A grassroots response to community mental health comes to us from Zimbabwe

Now, you and friends can read this moving story in Dr. Chibanda’s memoir, ‘The Friendship Bench’

Editor’s note from ReadTheSpirit magazine and New World Library:

With societies all over the globe suffering from epidemics of loneliness, depression, and mental illness, celebrated psychiatrist Dr. Dixon Chibanda’s new book The Friendship Bench: How Fourteen Grandmothers Inspired a Mental Health Revolution, offers a remarkably innovative method for delivering one of the most effective cures available: simple human connection.

As one of only five psychiatrists in all of Zimbabwe, Chibanda recognized, after losing a patient to suicide, that millions in his community were suffering depression, substance abuse, and mental illness with no hope of receiving care. He realized that the only way to narrow this gap was to leverage existing resources in the community, like the loving presence of grandmothers.

Chibanda partnered with fourteen strong-willed grandmothers to pioneer a community-based mental health initiative called The Friendship Bench program. Since 2006, Chibanda and his team have trained over 3,000 grandmothers in evidence-based talk therapy, which they deliver for free in more than 500 communities in Zimbabwe and beyond while sitting on designated Friendship Benches in public spaces like clinics or community centers. The success of the project has inspired a global movement, with Friendship Bench initiatives in Kenya, Vietnam, El Salvador, Washington DC, New Orleans, and beyond, bringing accessible mental healthcare to diverse communities.

We hope you will enjoy this excerpt from the book.

Then, here’s an excerpt from The Friendship Bench, by Dixon Chibanda, MD

Click the cover to visit the book’s Amazon page.

While the grandmothers and I certainly didn’t agree on everything, at least at first, we did come to an agreement that the screening tool I’d offered for common mental disorders, the Shona Symptom Questionnaire (SSQ-14), was a pertinent guide that could help them establish a sense of the severity of symptoms induced by social determinants — in other words, the severity of the clients’ mental health struggle. The SSQ-14 was a set of fourteen questions that inquired how a person had been feeling in the past seven days within such areas of their lives as sleep, mood, suicidal thoughts, hallucinations, motivation, and physical symptoms, among others. At the start of the project, clinic nurses from various facilities administered the questionnaire, which led to countless referrals to the Friendship Bench. Over time, we ended up getting self-referrals via word of mouth, and as the intervention became more popular, the grandmothers themselves offered the SSQ-14 to patients who came to them.

However, the grandmothers strongly felt that whatever issue a client might bring to them did not necessarily have to be attached to a clinical condition. Grandmother Jack was adamant that depression was a Western concept that didn’t resonate with her community. “You can’t use those terms here! They won’t mean anything to people needing emotional support,” she insisted.

One of the common symptoms of depression is “overthinking,” a term commonly referred to as kufungisisa in Shona. While the grandmothers recognized that it often accompanied stressful situations, they didn’t see it as the primary symptom of an illness at all. Rather, it was a natural response to a wide range of social, family, political, and economic challenges that people were facing — something I had also come to think about more deeply in the wake of Murambatsvina, as well as the loss of Erica.

“The problem itself is the thing that causes the kufungisisa,” Grandmother Jack explained. So focusing on the symptoms was meaningless when a person was depressed because they were HIV positive and couldn’t get the support they needed to live well with HIV, or they were in an abusive relationship and the community was just watching from a distance. Collective community response, she said, “is what will help most of the kufungisisa that people are facing. This is where kuvhura pfungwa [opening the mind] becomes important.”

Grandmother Kusi, who was always immaculately dressed no matter what the occasion, chimed in: “Yes! See, the average person coming to the bench does not want treatment for depression. They want treatment for their problems with money and people, and that is why it is better to offer them kuvhura pfungwa. Opening the mind is what leads to seeing clearly and realizing that they can do something about their unhappiness.”

The term kuvhura pfungwa had first been used in our meetings when Grandmother Jack, in her typically candid fashion, pointed out my failure to see the big picture. “We all need to open our minds,” she had said, smiling, “for only by opening our minds can we see the resources that are in each person, family, and community.”

Later on, together with the other grandmothers, she would consistently talk about kuvhura pfungwa to describe the first step of therapy that was necessary to create space for people to share their stories on the Friendship Bench.

“So what drives kuvhura pfungwa?” I asked the grandmothers one morning as we sat in the shed outside the clinic where we were now convening our regular meetings.

“Empathy that’s said out loud, not just felt,” responded Grandmother Jack.

“Making people feel respected and understood, regardless of their money or status or the problems they bring to the bench,” added Grandmother Kusi.

“The most difficult thing to do when talking to a person is noticing how we are judging them inside,” said Grandmother Hwiza. “And then, just being there and sending them empathy without judging them. We all struggle with this as humans, but ultimately, that is the highest level of kuvhura pfungwa. With all our imperfections, this is what we should strive for.”

“You know, Doctor, we all have that quick tendency to judge. I guess it’s our way of being seen to be in the right,” Grandmother Jack went on, “but I think with age, you learn to judge less. We hear about all sorts of dirt happening in the community, and we become that ear that everyone needs.”

I nodded as I took in the grandmothers’ words. “But what is it that makes you become less judgmental with age?”

“Well, when you’re old and ready to move on to the next world, you have seen so much and done so much that very little can shock you!” said Grandmother Jack.

“People worry more about things that haven’t actually happened,” said Grandmother Chizhande, who had a coarse voice but often gentle words to offer. “It’s the fear of the unknown that kills us most of the time.”

“And also, when you are old, everybody thinks you know everything,” Grandmother Jack added, “but the truth is, there is still a lot we don’t know — we’re just more likely not to panic in the face of disaster!”

“That is exactly what a person is looking for when they come to the Friendship Bench.” Grandmother Kusi sounded excited. “Sometimes, even when we have no idea what needs to happen, just listening makes a big difference, especially for people who are lonely.”

I was beginning to understand why the grandmothers felt that healing could begin only when a client was able to share their story. And it was impossible to share an emotional story with someone who didn’t express empathy, who didn’t make the person in need feel, as Grandmother Kusi had said, respected and understood. I began to wonder whether or not I had shared my support with Erica and others to the best of my ability, especially given that I’d always been trained to keep interactions with patients clean and simple — just the facts, ma’am.

“It’s also about the power of the human voice. You need to understand how to use it as a tool,” said Grandmother Jack. “The voice can be medicine.”

As I listened to them talk, I learned that the grandmothers believed the way one spoke to another person had a greater impact than structured therapy — and this included the timbre of the voice, the words used, the body language displayed, and, of course, the eye contact made. These were tools innate to every human being, but a lot of people had lost the ability to use them, often because of trauma and the destruction of supportive communities of people.

“How does the training you received help? And does it help at all?” I inquired. I myself had offered their initial training, along with two clinical psychologists.

“The training and the tools help to give structure,” Grandmother Hwiza replied, “especially that screening tool! Those fourteen questions help me to see how severe a situation is. But you still want to focus on the story and on listening.”

“The other thing I think is important from the training is the idea of the summary,” added Grandmother Kusi, referring to the practice of listening to a client’s story and then summarizing what they said back to them. “That can really help them to feel heard and even give them a new understanding.” She sighed. “People facing challenges have not often had the opportunity to sit and tell their story to a person who is genuinely interested in helping them.”

As I sat in the presence of the grandmothers, I wondered if I had done enough. Grandmother Jack’s gaze at me was piercing but kind, as if she could feel the guilt I still carried about Erica. “If the story is real and true empathy is conveyed,” she said, “that’s where the healing actually starts.”

Dixon Chibanda, MD, is the author of The Friendship Bench: How Fourteen Grandmothers Inspired a Mental Health Revolution.  His “Why I Train Grandmothers to Treat Depression,” TED talk has been viewed more than 3.2 million times and the Friendship Bench project he founded has been featured in major media like CBS Sunday Morning, The PBS News Hour, New York Times, LA Times, BBC World Service, and more. Visit him online at http://www.friendshipbench.org.

Excerpted from The Friendship Bench: How Fourteen Grandmothers Inspired a Mental Health Revolution. Copyright © 2025 by Dixon Chibanda, MD. Reprinted with permission from New World Library. www.newworldlibrary.com