A bench and a grandmother's ear: Zimbabwe's novel mental health therapy spreads overseas

After her son, the family's shining light and only breadwinner, was arrested last year, Tambudzai Tembo went into meltdown. In Zimbabwe, where clinical mental health services are scarce, her chances of getting professional help were next to zero. She contemplated suicide.

"I didn't want to live anymore. People who saw me would think everything was okay. But inside, my head was spinning," the 57-year-old said. "I was on my own."

A wooden bench and an empathetic grandmother saved her.

Older people are at the center of a homegrown form of mental health therapy in Zimbabwe that is now being adopted in places like the United States.

The approach involves setting up benches in quiet, discreet corners of community clinics and in some churches, poor neighborhoods and at a university. An older woman with basic training in problem-solving therapy patiently sits there, ready to listen and engage in a one-on-one conversation.

The therapy is inspired by traditional practice in Zimbabwe in which grandmothers were the go-to people for wisdom in rough times. It had been abandoned with urbanization, the breakdown of tight-knit extended families and modern technology. Now it is proving useful again as mental health needs grow.

"Grandmothers are the custodians of local culture and wisdom. They are rooted in their communities," said Dixon Chibanda, a psychiatry professor and founder of the initiative. "They don't leave, and in addition, they have an amazing ability to use what we call 'expressed empathy'… to make people feel respected and understood."

Last year, Chibanda was named the winner of a $150,000 prize by the U.S.-based McNulty Foundation for revolutionizing mental healthcare. Chibanda said the concept has taken root in parts of Vietnam, Botswana, Malawi, Kenya, and Tanzania and is in "preliminary formative work" in London.

In New York, the city's new mental health plan launched last year says it is "drawing inspiration" from what it calls the Friendship Bench to help address risk factors such as social isolation. The orange benches are now in areas including Harlem, Brooklyn and the Bronx.

In Washington, the organization HelpAge U.S. is piloting the concept under the DC Grandparents for Mental Health initiative, which started in 2022 as a COVID-19 support group of people 60 and above.

So far, 20 grandmothers determined to "stop the stigma around mental health and make it okay to talk about feelings" have been trained by a team from Friendship Bench Zimbabwe to listen, empathize and empower others to solve their problems, said Cindy Cox-Roman, the president and chief executive of HelpAge U.S..

Benches will be set up at places of worship, schools and wellness centers in Washington's low-income communities with people who "have been historically marginalized and more likely to experience mental health problems," she said.

Cox-Roman cited fear and distrust in the medical system, lack of social support and stigma as some of the factors limiting access to treatment.

"People are hurting, and a grandmother can always make you feel better," she said.

"We have so much wisdom in our older population and arms that can open. I reject ageism. Sometimes age brings wisdom that you don't learn until you get old," one of the grandmothers, 81-year-old Barbara Allen, said in a promotional video.

More than one in five U.S. adults live with a mental illness, according to the National Institute of Mental Health.

"The mental health crisis is real. Where it's a real crisis after the pandemic is that many clinicians have dropped out of the workforce," said Dr. Jehan El-Mayoumi, who works as an expert with HelpAge U.S. and is a founding director of the health equity Rodham Institute at Georgetown University. She has struggled to get psychiatrists for acutely suicidal patients.

El-Mayoumi said the Zimbabwean concept provides people with "someone you can trust, open up your heart to, that you can tell your deepest secrets (and) that requires trust, so that's what's so wonderful about the Friendship Bench."

The idea was born out of tragedy. Chibanda was a young psychiatrist, and one of just over 10 in Zimbabwe in 2005. One of his patients desperately wanted to see him, but she could not afford the $15 bus fare. Chibanda later learned that she had killed herself.

"I realized that I needed to have a stronger presence in the community," Chibanda said. "I realized that actually one of the most valuable resources are these grandmothers, the custodians of local culture."

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He recruited 14 grandmothers in the neighborhood near the hospital where he worked in the capital, Harare, and trained them. In Zimbabwe, they get $25 a month to help with transport and phone bills.

The network, which now partners with the health ministry and the World Health Organization, has grown to over 2,000 grandmothers across the country. Over 200,000 Zimbabweans sat on a bench to get therapy from a trained grandmother in 2023, according to the network.

Siridzayi Dzukwa, the grandmother who talked Tembo out of suicide, made a home follow-up visit on a recent day. Using a written questionnaire, she checked on Tembo's progress. She listened as Tembo talked about how she has found a new lease on life and now sells vegetables to make ends meet.

Dzukwa has become a recognizable figure in the area. People stop to greet and thank her for helping them. Some ask for a home visit or take down her number.

"People are no longer ashamed or afraid of openly stopping us on the streets and ask us to talk," she said. "Mental health is no longer something to be ashamed of."

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