When her son, the family’s shining star and sole breadwinner, was arrested last year, Tambudzai Tembo was heartbroken. In Zimbabwe, where clinical mental health services are scarce, her chances of getting professional help were almost zero. She considered suicide. “I didn’t want to live anymore. People who saw me thought everything was fine. But inside my head was spinning,” said Tembo, 57. “I was alone.” A wooden bench and a sympathetic grandmother saved her. Older people are at the center of a homegrown form of mental health therapy in Zimbabwe, which is now being adopted in places like the United States.
The approach involves setting up benches in quiet, discreet corners in community clinics and some churches, poor neighborhoods and universities. An older woman with basic training in problem-solving therapy sits there patiently, ready to listen and talk face-to-face. The therapy is inspired by a Zimbabwean traditional practice in which grandmothers were the go-to source for wisdom in difficult times. It was abandoned due to urbanization, the breakdown of close-knit families and modern technology. Now it is proving useful again with growing mental health needs.
Innovative Mental Health Initiative: The Friendship Bench
“Grandmothers are custodians of local culture and wisdom. They are embedded in their communities,” said Dixon Chibanda, a psychiatry professor and the initiative’s founder. “They don’t leave, and in addition, they have an amazing ability to use what we call ‘expressive 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 to revolutionize mental health care. The concept has taken root in Vietnam, Botswana, Malawi, Kenya and parts of Tanzania, and is in “early pilot work” in London, Chibanda said.
Global adoption
In New York, the city’s new mental health plan launched last year says it’s “taking inspiration” from something called Friendship Benches to help address risk factors like social isolation. The orange benches are now in areas including Harlem, Brooklyn and the Bronx. In Washington, the organization HelpAge USA is piloting the concept under the DC Grandparents for Mental Health initiative, launched in 2022 as a COVID-19 support group for people 60 and older.
Cindy Cox-Roman, president and chief executive of HelpAge USA, said so far 20 grandmothers have pledged to “end the stigma around mental health and make it okay to talk about feelings” after being trained by a team from Friendship Bench Zimbabwe to listen, empathize and empower others to solve their problems. She said the benches will be installed in places of worship, schools and wellness centers in low-income communities in Washington for people who have been “historically marginalized and more likely to experience mental health problems.”
Cox-Roman cited fear and mistrust in the medical system, lack of social support and stigma as some of the factors limiting access to treatment. “People are in pain, and a grandmother can always make you feel better,” she said. “Our elders have so much wisdom and arms that can open. I reject ageism. Sometimes age brings wisdom that you don’t learn until you’re older,” grandmother Barbara Allen, 81, said in a promotional video. More than one in five American adults suffer from a mental illness, according to the National Institute of Mental Health.
“The mental health crisis is real. It’s a real crisis after the pandemic when so many clinicians are out of the workforce,” said Dr. Jehan El-Mayoumi, who works as a specialist with HelpAge USA and is the founding director of the Rodham Institute for Health Equity 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 your heart to, tell your deepest secrets to (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, one of just over 10 psychiatrists in Zimbabwe in 2005. One of his patients was desperate to see him, but she couldn’t afford the $15 bus fare. Chibanda later learned she had committed suicide. “I realized I needed a stronger presence in the community,” Chibanda said. “I realized that one of the most valuable resources is really these grandmothers, who are the custodians of the local culture.”
She recruited and trained 14 grandmothers in the area near the hospital where she worked in the capital, Harare. In Zimbabwe, they receive $25 a month to help with transportation and phone bills. The network, which now partners with the Ministry of Health and the World Health Organization, has grown to more than 2,000 grandmothers across the country. According to the network, more than 200,000 Zimbabweans will sit on the bench to receive therapy from trained grandmothers in 2023.
Siridzayi Dzukwa, the grandmother who prevented Tembo from suicide, came to the home one recent day to follow up. Using a written questionnaire, she checked in on Tembo’s progress. She listened to Tembo talk about how she has found a new path in life and now sells vegetables to make ends meet. Dzukwa has become a well-known figure in the area. People stop to greet her and thank her for helping them. Some ask to meet at home or note down her number. “People are no longer shy or afraid to stop us openly on the streets and ask to talk,” she said. “Mental health is no longer something to be ashamed of.”
