --> 00:25:08,556 Speaker 1: we have all these technological developments. You know, we've done 370 00:25:08,676 --> 00:25:12,836 Speaker 1: so well technologically as a human race, but when you 371 00:25:12,876 --> 00:25:17,796 Speaker 1: look at relationships, it's going the other direction. And one 372 00:25:17,876 --> 00:25:21,276 Speaker 1: simple thing that we could all do is try to 373 00:25:21,316 --> 00:25:25,676 Speaker 1: create space for healing in our communities. Try to create 374 00:25:25,796 --> 00:25:30,636 Speaker 1: space to listen to the stories that our neighbors have, 375 00:25:30,996 --> 00:25:34,636 Speaker 1: the people in our neighborhood have, people in our communities. 376 00:25:35,116 --> 00:25:37,556 Speaker 1: You don't have to be a psychiatrist or a clinical 377 00:25:37,596 --> 00:25:41,076 Speaker 1: psychologist to make a difference in your community. You simply 378 00:25:41,116 --> 00:25:44,556 Speaker 1: have to be able to give space for people to 379 00:25:44,556 --> 00:25:47,836 Speaker 1: share their stories and you have to listen, and that 380 00:25:47,996 --> 00:25:52,036 Speaker 1: in itself is very very powerful. And of course, as 381 00:25:52,356 --> 00:25:55,196 Speaker 1: Friendship Bench, we want to take Friendship Bench to every 382 00:25:55,196 --> 00:25:57,716 Speaker 1: corner of the world, and so we're very happy to 383 00:25:57,796 --> 00:26:01,596 Speaker 1: work with people to collaborate with people who feel that 384 00:26:01,716 --> 00:26:04,996 Speaker 1: a Friendship Bench in their community or in their organization 385 00:26:05,516 --> 00:26:10,556 Speaker 1: could help address mental health challenges or just generally improve 386 00:26:10,636 --> 00:26:13,196 Speaker 1: the quality of life and make the world a bit 387 00:26:13,236 --> 00:26:17,716 Speaker 1: of place. Dixon Shabanda, thanks for joining us Unsolvable Pleasure. 388 00:26:17,876 --> 00:26:22,836 Speaker 1: Thank you for having me. Wow Schka Saszina, he's a 389 00:26:22,956 --> 00:26:26,276 Speaker 1: director of the Department of Mental Health and Substance Abuse 390 00:26:26,556 --> 00:26:30,276 Speaker 1: at the World Health Organization said, when it comes to 391 00:26:30,396 --> 00:26:34,516 Speaker 1: mental health, we are all developing countries, and that really 392 00:26:34,556 --> 00:26:38,076 Speaker 1: stayed with me. And I think that this episode has 393 00:26:38,116 --> 00:26:41,116 Speaker 1: been such a fitting last episode of this season of 394 00:26:41,236 --> 00:26:48,116 Speaker 1: Solvable because communicating, talking, sharing, these are all proven to 395 00:26:48,156 --> 00:26:52,596 Speaker 1: potentially keep hopelessness at bay. And it's been such a 396 00:26:52,636 --> 00:26:55,436 Speaker 1: privilege for me and I hope for you too to 397 00:26:55,556 --> 00:26:58,996 Speaker 1: hear from all of our guests, each one of them 398 00:26:59,036 --> 00:27:02,556 Speaker 1: a leading thinker, a leading doer, each one of them 399 00:27:02,556 --> 00:27:05,596 Speaker 1: with their own Solvable and each one of them taking 400 00:27:05,636 --> 00:27:10,716 Speaker 1: actions every day to solve the world's biggest problems. Thank 401 00:27:10,716 --> 00:27:13,236 Speaker 1: you so much to them, and thank you too to 402 00:27:13,356 --> 00:27:18,396 Speaker 1: our brilliant presenters over this series, Jacob Weisberg, Malcolm Gladwell, 403 00:27:18,676 --> 00:27:23,116 Speaker 1: Ann Applebaum and Ahmed Ali Akbar. And remember you can 404 00:27:23,196 --> 00:27:27,276 Speaker 1: hear all thirty episodes wherever you get your podcasts, and 405 00:27:27,436 --> 00:27:31,676 Speaker 1: you can learn more about solving today's biggest problems at 406 00:27:31,756 --> 00:27:37,276 Speaker 1: Rockefeller Foundation dot org slash Solvable. We will be back 407 00:27:37,316 --> 00:27:42,796 Speaker 1: with more inspiring conversations with brilliant problem solvers in twenty twenty. 408 00:27:43,396 --> 00:27:49,276 Speaker 1: I'm May Higgins, Now go Solve It. Solvable is a 409 00:27:49,356 --> 00:27:54,516 Speaker 1: collaboration between Pushkin Industries and the Rockefeller Foundation. Produced by 410 00:27:54,676 --> 00:27:58,836 Speaker 1: Laura Hyde, Hester Kant, Laura Sheeter, and Ruth Barnes of 411 00:27:58,996 --> 00:28:02,916 Speaker 1: Talk and Blade. Pushkin's executive producer is Neil la Belle. 412 00:28:03,436 --> 00:28:08,076 Speaker 1: Engineering by Jason Gambrell and the great folks at GSI Studios. 413 00:28:08,556 --> 00:28:13,196 Speaker 1: Research by cher Vincent, original music composed by Pascal Wise, 414 00:28:13,796 --> 00:28:18,196 Speaker 1: and special thanks to everybody at Pushkin, including Maya Kanig, 415 00:28:18,316 --> 00:28:23,436 Speaker 1: Maggie Taylor, Heather Faine, Julia Barton and Carlie Migliori, and 416 00:28:23,676 --> 00:28:29,076 Speaker 1: to Christine Heenan, Rachel Roberts, Sierra Remersheed, and Rajiv Shah 417 00:28:29,236 --> 00:28:32,716 Speaker 1: at the Rockefeller Foundation for making this series possible.