WEBVTT - The Mental Health Crisis is Solvable 0:00:15.076 --> 0:00:21.316 Pushkin. I'm a Higgins and this is Solvable Interviews with 0:00:21.356 --> 0:00:25.036 the world's most innovative thinkers working to solve the world's 0:00:25.076 --> 0:00:29.676 biggest problems. My name is Dixon Shibanda and my solvable 0:00:30.076 --> 0:00:34.556 is breaking the wall of depression by training grandmothers all 0:00:34.556 --> 0:00:39.516 over the world in basic cognitive behavioral therapy so they 0:00:39.556 --> 0:00:45.396 can provide care in their communities. Dixon Shabanda is an 0:00:45.436 --> 0:00:49.316 associate professor at the University of Zimbabwe and he's the 0:00:49.316 --> 0:00:53.636 director of the African Mental Health Research Initiative. He's also 0:00:53.716 --> 0:00:57.476 one of only sixteen psychiatrists in the whole of Zimbabwe. 0:00:57.876 --> 0:01:00.996 Now that country has a population of thirteen million people. 0:01:01.676 --> 0:01:05.516 So Dixon Shabandah created the Friendship Bench that's a place 0:01:05.556 --> 0:01:09.116 for people to seek and access therapy for mental healths. 0:01:09.956 --> 0:01:13.716 These friendship benches are run by women in the community. 0:01:14.076 --> 0:01:17.316 They're fondly referred to as grandmothers, and their work is 0:01:17.396 --> 0:01:21.356 proving hugely successful. It's even beginning to catch on around 0:01:21.356 --> 0:01:24.036 the world with a bench popping up here in New 0:01:24.116 --> 0:01:28.436 York and also throughout Kenya. We certainly need solvables like 0:01:28.516 --> 0:01:32.756 this because mental health is a global issue today and 0:01:32.916 --> 0:01:36.236 estimated three hundred and twenty two million people around the 0:01:36.276 --> 0:01:40.556 world live with depression, and the majority of those people 0:01:40.596 --> 0:01:45.476 are in non Western nations. Now, mental health is fundamental 0:01:45.596 --> 0:01:51.356 to our collective and our individual ability as humans to think, 0:01:51.436 --> 0:01:55.156 to experience emotions, to interact with each other, to earn 0:01:55.196 --> 0:01:59.276 a living, and really just to enjoy life. In low 0:01:59.276 --> 0:02:02.316 income countries likes and bad Way, where seventy two percent 0:02:02.356 --> 0:02:05.956 of the population live below the poverty line, you can 0:02:05.996 --> 0:02:09.436 imagine that getting access to really any form of mental 0:02:09.436 --> 0:02:14.076 health therapy, it's not only difficult, it's nearly impossible. But 0:02:14.396 --> 0:02:18.436 that's changing thanks to today's guest Dicks in Shabandah. You'll 0:02:18.436 --> 0:02:22.516 hear how in this conversation with Jacob Weisberg, I wanted 0:02:22.516 --> 0:02:26.476 to ask you what brought you to this problem? Well, 0:02:26.516 --> 0:02:30.436 the problem that I experienced, you know, as a junior 0:02:30.476 --> 0:02:35.596 psychiatrist in Zimbabwe, where I first started my work was 0:02:35.676 --> 0:02:39.436 just you know, quite huge, you know, just the sheer 0:02:39.476 --> 0:02:43.396 amount of work and the need for professionals. And I 0:02:43.476 --> 0:02:47.876 realized from a very early stage that working from a 0:02:48.036 --> 0:02:52.076 hospital which just wasn't going to enable me to reach 0:02:52.116 --> 0:02:55.596 out to the thousands of people that needed care, particularly 0:02:55.596 --> 0:02:58.916 for depression. And when I lost a client of mine 0:02:59.516 --> 0:03:05.756 Erica through suicide, I realized the need to actually take 0:03:06.196 --> 0:03:09.396 mental health to the community, and this is how this 0:03:09.516 --> 0:03:13.796 whole concept of working with grandmothers started. You know, a 0:03:13.956 --> 0:03:17.196 need to take evidence based mental health to the community 0:03:17.476 --> 0:03:21.876 and not just provided within health facilities or clinics. It's 0:03:21.876 --> 0:03:24.396 been a real struggle in this country, and I'm sure 0:03:24.876 --> 0:03:27.996 there's a different version of it Zimbabwe that you live through. 0:03:28.116 --> 0:03:32.276 But to put mental health on a par with physical health, 0:03:32.316 --> 0:03:35.996 people who will readily concede that everyone should have access 0:03:36.076 --> 0:03:40.956 to healthcare sometimes think that mental healthcare is secondary or 0:03:40.956 --> 0:03:44.756 a luxury of some kind. Yeah, that is unfortunately a 0:03:44.796 --> 0:03:49.316 problem which is a global problem. A lot of people 0:03:49.356 --> 0:03:54.476 do not realize that by sidelining mental health you inevitably 0:03:54.676 --> 0:04:00.716 have challenges in addressing the physical health issues because coal 0:04:00.796 --> 0:04:03.316 morbidity is kind of the norm in a lot of 0:04:03.436 --> 0:04:07.436 chronic diseases. If you think of things like hypotension or diabetes, 0:04:07.756 --> 0:04:10.076 you know a lot of people who from these chronic 0:04:10.156 --> 0:04:14.756 diseases do have core morbid mental health issues. And when 0:04:14.796 --> 0:04:18.116 you tackle just the physical and not tackle the mental 0:04:18.196 --> 0:04:21.396 health or the emotional well being or a person, you 0:04:21.516 --> 0:04:25.316 actually do not improve the outcomes or the physical aspect 0:04:25.356 --> 0:04:27.356 as well. So it's very important to have a very 0:04:27.396 --> 0:04:29.956 holistic approach. This is what the work that I do 0:04:30.076 --> 0:04:32.556 is all about. You know, it's not really just about 0:04:32.636 --> 0:04:36.396 mental health, but it's ensuring that mental health results in 0:04:36.796 --> 0:04:42.156 improved outcomes of other conditions that people may have and functionality, 0:04:42.236 --> 0:04:45.236 for instance, the number of people who struggle in the 0:04:45.236 --> 0:04:48.516 workplace as a result of mental health issues. You know. Again, 0:04:48.596 --> 0:04:52.196 if you address the mental health issues, you improve people's functionality. 0:04:52.596 --> 0:04:56.436 Organizations function better, companies produce better results, you know. So 0:04:56.956 --> 0:04:59.996 it's kind of endless if you think of the link 0:05:00.076 --> 0:05:02.636 of mental health with the challenges that are out there 0:05:02.676 --> 0:05:05.476 that the world is trying to address. What type of 0:05:05.516 --> 0:05:08.796 mental and emotional issues are you dealing with? How serious? 0:05:09.716 --> 0:05:12.476 So when we first started, our focus was on what 0:05:12.516 --> 0:05:16.596 we call common mental disorders, which in essence include things 0:05:16.636 --> 0:05:22.396 like depression anxiety disorders PDSD. And we use an algorithm 0:05:22.716 --> 0:05:27.156 to enable us to determine the severity of the symptoms 0:05:27.156 --> 0:05:30.796 that a person presents with. And so if someone is, 0:05:30.876 --> 0:05:34.996 for instance, a red flag, someone is for instance, suicidal, 0:05:35.476 --> 0:05:38.316 the grandmothers on the bench will refer that person to 0:05:38.396 --> 0:05:41.956 the next level. So we have these algorithms that enable 0:05:42.116 --> 0:05:45.236 us to address the needs of pretty much everyone who 0:05:45.236 --> 0:05:48.116 comes to the bench, either directly on the bench or 0:05:48.156 --> 0:05:51.236 by referring them to the next level, depending on what 0:05:51.356 --> 0:05:54.276 it is they present with, Jackson, How did you come 0:05:54.356 --> 0:05:57.676 up with this idea of the bench? So when I 0:05:57.716 --> 0:06:01.716 first made the decision to introduce something at community level, 0:06:02.076 --> 0:06:04.916 a lot had been happening in my country. In two 0:06:04.916 --> 0:06:08.716 thousand and five, the country went through a lot of 0:06:08.756 --> 0:06:13.196 social or economic upheavals, and it was against the background 0:06:13.436 --> 0:06:18.076 of these upheavals that a need to introduce something at 0:06:18.156 --> 0:06:25.876 community level came. And unfortunately, because there were no psychiatrists 0:06:25.996 --> 0:06:30.036 or doctors available, I was instructed to try and come 0:06:30.116 --> 0:06:35.236 up with a solution using community grandmothers. And because we 0:06:35.236 --> 0:06:38.636 couldn't use any of the buildings, we were also told, well, 0:06:38.796 --> 0:06:41.316 try and come up with something outside of the building. 0:06:41.396 --> 0:06:44.116 So it was really more of necessity, you know, and 0:06:44.196 --> 0:06:49.396 through an iterative process with the grandmothers, we eventually came 0:06:49.476 --> 0:06:53.076 up with the idea of actually delivering therapy on a bench. 0:06:53.156 --> 0:06:56.436 It was really necessitated by the fact that there was nothing, 0:06:56.476 --> 0:07:00.316 absolutely nothing, and so all I had with these grandmothers 0:07:00.796 --> 0:07:04.356 and the idea of doing something on a bench. So, Dickson, 0:07:04.396 --> 0:07:07.196 you've seen the effectiveness of the friendship bench. Can you 0:07:07.236 --> 0:07:09.876 give us an example. Sure, let me give you an 0:07:09.876 --> 0:07:14.836 example of Derek. Derek was a young man who was 0:07:14.916 --> 0:07:20.116 employed in the tea industry in Zimbabwe and he was 0:07:20.236 --> 0:07:25.916 referred to the friendship bench after a third unsuccessful attempt 0:07:26.316 --> 0:07:30.036 to kill himself. And this was the first time really 0:07:30.476 --> 0:07:35.276 he had the opportunity to tell his story. And when 0:07:35.276 --> 0:07:40.676 the grandmother invited him to share his story, he suddenly 0:07:40.796 --> 0:07:46.556 had this overwhelming sense of relief because he could really 0:07:46.596 --> 0:07:49.556 then share his story with the grandmother and that was, 0:07:49.636 --> 0:07:54.196 in essence, the beginning of his healing. Often it's simply 0:07:54.236 --> 0:07:58.796 about letting people share their stories. And after he shared 0:07:58.836 --> 0:08:03.996 his story, the grandmother worked through and enabled him to 0:08:04.116 --> 0:08:07.516 prioritize the things that needed to be done in order 0:08:07.796 --> 0:08:12.516 to help him through the challenges that he was facing. See, 0:08:12.556 --> 0:08:16.236 Derek was living with HIV and he was struggling to 0:08:16.276 --> 0:08:19.356 get his medication. He was struggling to come to terms 0:08:19.356 --> 0:08:22.956 with being HIV positive. And that was his story. And 0:08:23.116 --> 0:08:29.916 today Derek is still functional and he's kept his job. Yeah, 0:08:30.036 --> 0:08:33.876 that is a great story. The grandmothers can't prescribe drugs. 0:08:33.916 --> 0:08:38.156 I'm assuming what do they do with patients who are 0:08:38.196 --> 0:08:42.356 in need of some medical and intervention. Well, they refer 0:08:42.556 --> 0:08:45.596 so as I said earlier on, we have this algorithm 0:08:45.956 --> 0:08:49.396 and based on the severity of symptoms that a client 0:08:49.876 --> 0:08:54.316 presents with, they will then refer to the next level, 0:08:54.356 --> 0:08:58.236 and the next level will establish whether there's need for medication. 0:08:58.316 --> 0:09:02.756 If there's need for medication, the clinic nurse will prescribe 0:09:02.756 --> 0:09:07.236 the medication, not the grandmother or the psychiatrist will prescribe 0:09:07.276 --> 0:09:11.556 the medication. So the entry point into Friendship Bench is 0:09:11.556 --> 0:09:17.756 a screening of basic symptoms for common mental disorders. For instance, 0:09:17.756 --> 0:09:21.356 the questionnaire will include questions related to sleep. You know, 0:09:21.436 --> 0:09:23.836 how have you been sleeping in the last week, and 0:09:23.956 --> 0:09:26.916 have you found it difficult to cope in the last week? 0:09:26.996 --> 0:09:30.516 Have you found yourself feeling tearful in the last week? 0:09:30.596 --> 0:09:34.676 Have you had thoughts of ending your life? Those kind 0:09:34.676 --> 0:09:37.956 of questions, And depending on the number of yes responses 0:09:37.996 --> 0:09:42.076 that the grandmother gets, she will then know where to 0:09:42.276 --> 0:09:46.116 place a client. You know, whether this is a client 0:09:46.436 --> 0:09:50.236 that should receive the full Friendship Bench or they should 0:09:50.236 --> 0:09:53.756 immediately be referred because it's a red flag, So we 0:09:53.836 --> 0:09:57.356 try to use those categories to ensure that we really 0:09:57.596 --> 0:10:01.516 don't cause any harm to anyone through this intervention. So 0:10:01.596 --> 0:10:04.876 it's really an essence as stepped care kind of approach 0:10:05.156 --> 0:10:08.396 to addressing the treatment gap with a bulk of the 0:10:08.796 --> 0:10:11.596 client and so are taken care of by grandmothers and 0:10:11.756 --> 0:10:15.556 those that they can't help go to the next level. Dickson, 0:10:15.596 --> 0:10:18.316 you said it's evidence based. What is the evidence that 0:10:18.396 --> 0:10:22.716 you have about how the effectiveness of this compares to 0:10:23.076 --> 0:10:26.996 other more conventional forms of initial treatment. Yeah, that's a 0:10:27.036 --> 0:10:30.276 great question, you know. So in the world of research, 0:10:30.876 --> 0:10:36.156 the gold standard for effectiveness is what we call the 0:10:36.156 --> 0:10:40.236 the randomized trial, and so we carried out a cluster 0:10:40.396 --> 0:10:45.036 randomized controlled trial of the Friendship Bench, which is actually 0:10:45.076 --> 0:10:49.116 published in the Journal of the American Medical Association. And 0:10:49.236 --> 0:10:53.236 in this cluster randomized controlled trial, we had twenty four 0:10:53.276 --> 0:10:58.716 clinics that we're randomized into intervention arm, which was the 0:10:58.756 --> 0:11:03.956 Friendship bench or usual care, which essentially is being seen 0:11:03.996 --> 0:11:09.516 by a clinic nurse or a psychiatrist or receiving rozac 0:11:09.676 --> 0:11:13.116 for depression. So that was one arm and we compared 0:11:13.556 --> 0:11:17.196 the primary outcome was HQ nine, which is a measure 0:11:17.316 --> 0:11:20.996 for depression symptoms, and we followed our clients over a 0:11:21.116 --> 0:11:26.116 six month period and after six months, our results showed 0:11:26.156 --> 0:11:33.076 that grandmothers were statistically much better than usual care, which 0:11:33.116 --> 0:11:38.996 include nurses and psychiatrists in alleviating symptoms of depression on 0:11:39.036 --> 0:11:42.516 the bench, you know, and so that evidence is published, 0:11:42.556 --> 0:11:45.516 it's out there and people can look at it. But 0:11:45.716 --> 0:11:49.476 not only that, we have well over fifty peer reviewed 0:11:49.516 --> 0:11:53.156 publications about the Friendship Bench, how it works and why 0:11:53.156 --> 0:11:58.916 it works, both quantitative publications and qualitative publications which describe, 0:11:58.996 --> 0:12:02.436 you know, the process, which describe the experience of both 0:12:02.436 --> 0:12:05.876 the grandmothers and the experience of the clients. So the 0:12:05.916 --> 0:12:09.596 evidence is quite rigorous that we have managed to together 0:12:09.756 --> 0:12:12.516 and publish over the past couple of years. There's often 0:12:12.596 --> 0:12:16.756 stigma attached to depression, and the stigma is different in 0:12:16.916 --> 0:12:20.916 different cultures. What's it like in Zimbabwe and how do 0:12:20.956 --> 0:12:25.156 you deal with that? So there's no difference in Zimbabwe 0:12:25.196 --> 0:12:29.396 with regards to stigma attached to different forms of mental illness. 0:12:30.476 --> 0:12:33.156 But the way we've dealt with it on the Friendship 0:12:33.156 --> 0:12:39.356 Bench is we have avoided the medicalization or the use 0:12:39.436 --> 0:12:45.476 of clinical terms to describe clients that come to the bench. 0:12:45.916 --> 0:12:48.476 The first thing that we emphasize on the Friendship bench, 0:12:48.516 --> 0:12:53.276 for instance, is the desire for our team to improve 0:12:53.356 --> 0:12:56.636 a person's quality of life, and we do not refer 0:12:56.756 --> 0:13:01.236 to clients based on their diagnosis. And the other thing 0:13:01.316 --> 0:13:06.596 is we use local indigenous terms to describe what they're 0:13:06.636 --> 0:13:09.476 going through, like for instance, we would never use the 0:13:09.476 --> 0:13:13.396 word depression. The term that is used on the Friendship 0:13:13.396 --> 0:13:17.196 bench in my language is kufungi sisa, which literally means 0:13:17.396 --> 0:13:21.676 thinking too much, and that often resonates with people when 0:13:21.716 --> 0:13:24.996 it comes to depression. When you think of the actual 0:13:25.156 --> 0:13:29.476 intervention itself on the bench, the different sessions we use 0:13:29.676 --> 0:13:33.916 language again which resonates with the community. We talk about 0:13:34.036 --> 0:13:38.676 kuvurap funga, which literally means opening up the mind. We 0:13:38.716 --> 0:13:43.116 talk about kusimud zera, which literally means uplifting, and then 0:13:43.156 --> 0:13:46.876 we talk about kusimbisa, which is strengthening. You know, none 0:13:46.916 --> 0:13:50.396 of those terms are medical in whatever way you look 0:13:50.436 --> 0:13:54.596 at them, but they are very powerful and communities resonate 0:13:54.676 --> 0:13:59.276 with those words. They can identify with kuvapunga or opening 0:13:59.356 --> 0:14:01.996 up of the mind, because that's really what people want 0:14:01.996 --> 0:14:04.916 when they present their story. They want to open up 0:14:04.996 --> 0:14:07.516 their minds so they can see how through that story 0:14:07.836 --> 0:14:10.716 they can get healing. Through that story, they can get 0:14:10.716 --> 0:14:13.196 a sense of direction in terms of what needs to 0:14:13.236 --> 0:14:16.396 happen in their lives. And again, if you look at 0:14:16.436 --> 0:14:19.436 New York City, they are pretty much doing the same thing. 0:14:19.476 --> 0:14:23.036 They are not labeling people, they are creating an opportunity 0:14:23.116 --> 0:14:26.596 for people to tell their stories. That's wonderful. And do 0:14:26.636 --> 0:14:30.156 you think that would apply as well in the developed 0:14:30.196 --> 0:14:33.596 world or is there something about traditional culture of the 0:14:33.676 --> 0:14:36.356 kind you were operating in a Zimbabwe and the role 0:14:36.396 --> 0:14:40.916 of grandmothers there that makes it specially effective. I think 0:14:40.956 --> 0:14:44.236 it would apply in the developed world as well. What 0:14:44.356 --> 0:14:47.116 we've learned from Friendship Bench is that grandmothers are the 0:14:47.196 --> 0:14:53.356 custodians of local culture and wisdom, and using grandmothers in 0:14:53.396 --> 0:14:58.396 any culture is a great way of connecting people and 0:14:58.476 --> 0:15:03.916 really addressing some of the issues around, for instance, loneliness. 0:15:04.716 --> 0:15:06.836 You know, so, I think, as I said earlier on, 0:15:06.916 --> 0:15:10.756 this model works and it's kind of universal. I think 0:15:10.956 --> 0:15:13.076 from what we're seeing in terms of, you know, the 0:15:13.156 --> 0:15:17.076 different places in the world that are using Friendship Bench. 0:15:17.436 --> 0:15:21.596 I also wonder, Dickson, is there something about doing this 0:15:21.796 --> 0:15:25.476 therapy out of doors as opposed to in a closed room. 0:15:25.556 --> 0:15:28.636 That makes a difference to the patients. See from the 0:15:28.676 --> 0:15:31.996 feedback that we get from patients doing this kind of therapy, 0:15:32.036 --> 0:15:36.236 Outdoors almost kind of takes away the stigma that is 0:15:36.276 --> 0:15:40.996 associated with being indoors and seeing a therapist who is 0:15:41.036 --> 0:15:45.596 formally dressed or a psychiatrist. In fact, the name itself, 0:15:45.636 --> 0:15:49.116 you know, the Friendship Bench, just takes away the stigma. 0:15:49.316 --> 0:15:52.156 When we first started, you know, we actually called it 0:15:52.196 --> 0:15:55.636 the mental health bench. And guess what, no one wanted 0:15:55.676 --> 0:15:59.476 to come to the mental health bench and the grandmothers, 0:15:59.516 --> 0:16:03.276 the grandmothers advised that I changed the name, change the 0:16:03.356 --> 0:16:06.516 name to Friendship Bench, because that's what really was happening. Yet, 0:16:06.556 --> 0:16:10.236 this was about creating friendship through stories. And when we 0:16:10.316 --> 0:16:13.756 change the name, you know, again it's it took away 0:16:13.836 --> 0:16:19.116 that that clinical aspect or clinical connotations, and it just 0:16:19.276 --> 0:16:22.596 became a lot more acceptable. I think that one of 0:16:22.636 --> 0:16:25.196 the powers of Friendship Bench, whether you look at Friendship 0:16:25.196 --> 0:16:27.836 Bench in New York City, it's it's that it's outdoors, 0:16:27.916 --> 0:16:31.276 which gives people that freedom to express themselves. What's it 0:16:31.356 --> 0:16:33.876 like for the grandmothers? First of all, do they get 0:16:33.876 --> 0:16:37.556 paid and second of all, do they all take to 0:16:37.596 --> 0:16:39.556 it in the same way. I mean, I imagine that 0:16:39.556 --> 0:16:41.676 this is the kind of work that is on the 0:16:41.716 --> 0:16:45.316 one hand, very fulfilling, but on the other hand, very difficult, 0:16:45.756 --> 0:16:50.396 including emotionally. For that. Yeah, it was one of our concerns, 0:16:50.596 --> 0:16:53.556 you know, a few years ago and a colleague of mine, Ruth, 0:16:54.276 --> 0:16:57.316 who is a clinical psychologist working on the friendship bench, 0:16:58.036 --> 0:17:02.596 she actually took it upon herself to try and look 0:17:02.836 --> 0:17:07.316 into how the grandmothers, you know, we're coping with doing 0:17:07.356 --> 0:17:10.836 all these work. So that was really her PhD topic 0:17:10.996 --> 0:17:14.716 to really look into how the grandmothers were managing to 0:17:14.756 --> 0:17:17.756 do all this. Our hypothesis was, you know, we're probably 0:17:17.796 --> 0:17:21.796 going to see a lot of these grandmothers stressed, burned out, 0:17:21.916 --> 0:17:25.036 and they will they will themselves have very high rates 0:17:25.076 --> 0:17:29.876 of common mental disorders. But surprisingly, out of a random 0:17:29.956 --> 0:17:34.436 sample of hundreds of grandmothers, we found that the actual 0:17:34.676 --> 0:17:38.716 rates of common mental disorders amongst the grandmothers who were 0:17:38.756 --> 0:17:42.276 working on the friendship bench who was much lower than 0:17:42.316 --> 0:17:45.156 the community of people who were not working on the 0:17:45.236 --> 0:17:48.876 friendship bench. And we then went deeper into it to 0:17:48.916 --> 0:17:53.636 find out how this was possible, and the themes that 0:17:53.836 --> 0:17:56.916 kept emerging from their grandmothers, you know, had a lot 0:17:56.956 --> 0:17:59.996 to do with altruism. Working on the bench for the 0:18:00.076 --> 0:18:04.596 grandmothers in their communities gave them a sense of purpose 0:18:05.436 --> 0:18:08.676 and over the years that sense of purpose, you know, 0:18:08.876 --> 0:18:14.156 resulted in mastery of a skill to really empower others 0:18:14.156 --> 0:18:16.916 in the community and help others in the community. And 0:18:16.996 --> 0:18:20.076 it also gave the grandmothers a sense of autonomy which 0:18:20.116 --> 0:18:25.396 is very empowering. So in essence, the grandmothers are benefiting 0:18:25.476 --> 0:18:30.076 from this work while they help people. And are they 0:18:30.276 --> 0:18:33.156 paid and does that matter? So they do get an 0:18:33.156 --> 0:18:37.556 allowance from the city Health Department. I must say recently, 0:18:37.636 --> 0:18:42.356 the government of Zimbabwe this year finally after a long time, 0:18:42.796 --> 0:18:47.596 it decided to endorse Friendship Bench as a national program 0:18:48.076 --> 0:18:52.596 which is now integrated in the health system of the country. 0:18:52.996 --> 0:18:55.316 So they do get an allowance. But we also get 0:18:55.356 --> 0:18:57.956 a lot of people who do Friendship Bench for free, 0:18:58.036 --> 0:19:02.076 who volunteer. For instance, we've taken Friendship Bench to schools. 0:19:02.516 --> 0:19:06.396 As you know, mental health issues are quite topical with 0:19:07.276 --> 0:19:09.956 young people. In fact, young people at the most affected 0:19:10.276 --> 0:19:12.876 by depression. If you look at some of the statistics 0:19:12.916 --> 0:19:16.116 coming out of the world Health organization, and so we've 0:19:16.116 --> 0:19:20.836 been taking Friendship Bench to universities where we're introducing a 0:19:20.996 --> 0:19:25.716 peer driven Friendship bench where university students are trained to 0:19:25.756 --> 0:19:28.516 sit on the bench to provide the service to other 0:19:29.076 --> 0:19:33.076 students because Zimbabwe has one of the highest suicide rates 0:19:33.076 --> 0:19:35.636 in that part of Africa, and so we see this 0:19:35.796 --> 0:19:39.396 as an effective intervention where young people are reaching out 0:19:39.796 --> 0:19:44.556 to provide support to other young people. And again it's 0:19:44.676 --> 0:19:50.076 all rooted in storytelling. You referred a little obliquely to 0:19:50.396 --> 0:19:55.036 what's happened in Zimbabwe, but obviously you have this devastating 0:19:55.076 --> 0:20:02.476 combination of long term political repression with economic collapse. Has 0:20:02.556 --> 0:20:07.396 that produced special circumstances or a larger number of people 0:20:07.996 --> 0:20:12.796 in need of this kind of cognitive therapy. So, while 0:20:12.876 --> 0:20:16.036 Zimbabwe is unique in the sense that it has a 0:20:16.116 --> 0:20:21.196 lot of problems, when you look at the global burden 0:20:21.836 --> 0:20:27.156 of common mental disorders, it's not unique to Zimbabwe. The 0:20:27.276 --> 0:20:33.076 whole world is desperately in need of evidence based interventions 0:20:33.236 --> 0:20:38.076 such as Friendship Bench that really seek to narrow or 0:20:38.116 --> 0:20:41.836 reduce the treatment gap for these conditions so that everyone 0:20:41.876 --> 0:20:46.196 everywhere has access to this much needed help. So, yes, 0:20:46.476 --> 0:20:49.836 Zimbabwe has a whole lot of challenges. I mean historically, 0:20:50.276 --> 0:20:52.756 you know, if you look at Zimbabwe, it's a country 0:20:52.796 --> 0:20:57.796 that is characterized by several generations of trauma. When you 0:20:58.556 --> 0:21:03.076 think of the right in the eighteenth century, the Pioneer Column, 0:21:03.116 --> 0:21:06.316 and then you had the Rhodesian Bush War, and then 0:21:06.476 --> 0:21:10.196 you had the massacre of more than twenty thousand debility 0:21:10.236 --> 0:21:13.596 speaking people. You know, the farm invasions where white folks 0:21:13.636 --> 0:21:16.196 were kicked off their farms and a lot of them killed. 0:21:16.916 --> 0:21:20.956 It's just a history of tragedy and with that history 0:21:21.636 --> 0:21:25.756 comes a need for healing. And I see the Friendship 0:21:25.796 --> 0:21:32.196 Bench as a platform providing an opportunity for healing, not 0:21:32.276 --> 0:21:35.436 only for Zimbabwe, but for the world. And as I 0:21:35.476 --> 0:21:40.316 said earlier on, people thrive through storytelling, and we all 0:21:40.356 --> 0:21:45.156 have a story to tell. And if we can leverage 0:21:45.236 --> 0:21:52.596 our ability to use these stories to facilitate healing, I 0:21:52.716 --> 0:21:55.516 believe that we could be moving in a direction where 0:21:56.236 --> 0:21:58.556 the world becomes a better place for all of us. 0:21:58.916 --> 0:22:01.236 And so, in a small way, that's what I believe in, 0:22:01.356 --> 0:22:03.636 you know, and that's why I keep carrying on doing 0:22:03.636 --> 0:22:06.716 this work on Friendship Bench. It's not just about mental health, 0:22:06.756 --> 0:22:09.356 it's about the big picture takes a news say in 0:22:09.396 --> 0:22:12.236 a small way, but not that small anymore. What's the 0:22:12.356 --> 0:22:17.796 scale of friendship Bench now in Zimbabwe and then everywhere else? 0:22:18.276 --> 0:22:22.316 So in Zimbabwe we are seeing thousands of people every month. 0:22:22.396 --> 0:22:24.636 I mean in the last two years we reached out 0:22:24.716 --> 0:22:30.076 to over sixty thousand people, and we don't have accurate 0:22:30.156 --> 0:22:35.156 figures for places like Malawi, Zanzibar and Kenya where we've 0:22:35.196 --> 0:22:38.996 recently introduced. What we do know is friendship Bench New 0:22:39.076 --> 0:22:42.316 York City in the Bronx and Harlem is doing extremely 0:22:42.356 --> 0:22:45.636 well and they managed to reach out to over eighty 0:22:45.676 --> 0:22:49.916 thousand people a year ago, and so I guess the 0:22:50.036 --> 0:22:53.636 numbers are growing exponentially. But what I really would like 0:22:53.716 --> 0:22:57.516 to see is a situation where friendship Bench is reaching 0:22:57.556 --> 0:23:02.396 out to millions of people across the world and also 0:23:03.156 --> 0:23:07.636 friendship Bench being recognized as a platform that really can 0:23:07.876 --> 0:23:13.116 enable people to open up and tell their stories in 0:23:13.156 --> 0:23:17.756 a safe environment, telling their stories so that we have healing. 0:23:18.316 --> 0:23:21.676 It's clear the idea of spreading around the world, But 0:23:21.756 --> 0:23:26.076 what's next for the bench as a project. So as 0:23:26.076 --> 0:23:29.796 a project, we are now really looking at how we 0:23:29.876 --> 0:23:34.516 can reach our first million clients, not just you know, 0:23:34.556 --> 0:23:37.676 in Zimbabwe, but in the different parts of the world 0:23:37.716 --> 0:23:41.716 where we've introduced friendship Bench. We are about to introduce 0:23:41.756 --> 0:23:46.516 friendship Bench in Rwanda, we are planning to go to Liberia, 0:23:46.636 --> 0:23:49.876 you know, we've just started in Kenya. And so what 0:23:49.916 --> 0:23:53.876 we're really working on is how to bring on board 0:23:54.196 --> 0:23:58.796 a digital component to enhance the work that the Grandmothers 0:23:58.796 --> 0:24:02.036 are doing because now we're really dealing with big data, 0:24:02.236 --> 0:24:06.156 and with big data, we need to really look at 0:24:06.196 --> 0:24:08.756 how best we can learn from the data that is 0:24:08.796 --> 0:24:12.236 being collected. How can we improve friendship Bench. How can 0:24:12.276 --> 0:24:16.396 friendship Bench continue to serve communities, How can friendship Bench 0:24:16.476 --> 0:24:20.156 continue to improve lives across the world. So that's really 0:24:20.196 --> 0:24:23.116 our next big challenge. And for all of that, obviously 0:24:23.156 --> 0:24:27.236 we need support and we are we are looking for 0:24:27.356 --> 0:24:31.316 partners who can help us to really reach every corner 0:24:31.396 --> 0:24:34.436 of the world and make mental health, you know, evidence 0:24:34.476 --> 0:24:37.236 based mental health accessible for all. Well, that brings me 0:24:37.276 --> 0:24:39.636 to the last question I always like to ask, which 0:24:39.716 --> 0:24:44.396 is how can listeners advance this? How can they get involved? 0:24:44.436 --> 0:24:48.196 How can they help? If you want to help friendship Bench, 0:24:48.276 --> 0:24:52.676 people can do is really within themselves in their communities, 0:24:53.556 --> 0:24:58.836 try to create space for healing. The world today is 0:24:58.916 --> 0:25:04.076 facing numerous challenges, numerous problems. You know, on the one hand, 0:25:04.836 --> 0:25:08.556 we have all these technological developments. You know, we've done 0:25:08.676 --> 0:25:12.836 so well technologically as a human race, but when you 0:25:12.876 --> 0:25:17.796 look at relationships, it's going the other direction. And one 0:25:17.876 --> 0:25:21.276 simple thing that we could all do is try to 0:25:21.316 --> 0:25:25.676 create space for healing in our communities. Try to create 0:25:25.796 --> 0:25:30.636 space to listen to the stories that our neighbors have, 0:25:30.996 --> 0:25:34.636 the people in our neighborhood have, people in our communities. 0:25:35.116 --> 0:25:37.556 You don't have to be a psychiatrist or a clinical 0:25:37.596 --> 0:25:41.076 psychologist to make a difference in your community. You simply 0:25:41.116 --> 0:25:44.556 have to be able to give space for people to 0:25:44.556 --> 0:25:47.836 share their stories and you have to listen, and that 0:25:47.996 --> 0:25:52.036 in itself is very very powerful. And of course, as 0:25:52.356 --> 0:25:55.196 Friendship Bench, we want to take Friendship Bench to every 0:25:55.196 --> 0:25:57.716 corner of the world, and so we're very happy to 0:25:57.796 --> 0:26:01.596 work with people to collaborate with people who feel that 0:26:01.716 --> 0:26:04.996 a Friendship Bench in their community or in their organization 0:26:05.516 --> 0:26:10.556 could help address mental health challenges or just generally improve 0:26:10.636 --> 0:26:13.196 the quality of life and make the world a bit 0:26:13.236 --> 0:26:17.716 of place. Dixon Shabanda, thanks for joining us Unsolvable Pleasure. 0:26:17.876 --> 0:26:22.836 Thank you for having me. Wow Schka Saszina, he's a 0:26:22.956 --> 0:26:26.276 director of the Department of Mental Health and Substance Abuse 0:26:26.556 --> 0:26:30.276 at the World Health Organization said, when it comes to 0:26:30.396 --> 0:26:34.516 mental health, we are all developing countries, and that really 0:26:34.556 --> 0:26:38.076 stayed with me. And I think that this episode has 0:26:38.116 --> 0:26:41.116 been such a fitting last episode of this season of 0:26:41.236 --> 0:26:48.116 Solvable because communicating, talking, sharing, these are all proven to 0:26:48.156 --> 0:26:52.596 potentially keep hopelessness at bay. And it's been such a 0:26:52.636 --> 0:26:55.436 privilege for me and I hope for you too to 0:26:55.556 --> 0:26:58.996 hear from all of our guests, each one of them 0:26:59.036 --> 0:27:02.556 a leading thinker, a leading doer, each one of them 0:27:02.556 --> 0:27:05.596 with their own Solvable and each one of them taking 0:27:05.636 --> 0:27:10.716 actions every day to solve the world's biggest problems. Thank 0:27:10.716 --> 0:27:13.236