Dixon Chibanda
Dixon Chibanda, a professor of psychiatry and global mental health at the University of Zimbabwe and the London School of Hygiene and Tropical Medicine, is Founder of the Friendship Bench and the recipient of the 2023 McNulty Prize.
LONDON – The world is in the grips of a mental-health crisis. From rising climate anxiety in rich countries like the United States to intense trauma in conflict zones like Ukraine and Gaza (especially among children), psychological suffering has become widespread, and traditional health-care services cannot keep up. This leaves tens of millions of people at risk of serious pathologies and suicide.
As it stands, more than 25% of the world’s population reports feelings of social isolation and loneliness, and more than 150,000 people aged 15-29 die by suicide each year. Climate change threatens to increase these bleak figures. As the American Psychiatric Association reports, climate change can “lead to job loss, force people to move, and harm social cohesion and community resources, all of which have mental-health consequences.” Moreover, contemplating climate change and its consequences for both “national security and individual well-being” can cause “significant distress.”
No groups are spared. Young people fear for their future; older people grieve the destruction of the world of their childhoods; and activists and climate scientists suffer from emotional burnout and despair. And this is to say nothing of the post-traumatic stress and depression experienced by those already affected by climate-related disasters, particularly in vulnerable developing economies.
Traditionally, a psychiatric patient would engage in one-on-one therapy with a trained doctor. But even rich-country health systems lack the capacity to offer such services as widely as is needed: in the US, more than 150 million people live in areas with too few mental-health professionals. Within a few years, the country could be short by as many as 31,100 psychiatrists.
The situation is even worse in poor and conflict-affected countries, where traditional psychiatric interventions are often very difficult to access, if they are available at all. Consider my home country, Zimbabwe: despite being a country of 16 million, it has just 13 psychiatrists and 20 clinical psychologists.
The consequences of this shortfall became starkly apparent in 2019, when Cyclone Idai tore through parts of Zimbabwe. The storm’s powerful winds and heavy rains – and the massive flooding and landslides they triggered – led to hundreds of deaths, displaced about 60,000 people, and demolished 50,000 homes. It also decimated unharvested crops, destroyed seed stocks, and killed livestock, leaving people without food or livelihoods. All of this contributed to mental-health problems, including post-traumatic stress disorder.
Barely a year later, things got much worse: the COVID-19 pandemic forced nationwide lockdowns that further undermined people’s socioeconomic well-being. The resulting mental-health problems were well beyond the health-care system’s capacity to handle.
But that did not mean Zimbabwe had no options. The Friendship Bench project, which I founded, trains community volunteers without any prior medical or mental-health training to provide talk therapy from wooden park benches in all ten provinces of the country. We have so far trained more than 2,000 of these “grandmothers” to provide counseling to their local communities.
The program works. In 2016, a randomized clinical trial found that patients with common mental disorders and indicators of depression who received Friendship Bench counseling had a significant decrease in symptoms. Communities with access to Friendship Bench services also experienced improvements in other areas, from HIV outcomes to maternal and child health. Even the grandmothers delivering the therapy report that they have benefited from a stronger sense of belonging and resilience.
Others in lower-resource countries have also been pioneering new, scalable models for delivering high-quality, low-cost psychiatric care to communities where it was not previously available. One trailblazer is Sangath, an NGO headquartered in the Indian state of Goa that trains ordinary people to deliver psychosocial treatments, particularly in areas with little access to mental-health services. Clinical trials have consistently shown that these “lay counselors” are effective in addressing a wide range of mental-health conditions, from depression and anxiety to alcohol-use disorders.
Similarly, StrongMinds trains “mental-health facilitators” to provide free group therapy to low-income women and adolescents with depression in Uganda and Zambia. The organization reports a powerful impact, not least in supporting communities affected by climate-related environmental disasters. And this impact is set to grow: StrongMinds founder and CEO Sean Mayberry expects the program to reach 335,000 people this year.
Western models of psychiatric care are too resource-intensive to be rolled out across the world, particularly in Africa and South Asia, where fast-growing populations and accelerating climate risks pose huge challenges. But well-crafted community-based initiatives are both cost-effective and highly scalable. Beyond improving individual mental health and resilience, such programs strengthen community cohesion and encourage collective problem-solving, both of which will become increasingly important as the climate crisis intensifies.
Tackling the global mental-health crisis effectively will require greater engagement from the international community. The World Health Organization’s Special Initiative for Mental Health, which sought to deliver greater access to mental-health services across its six regions in 2019-23, was a step in the right direction. But it must be sustained and expanded. Meanwhile, local and national governments and philanthropies should embrace new, locally-based approaches that have proved their ability to help communities cope with growing risks to their lives, livelihoods, and well-being.
