“There are several things that happened all at once that triggered the idea of Friendship Bench,” Harare-based psychiatrist and health activist Dr Dixon Chibanda tells me. “The first was the loss of a patient by suicide,” he says. “She couldn’t come to the hospital for review because she could not afford the bus fare required to make the journey to see me at the hospital, as she lived in Mutare and I was in Harare. That’s a 260 kilometre trip. This loss made me realise that expecting people to come to me would probably not work if we wanted to increase access to evidence-based care.”

The second trigger was Operation Murambatsvina (Move the Rubbish). A devastating two-month-long, military-style urban clean-up campaign the Zimbabwean government carried out in 2005, which left 700,000 people destitute in cities across the country. “Based on what we saw on the ground, people were highly traumatised. There was this urgent need to do something at a community level, and how we were working back then was just not enough,” Chibanda says.

These concurrent events led Chibanda, then the country’s only psychiatrist working in a public hospital, to wonder what he could do to enable people who needed mental health support to access services without having to visit the hospital.

Chibanda initiated a study across 12 clinics in Harare to measure the toll Operation Murambatsvina took on residents’ mental wellbeing. The findings were staggering. Over 40% of respondents to his survey met the clinical threshold for depression. The severity of the need for services was evident, but there was neither money nor expertise to deploy.

Initially Chibanda thought he could recruit doctors and qualified nurses who, after a bit of training, would be able to provide the necessary therapeutic support. But he faced a lot of resistance. “The nurses were too busy doing the work that keeps primary health care facilities running—maternal and child health, immunisation, HIV testing and support—and they didn’t have time for additional tasks. At the same time, many young people were leaving the country, fleeing the political and economic turmoil that Murambatsvina was a symptom of, so we had to think of a different strategy.”

That rethink led to an experiment that has come to define the so-called Friendship Bench. Chibanda realised that grandmothers were the only consistent demographic group with deep roots in the community who were available and willing to be trained to provide support services in their communities.

Friendship Bench is “therapy delivered by trained grandmothers from wooden park benches in communities across Zimbabwe. The therapy is based on cognitive behavioural therapy principles,” explains Chibanda. “Essentially, we train community trainers who go on to train grandmothers. We facilitate the allocation of wooden park benches in those communities, as well as referrals to the wooden benches through social media, primary health care facilities and even police stations.”

“Why a park bench out in the open?” I ask.

“The key idea is to destigmatise mental health and create space for people to share their stories in a non-judgemental, non-clinical setting,” answers Chibanda. “One of the problems we face in mental health or psychiatry is the medicalisation of everything emotional or psychological. So, the bench is really a symbol, a platform, for dialogue. It’s a place where you are invited to share your story. People feel good to sit somewhere and talk to someone who is not judging them, someone who truly listens and helps them to reflect on what they are struggling with. 

“In every part of our process—the placement of the benches, who we train to provide therapy, even who gets to make the benches to our specifications in each community—we involve community stakeholders. We have realised that it’s essential to engage the gatekeepers present in each community intensively. The benches are discreetly located outside community clinics and various other public spaces, and we work with members of those communities to determine where they feel comfortable for those benches to be. It’s not something that we impose.”

From the beginning, language has been key to the success of Friendship Bench. At first, Chibanda had called the project “Mental Health Bench”. “The grandmothers took me aside and said the name was stigmatising and that we needed something that would be more inviting and would encourage people to want to sit and talk.” Friendship Bench was ultimately adopted. A lexicon that Chibanda refers to as “local, indigenous idioms of distress” has since been developed and is in heavy rotation in all the programme’s activities.

“We have tried to remove some of the Western diagnostic criteria—the medicalised language of the mental health bible, if you like—and instead use local descriptors that tend to be more relatable and less stigmatising,” he continues. “For example, kufungisisa—the Shona equivalent of depression—has no stigma. So, we increasingly rely on the local language wherever we go. When we went to Zanzibar to introduce the Friendship Bench, we spent a lot of time discussing and trying to understand what friendship meant in the Zanzibari context before deciding what to call the project there. The experience has been similar in Kenya. Our experience in the early days in Harare taught us that what you name things is critical. It will either make or break a programme like this.”

“If I could have it my way,” says Chibanda, “I would have Friendship Benches in every park, at bus, police and train stations. I would have a bench in those public spaces to enable people to understand and appreciate the importance of sharing their stories and interacting with each other in more meaningful ways that strengthen both the individual and community. Our vision is to have a Friendship Bench within walking distance everywhere. Friendship Bench is not just about mental health. It’s about bringing people together—mental health is simply an entry point. The issues that we have ended up addressing are not just mental health. We are dealing with the social determinants of health—things like intimate partner violence, poverty, unemployment, living with HIV, and issues relating to safety and wellbeing for the LGBTQ community. So, it’s a way to address the problems crucial to building strong communities.”

The success of the programme has not gone unnoticed. It has recently been included as a pillar of Zimbabwe’s National Strategic Plan for Mental Health. “We have a [memorandum of understanding] with the government of Zimbabwe to introduce Friendship Benches across the country, but the government is still more interested in investing in traditional health facilities,” Chibanda says cautiously. “But,” he adds, “I think Friendship Bench’s future is beyond health facilities. We are also part of the World Health Organisation Special Initiative [for Mental Health], and the idea is to liberate WHO resources, both at Geneva and Afro-country region level two, to introduce Friendship Bench in more parts of the world, particularly in the Africa region. We are pushing to see the Friendship Bench incorporated into health policies and implemented alongside other existing structures—not just health, but also social ones.”

A key pillar of the programme is the evidence-driven approach that Chibanda and his team have insisted be applied across all their activities. 

“It’s been central,” says Chibanda. “Because I’m in Africa, and Black. If I want the world to recognise our work, I must go through that path. There are people doing mental health work in other parts of the world who have absolutely no science behind their work. But, because they happen to be coming from the right part of the world, and they are the right colour, they get recognition. To get that same recognition, I have to have a solid scientific background in what I do. The other reason is that science is essential for the team; it helps us figure out what’s going wrong, what needs fixing and improvement. We are constantly publishing in peer-reviewed journals and have published over 100 peer-reviewed papers. It’s good for the organisation. It gives us credibility.”