Open Source: Sharing Insights & Stories About Scaling Mental Health Treatment

Our Origin Story 

By Sean Mayberry

StrongMinds exists to bring treatment for depression to as many people as possible. We don’t need to be the organization that treats every person. We just want them treated. We want each person to live a healthy and happy life and believe that that is possible only when we destroy the barriers to mental health care.

StrongMinds has provided depression treatment to more than a half-million people in Africa. Over the past decade, we have surmounted countless obstacles and channeled hard learnings into innovations that have enabled us to deliver depression treatment at the scale that we do.

In this blog, I will share behind-the-scenes insights into the lessons and innovations that have shaped our program and outcomes. For the global mental health community to succeed, there should be no trade secrets. If we want each person to live the life they deserve, all the information we develop must be open source. 

If you want to take what we have learned and tweak it, please go ahead. But pay it forward by sharing what you learn. 

In the first installment of Open Source, I will share our origin story and the key insights that led us to embark on our journey to radically expand access to depression treatment globally.

While working in Africa for over a decade on infectious diseases, I saw that mental illnesses such as depression were pervasive, and yet the vast majority were misunderstood, undiagnosed, and untreated.

While working in the Democratic Republic of the Congo on a large campaign to fight malaria where we distributed over 10 million bed nets, I was struck by the fact that, consistently, 20 to 30 percent of the people receiving these free nets were not using them. Over time, I spoke with other NGO leaders and found they had similar frustrations – that no matter how hard they tried, a consistent 20-30 percent of their target population seemed resistant to adopting these types of life-saving measures. 

I wondered if underlying depression was the problem. Depression is a mental health disorder that can overwhelm and exhaust people. It can reduce focus and impair cognition. I wondered if, by treating underlying depression, we could improve uptake of health-seeking behaviors – such as using a mosquito net or attending a general health screening – and ultimately improve the lives of millions.

I mulled this question for years, searching for a possible solution that could effectively scale mental health treatment to people in Africa who would otherwise have no access. 

In 2012, I came across an article in The New York Times called “Fighting Depression, one village at a time,” by Tina Rosenberg. 

The article not only confirmed the high prevalence of depressive disorders in low-and middle-income countries but also highlighted the disproportionate impact it can have on people in low-resource and marginalized communities.

The article highlighted a number of promising interventions and studies that utilized a clinical method called group interpersonal therapy (IPT-G), which was first developed by Myrna Weissman and Gerard Klerman.

One of the studies cited a problem they found in Uganda. There weren’t enough doctors or nurses to implement the treatments, so they had to train laymen to implement the program.

This method is called task-shifting and it is widely used across the health sector. It is when tasks can be completed by individuals other than those that typically carry them out, many times with less or no specialized training. It allows people to receive care even if professionals are scarce. I believed this could be the key to scaling the IPT-G model in a cost-effective way.

This key insight: that we could deliver an effective, evidence-based, and scalable depression treatment program that had the potential to reach millions, was the inspiration behind StrongMinds. 

Task-shifting was, and remains, critical to our success. In my next post, we’ll take a deeper dive into task-shifting and what it means in practical terms.

I hope that you gain valuable insights from what we have to share, but more importantly, I encourage you to share what you learned with others so that together we can expand access to mental health care.