Getting mental health care in America can be difficult. In Zimbabwe, it's near impossible.

The country is home to 15 million people and only about 10 psychiatrists. For comparison, the United States has at least 24,000 psychiatrists. But depression and anxiety are not just a first world problem.

"Common mental disorders impose a huge burden on all countries of sub-Saharan Africa," said health researcher Dr. Dixon Chibanda in a press release.


Zimbabwe has a secret weapon though: the Friendship Bench.

Image from The Friendship Bench Project, used with permission.

Developed from over 20 years of community research, The Friendship Bench Project is a different and smart way to tackle mental health care.

You can find one of the inviting benches outside some of Zimbabwe's many health clinics. Sitting down, you might get a visit from an older woman. These women are known as golden ladies or grandmothers. You can talk to them. They listen. Then, they might help you identify problems in your life or give you advice to help you feel positive and in control.

Its might seem simple, but these grandmothers are health workers — and very effective.

Photo from Grand Challenges Canada/Flickr, used with permission.

They're not just dispensing random advice. The grandmothers are health care workers who've have been trained in what's called problem-solving therapy. And it turns out it could be a pretty effective strategy.

A recent study published in the Journal of the American Medical Association compared the grandmothers against the usual care options, including a nurse assessment or optional medications. The study found that after six visits to the Friendship Bench, visitors were three times less likely to have the symptoms of depression six months later (50% versus 14%). The results were even more striking for anxiety or suicidal thoughts.

There were, of course, a few limitations to the study. Not a lot of men signed up, for example. And there's some more nuance, like exactly how the comparison was done. If you're interested, the full text is here. But the bottom line is that it seems to have worked.

Better mental health care is important for everyone, but low- and middle-income countries may need it especially badly.

"In many parts of Africa, if you are poor and mentally ill, your chances of getting adequate treatment are close to zero," said Karlee Silver in a press release about the Friendship Bench Project. Worse still, in many places in Africa, there's still a stigma — sometimes very serious stigma — around mental disorders and mental health care.

And all this adds up. In addition to adding to human suffering, the cost of treating mental health problems and lost productivity are estimated to cost low- and middle-income countries $870 billion a year. The number may grow to more than $2 trillion by 2030.

That's why it's so heartening to see clever programs like The Friendship Bench Project at work.

Photo from Grand Challenges Canada / ZAPP.

So far, over 27,500 people have used The Friendship Bench Project.  

The program's been working with a number of other organizations too, such as the Zimbabwe Ministry and Health and Grand Challenges Canada. They are currently located in a few of Zimbabwe's cities, including Harare, the capital, but are planning to expand to even more clinics.

They also plan to reach out to more vulnerable populations, such as youth or refugees, in the future.

Connections Academy

Wylee Mitchell is a senior at Nevada Connections Academy who started a t-shirt company to raise awareness for mental health.

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Teens of today live in a totally different world than the one their parents grew up in. Not only do young people have access to technologies that previous generations barely dreamed of, but they're also constantly bombarded with information from the news and media.

Today’s youth are also living through a pandemic that has created an extra layer of difficulty to an already challenging age—and it has taken a toll on their mental health.

According to Mental Health America, nearly 14% of youths ages 12 to 17 experienced a major depressive episode in the past year. In a September 2020 survey of high schoolers by Active Minds, nearly 75% of respondents reported an increase in stress, anxiety, sadness and isolation during the first six months of the pandemic. And in a Pearson and Connections Academy survey of US parents, 66% said their child felt anxious or depressed during the pandemic.

However, the pandemic has only exacerbated youth mental health issues that were already happening before COVID-19.

“Many people associate our current mental health crisis with the pandemic,” says Morgan Champion, the head of counseling services for Connections Academy Schools. “In fact, the youth mental health crisis was alarming and on the rise before the pandemic. Today, the alarm continues.”

Mental Health America reports that most people who take the organization’s online mental health screening test are under 18. According to the American Psychiatric Association, about 50% of cases of mental illness begin by age 14, and the tendency to develop depression and bipolar disorder nearly doubles from age 13 to age 18.

Such statistics demand attention and action, which is why experts say destigmatizing mental health and talking about it is so important.

“Today we see more people talking about mental health openly—in a way that is more akin to physical health,” says Champion. She adds that mental health support for young people is being more widely promoted, and kids and teens have greater access to resources, from their school counselors to support organizations.

Parents are encouraging this support too. More than two-thirds of American parents believe children should be introduced to wellness and mental health awareness in primary or middle school, according to a new Global Learner Survey from Pearson. Since early intervention is key to helping young people manage their mental health, these changes are positive developments.

In addition, more and more people in the public eye are sharing their personal mental health experiences as well, which can help inspire young people to open up and seek out the help they need.

“Many celebrities and influencers have come forward with their mental health stories, which can normalize the conversation, and is helpful for younger generations to understand that they are not alone,” says Champion.

That’s one reason Connections Academy is hosting a series of virtual Emotional Fitness talks with Olympic athletes who are alums of the virtual school during Mental Health Awareness Month. These talks are free, open to the public and include relatable topics such as success and failure, leadership, empowerment and authenticity. For instance, on May 18, Olympic women’s ice hockey player Lyndsey Fry will speak on finding your own style of confidence, and on May 25, Olympic figure skater Karen Chen will share advice for keeping calm under pressure.

Family support plays a huge role as well. While the pandemic has been challenging in and of itself, it has actually helped families identify mental health struggles as they’ve spent more time together.

“Parents gained greater insight into their child’s behavior and moods, how they interact with peers and teachers,” says Champion. “For many parents this was eye-opening and revealed the need to focus on mental health.”

It’s not always easy to tell if a teen is dealing with normal emotional ups and downs or if they need extra help, but there are some warning signs caregivers can watch for.

“Being attuned to your child’s mood, affect, school performance, and relationships with friends or significant others can help you gauge whether you are dealing with teenage normalcy or something bigger,” Champion says. Depending on a child’s age, parents should be looking for the following signs, which may be co-occurring:

  • Perpetual depressed mood
  • Rocky friend relationships
  • Spending a lot of time alone and refusing to participate in daily activities
  • Too much or not enough sleep
  • Not eating a regular diet
  • Intense fear or anxiety
  • Drug or alcohol use
  • Suicidal ideation (talking about being a burden or giving away possessions) or plans

“You know your child best. If you are unsure if your child is having a rough time or if there is something more serious going on, it is best to reach out to a counselor or doctor to be sure,” says Champion. “Always err on the side of caution.”

If it appears a student does need help, what next? Talking to a school counselor can be a good first step, since they are easily accessible and free to visit.

“Just getting students to talk about their struggles with a trusted adult is huge,” says Champion. “When I meet with students and/or their families, I work with them to help identify the issues they are facing. I listen and recommend next steps, such as referring families to mental health resources in their local areas.”

Just as parents would take their child to a doctor for a sprained ankle, they shouldn’t be afraid to ask for help if a child is struggling mentally or emotionally. Parents also need to realize that they may not be able to help them on their own, no matter how much love and support they have to offer.

“That is a hard concept to accept when parents can feel solely responsible for their child’s welfare and well-being,” says Champion. “The adage still stands—it takes a village to raise a child. Be sure you are surrounding yourself and your child with a great support system to help tackle life’s many challenges.”

That village can include everyone from close family to local community members to public figures. Helping young people learn to manage their mental health is a gift we can all contribute to, one that will serve them for a lifetime.

Join athletes, Connections Academy and Upworthy for candid discussions on mental health during Mental Health Awareness Month. Learn more and find resources here.

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