Treating Depression at Scale in Africa
StrongMinds is the only organization working to scale a model to treat depression throughout Africa. Our unique community-based model of group talk therapy is simple, innovative and cost-effective.
Group Talk Therapy to Treat Depression
In response to the depression crisis in Africa, StrongMinds conducted extensive research and analysis to identify the most appropriate treatment intervention to treat depressed women. StrongMinds ultimately selected Group Interpersonal Psychotherapy (IPT-G) as the core methodology.
IPT-G is a simple, proven and cost-efficient community-based model to treat depression that focuses on relationships among group members. Groups are led by a facilitator over a period of 12 weeks to help members identify the root causes and triggers of their depression, and formulate strategies to overcome those triggers. Since depression is episodic and recurrent throughout most people’s lives, these newly acquired skills have both immediate and a long-term preventive impacts for the sufferer.
Adapting IPT-G to impoverished women in sub-Saharan Africa
Since 2013, StrongMinds has been focused on creating a model that is effective in treating depression and easy to scale to reach the most vulnerable women with depression in sub-Saharan Africa. This drive has led to the creation of a model of intervention that is uniquely StrongMinds.
Using Group Interpersonal Psychotherapy (IPT-G) as the foundation, StrongMinds has adapted and enriched this approach with specific role-playing activities and interactive visuals and charts. Each talk therapy group lasts 12 weeks, with the women coming together each week for approximately 90 minutes. Each session time varies due to the level of emotion being exhibited by the group members.
The 12 weeks are broken into three phases, each with distinct objectives:
- Initial Phase: Group Sessions 1-4 This phase focuses on creating initial bonds between group members and building rapport with one another so women feel comfortable sharing personal information and discussing the reasons for their depression.
- Middle Phase: Group Sessions 5-9 This phase ensures that all members are actively engaged and helping each other by making suggestions regarding one another’s problems. This is also the phase where important progress is made for members to fully understand all the symptoms and triggers of depression.
- Termination Phase: Group Sessions 10-12 This phase focuses on preparing members to end formal sessions. Members are reminded to continually identify their own triggers of depression in the future and what they should do to respond. Individual action plans are created and reviewed.
The StrongMinds model is achieving the same results as academic studies. Women who complete our talk therapy groups not only resolve their current depressive state — they also learn coping strategies to help prevent future depressive episodes.
Roughly 75% of the groups continue to meet after formal sessions conclude. This continual connection allows the women to work through their depression triggers together as they arise. In addition, many groups form Village Saving and Loans Associations, which provide financial stability and allow the women to better provide for their families.
Group Interpersonal Therapy (IPT-G)
IPT-G was first tested in Uganda by Johns Hopkins University (JHU) in a randomized controlled trial in 2002. Using lay community workers with only a high school education, the researchers found IPT-G was remarkably successful, reducing the depressive symptoms of 93 percent of the 224 patients they treated. A separate group psychotherapy trial, in Africa in 2012 and again led by JHU researchers, was equally successful. The JHU research study in 2002 showed that positive effects of IPT-G continued for six months. In fact, some groups continued meeting for many years, maintaining greatly reduced depression levels among participants.
SCALING OUR MODEL ACROSS THE SUBCONTINENT
Group interventions are well suited for the African culture, given the strong presence of groups throughout its society. The StrongMinds talk therapy model is based on a 12-week period of 60-90 minute sessions. StrongMinds’ Mental Health Facilitators are not mental health experts, but local professionals who are trained and certified in StrongMinds’ psychotherapy model. Every 12 weeks a new cycle of StrongMinds Therapy Groups begin, each Mental Health Facilitator leads 10-12 groups per week, with an average of 12 women per group, treating 300-400 women per year.
Creating self-sustaining communities that can pass on to others what they have learned in IPT-G is critical for scaling. So we created Peer Therapy Groups (PTG), self-replicating, volunteer-led talk therapy groups of eighteen people led by individuals trained in IPT-G. For this program component, MHFs recruit STG graduates eager to give back to their communities and train them to be volunteer Peer Facilitators (PFs). To train, PFs co-facilitate STGs with MHFs for two cycles (24 weeks). This on-the-job training provides structured opportunities for PFs to learn the method, sharpen their skills, and increase confidence in their own abilities. They then deliver a simplified version of IPT-G therapy in the PTGs in perpetuity in their own communities, reporting to a Peer Therapy Program Manager for support and on-going refresher trainings. The PTG model is a self-replicating one in which a PF trains a member of her own PTG to become a PF herself who, in turn, trains more patients and on and on in a viral expansion process across geography and time, eventually carrying the treatment to scale and across multiple generations. PTGs also serve as conduits for other resources from SM, governments, and INGOs. They receive cash stipends tied to the submission of program data. Since completing the first full-year pilot of this program in 2016, 8,000 people have participated.
Once fully implemented on a large scale, StrongMinds will significantly impact the depression epidemic in Uganda and Africa because of the building capacity of local women to treat other for depression.
In addition, StrongMinds is scaling by working with large International Non-Government Organizations (INGO). In the beginning of 2016, StrongMinds worked with the International Rescue Committee (IRC) to treat female refugees in Uganda. Later in 2016, StrongMinds began working with BRAC-Uganda to treat adolescent girls with depression. Today, by leveraging partnerships with select INGOs across Zambia and Uganda, StrongMinds is able to reach more women with depression while making the work of the other organizations more effective because the women are able to function better.