Grandmothers help the world “reimagine mental health care”

March 14, 2023

By Courtney Wise

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Zimbabwe’s grandmothers: “Helping the world reimagine health care”

About 20 years ago, psychiatrist Dixon Chibanda of Zimbabwe lost a patient to suicide, The young woman couldn’t get mental health care in her village, he told the Boston Globe, and she couldn’t afford the 160-mile bus ride to see him. At the time, Chibanda was one of only 15 psychiatrists in Zimbabwe – a nation of 16 million people. His patient’s tragic death led him on a crusade to remove barriers to mental health care. Recruiting more mental health professionals was untenable, so he turned to grandmothers.

“The most important resource that is left in most communities are grandmothers, because they are custodians of the local culture and wisdom,” Chibanda has said. Grandmothers were also seen as highly respected, empathetic, and experienced at caregiving. Chibanda partnered with Zimbabwe’s Ministry of Health and Child Care and the University of Zimbabwe to develop a program that trains elders in “problem-solving therapy.” The evidence-based training helped the grandmothers hone their abilities to listen, to make people feel heard and seen, and enrich patients’ feelings of belonging. Rather than sitting under flourescent lights in a clinic, Chibanda suggested they conduct their free sessions on a park bench.

Chibanda has the grandmothers to thank for both the name “Friendship Bench” and the organization’s deeply unpretentious approach. (He was going to call it a “Mental Health Bench,” but the grandmothers protested that the stigma associated with mental illness might get in the way.) It’s the grandmothers who encourage the use of cultural terms, rather than clinical ones, to get program participants to discuss their challenges. Rather than say depression or anxiety, for instance, grandmothers often use kufungisisa, which means “thinking too much.”

Susan Chali discovered the program when her marriage was in crisis and she was having trouble feeding her children and paying their school fees. “In the beginning, I thought I was no longer human because of the troubles that I had,” she told the Globe. Through her conversations with grandmother Sabinah Dovi on the Friendship Bench, Chali gained new confidence and skills. “The way Sabinah talked to me,” Chali said, “removed all the pain I had in my heart. I started out crying, but in the end I was happy. I got the feeling that I was accepted in the community.” The program now serves 60,000 people in Zimbabwe and has pilots in countries from Vietnam to Kenya.

Ever experienced physical discomfort following intensive mental health therapy? You’re not alone

Digging into traumatic events and memories can trigger what cognitive neuroscientist Caroline Leaf calls “the treatment effect.” As Leaf told Shape magazine, “The increased awareness from the work you’re doing on your thoughts (which is very challenging, to say the least), increases your sense of autonomy, This can also increase your stress levels and anxiety because you’re starting to become more aware of what you’re going through, how you’ve handled your stress and trauma, and why you’ll have to face some deep, internal issues” — which means, the article suggests, that you might “feel pretty beat up post therapy.”

An article in Real Simple also discusses these “emotional hangovers” from intensive thearpy, often resulting in exhaustion, headaches or migraines, muscle aches and weakness, gastrointestinal issues, fatigue, and difficulty sleeping. Clinical psychologist Adam Fried suggests reserving a few minutes after therapy sessions to recover and re-energize. Another psychotherapist, Lise LeBlanc, told Real Simple that she often suggests clients schedule an extra 15 to 20 minutes after their session to have a short nap or meditation. “After stirring up difficult thoughts and emotions, we need to give ourselves time to process and settle,” she said. “Otherwise, there is no way for the mind to consolidate insights, shift mental patterns, and release emotions.”

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Vitamin D is good for you, but unlikely to protect against mental illness

That’s the latest from Scientific American, despite research published just last month in PLOS One suggesting that vitamin D is associated with a reduced risk of suicide attempts among U.S. veterans. “Imagine if getting a little vitamin D pill would reduce the mental health burden around the world. That would be incredible, right? That’s the kind of pipe dream I think people are chasing with this research,” said Brian Lee, an epidemiologist at Drexel University.

Vitamin D packs a good punch: Studies in rodents suggest the vitamin supports the cellular basis of learning and memory. It’s also a potent anti-inflammatory, and inflammation is thought to be connected to depression. Still, experts say more evidence is needed to associate a person’s vitamin D levels with improved mental health.

In fact, Australia-based psychiatrist and epidemiologist John McGrath said low vitamin D is more likely to be an indicator of illness rather than its cause. Why? People sick with conditions that keep them inside, rather than outdoors, tend to have lower levels of vitamin D, he said. “If you have an illness like depression…and then you change your behaviors, you get less vitamin D because of your changed behavior. Low vitamin D may be one of those bystander or proxy markers that just goes along with your behavior.”

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In other news…

Lawmakers in Massachusetts are weighing whether or not to allow their courts to force mentally ill citizens into treatment. Despite reports from advocacy groups that say there is little evidence court-ordered treatment is effective, and that such mandates are imposed disproportionately on people of color, researchers say studies on the impact of court-mandated treatment are mixed, according to WBUR. “The question that a lot of people still have which really hasn’t been answered is, is it successful because of the court-ordered component of it? Or is it successful because of the wraparound services that these people have access to that they wouldn’t otherwise have,” says Arizona State University associate clinical law professor Susan McMahon.

Depression is not a life sentence. In fact, it’s common and, for most people, very treatable. This article in the Philadelphia Inquirer highlights four Philadelphians and their journeys with the mood disorder, including what began to change for the better when they reached out and asked for help.

Veterinarian Karen Fine spoke with NPR’s Fresh Air about her new book, The Other Family Doctor, and what animals have taught her about life, love, death, and grief throughout her career. In part of the 36-minute conversation, Fine also discusses the need to expand mental health support for vet health professionals. Rates of suicide among veterinarians are disproportionately high compared to other professions. “There’s been a big focus on wellness, that veterinarians should try to take good care of ourselves and get enough sleep and eat right and exercise,” Fine said. “And I kind of feel like that’s a very good start. But we also need to try to focus on why this work is so difficult and how bonded people are to their animals and how intense some of these interactions are. … I think people, too, need to maybe understand how difficult this work can be.”

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7

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