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Over the past few years, the impact of untreated mental health conditions has become undeniable, as families around the world struggle with the impact of the COVID-19 pandemic in addition to the stressors of everyday life. This is particularly true in sub-Saharan Africa, where the mental health treatment gap was already significant prior to the pandemic. Globally, policymakers are waking up to the need to address mental health at a systemic level, with low-cost, scalable approaches that can rapidly serve those most in need. At StrongMinds, we applaud this growing awareness. Our mission is to scale access to mental health services for low-income women and adolescents in Africa.
Depression is a silent epidemic in Africa, especially for women, who are affected at twice the rate of men. Yet most African governments spend less than 1% of their allocated health budget on mental health. The World Health Organization estimates that 85% of people with depression have no access to effective treatment.
In Uganda and Zambia, where StrongMinds currently works, we see first-hand how depression impacts a woman’s ability to function in day-to-day life. She may be less productive, have a lower income, and have poorer overall physical health. If she is a mother, the negative impact can also extend to her entire family. Research shows that children of depressed mothers are more likely to have poor health, struggle in or miss school, and suffer from depression themselves. Untreated depressive symptoms in young people are linked to increased alcohol use and high-risk sexual behaviour.
For every individual woman treated for depression, an estimated four members of her family benefit.
However, the vast gap in access to mental health services and the burden of depression that so many women bear doesn’t have to exist. Sean Mayberry, Founder and CEO of StrongMinds, came across the findings of a randomised controlled trial in Uganda from 2002 that had remarkable success in treating depression with group interpersonal psychotherapy (IPT-G). The study, by researchers from Johns Hopkins University and Columbia University, used lay community workers with a high school education. The results were overwhelmingly positive, with more than two-thirds of the women remaining depression-free well beyond the conclusion of formal therapy groups and reporting improvements in their economic and social lives.
Inspired by this initial study, in 2013 StrongMinds adapted the model to treat underserved women and adolescents with depression in Uganda, and later in Zambia.
IPT-G uses a participatory approach, empowering socially isolated and vulnerable women and adolescents to improve relationships, develop communication and conflict resolution skills, and foster lasting support networks. The StrongMinds IPT-G model is used in a culturally adapted format delivered over an eight-week period by local lay workers and volunteer community members. The facilitators help therapy group members to identify the root causes and triggers of their depression and design strategies to overcome them, ultimately reducing their depression symptoms without the use of medication. Since depression is episodic and recurrent throughout most people’s lives, these newly acquired skills have immediate as well as long-term preventative impacts for the client. The model is proven, cost-effective and highly scalable. The World Health Organization recommends IPT-G as a first-line intervention for depression in resource-poor settings.
Since beginning fieldwork in 2014, we have treated over 140,000 individuals for depression. Over 80% of the women we treat are depression-free at the conclusion of therapy and remain so six months post-treatment. For every individual woman treated for depression, an estimated four members of her family benefit. When a woman is no longer depressed, her whole family thrives. StrongMinds finds that 16% of women treated report an increase in work attendance, 13% report an increase in family food security, and 30% say their children have fewer school absences. These results align with existing research that illustrates the extensive benefits of depression treatment for health, adherence to economic productivity and children’s health and development.
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In 2020, StrongMinds was pushed to adapt our in-person therapy due to the COVID-19 pandemic. We launched our first-ever public education campaign to inform about depression symptoms and to serve as a referral source to our newest offering—teletherapy. Our phone-based therapy has the same success rate as in-person therapy and has offered some unique advantages, such as convenience and more anonymity for our clients. As far as we know, this is the first instance of teletherapy IPT-G serving Africa.
With our IPT-G model designed to be uniquely flexible and responsive to local conditions, we are equipped to reach significantly more women throughout Sub-Saharan Africa through partnerships. We are seeing increased interest from NGOs and local governments, who are turning to StrongMinds for recommendations and additional mental health capacity building by integrating our model within their programmes. This scaling method will help us reach more women in some of the most remote and impoverished areas that would otherwise never have access to mental health resources.
We have a responsibility to ensure everyone has access to quality depression treatment. StrongMinds is uniquely positioned to scale to meet the growing mental health needs—but we fear if we don’t do it, no one will. Despite the lack of funding devoted to mental health globally, StrongMinds will continue to innovate and strive to advance our work until we’ve reached every woman in need of our support, changing her life, and the life of her family.