“Grand­moth­ers” can help with de­pres­sion, anx­i­ety

The Denver Post - - FEATURES - By Juli Fraga

Men­tal Health Amer­ica, an ad­vo­cacy group, paints a bleak pic­ture of psy­cho­log­i­cal care in the United States. Al­most 20 per­cent of Amer­i­cans suf­fer from a men­tal ill­ness, ac­cord­ing to data from 2016, but more than half of these in­di­vid­u­als never re­ceive help. Bar­ri­ers such as lim­ited ac­cess to men­tal health care, the cost of treat­ment and a lack of in­surance can af­fect a per­son’s abil­ity to re­ceive care.

Twenty-five per­cent of Amer­i­cans in need of men­tal health care re­ceive treat­ment from their pri­mary-care physi­cians in­stead of from men­tal health spe­cial­ists.

The Friend­ship Bench Pro­ject in Zimbabwe sug­gests that peer coun­selors may be able to help to fill this gap in health care.

In Harare and other cities in Zimbabwe, lay health work­ers known as “com­mu­nity grand­moth­ers” meet with in­di­vid­u­als strug­gling with de­pres­sion, anx­i­ety and trauma. Their meet­ings take place on wooden park benches out­side health clinics.

Ac­cord­ing to the World Health Or­ga­ni­za­tion, de­pres­sion af­fects at least 300 mil­lion peo­ple world­wide, while even more suf­fer from anx­i­ety. Be­cause of the high preva­lence of these con­di­tions, doc­tors re­fer to them as the “com­mon colds of men­tal ill­nesses.” But un­like the cold virus, these dis­or­ders aren’t al­ways reme­died.

Sim­i­lar to rates in the United States, anx­i­ety and de­pres­sion in Harare af­fect more than 25 per­cent of the pop­u­la­tion. They are the most com­mon men­tal-health dis­or­ders in sub-Sa­ha­ran Africa. Thir­teen psy­chi­a­trists are avail­able to treat Zimbabwe’s more than 14 mil­lion res­i­dents, mak­ing ac­cess nearly im­pos­si­ble for most.

The grand­moth­ers in Harare were trained in prob­lem-solv­ing ther­apy through a pro­ject paid for by Grand Chal­lenges Canada, a gov­ern­ment ef­fort to im­prove global health. All were ed­u­cated el­ders, and most had ex­pe­ri­ence in com­mu­nity health out­reach. They also knew how to use a cell­phone and lived near a health clinic.

Over nine days, the grand­moth­ers were trained to help pa­tients iden­tify and solve their prob­lems. The train­ing cov­ered such top­ics as men­tal dis­or­ders, coun­sel­ing skills, prob­lem-solv­ing ther­apy and self-care, which is the abil­ity to take care of one’s men­tal health and well-be­ing.

Dixon Chibanda, a psy­chi­a­trist in Harare, co-de­vel­oped the Friend­ship Bench pro­gram af­ter find­ing that many peo­ple were hes­i­tant to share their psy­chi­atric trou­bles with a doc­tor; they felt safer dis­clos­ing their prob­lems to a com­mu­nity mem­ber such as a trusted el­der.

The grand­moth­ers do not la­bel their pa­tients with a psy­chi­atric di­ag­no­sis. In­stead, they work to­ward so­lu­tions. Us­ing indige­nous terms rather than the sci­en­tific lan­guage of Western medicine, the ther­apy in­cludes three parts: ku­vhura pfungwa (open­ing the mind), kusimudzira (up­lift­ing) and kusim­bisa (strength­en­ing). This ap­proach is meant to elim­i­nate shame and em­power pa­tients, help­ing them re­gain hope.

A study whose find­ings were pub­lished in De­cem­ber in the jour­nal JAMA in­cluded 573 peo­ple strug­gling with anx­i­ety and de­pres­sion. Pa­tients with sui­ci­dal thoughts, de­men­tia, psy­chosis and late-stage AIDS were not el­i­gi­ble to par­tic­i­pate, nor were preg­nant and post­par­tum women.

The par­tic­i­pants, al­most all of whom were women, were di­vided into two groups. Half re­ceived the Friend­ship Bench in­ter­ven­tion, which in­cluded six in­di­vid­ual weekly ses­sions with a com­mu­nity grand­mother. They also re­ceived group ther­apy. The other half re­ceived stan­dard care, which in­cluded med­i­ca­tion and ad­vice from nurses.

The re­sults sug­gest that park­bench ther­apy can heal.

Six months af­ter the treat­ment ended, par­tic­i­pants who re­ceived ther­apy from the grand­moth­ers were one-third as likely as those who re­ceived stan­dard care to have de­pres­sive symp­toms. Their anx­i­ety symp­toms also im­proved.

Chibanda is hope­ful that this in­ter­ven­tion could fill men­tal­health gaps in other coun­tries, too, in­clud­ing the United States.

“I’ve spent time in the United States, and I am fa­mil­iar with the poor ac­cess to psy­chi­atric care, par­tic­u­larly within in­ner cities and dis­en­fran­chised com­mu­ni­ties,” he says.

Peer sup­port groups ex­ist in the United States, but they are of­ten for spe­cific con­cerns such as ad­dic­tion, eat­ing dis­or­ders and al­co­holism. Of­ten, peer lead­ers don’t re­ceive any men­tal­health train­ing, and these groups op­er­ate sep­a­rately from the hos­pi­tal and health clinic set­ting, which makes re­fer­ring a pa­tient for treat­ment chal­leng­ing.

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