How mental health charity Strongminds is disrupting depression in Africa

Solutions

A couple of weeks ago, I wrote a story about why mental health is one of the most neglected problems in the developing world.

In the article, I highlighted the work of Strongminds, a charitable organization that is treating depression at scale in Uganda, focusing particularly on women.

Inspired by the inventiveness of their solution, I reached out to Strongminds founder Sean Mayberry and program director Kari Frame. I wanted to know more about their approach to mental health and how they’re disrupting depression in Africa.

We started with a general introduction of Strongminds’ work, then they explained why they decided to dedicate two brand new programs to targeting adolescents and refugees, and finally, I asked them why, after Uganda, they’re now extending their operations to Zambia.

Kinder World: Sean, you founded Strongminds in early 2013. Why? What did you want to achieve?   

Sean Mayberry: Our mission was and is to improve the mental health of women and girls in Africa by focusing on depression, the most pervasive and debilitating mental illness in the world.

So far, we’ve treated over 43,000 women of all ages, but our goal is to treat 2 million women by the year 2025.

Given the extreme scarcity of mental health professionals in Africa, to even dream of achieving such a goal we can’t afford to employ a model that relies on doctors and nurses.

So, we perfected a depression intervention based on Group Interpersonal Psychotherapy. A cycle of group therapy consists of a 12-week period of 60-90-minute sessions and, in the end, we encourage women who complete it to run their own peer therapy group, making the process scalable and low-cost.

Keep in mind that there are at least 66 million women in Africa who suffer from depression and, according to the World Health Organization, approximately 85 percent of them have no access to treatment

This is a gigantic problem that needs effective, scalable solutions.

Mental health should be a priority for international aid. It should really be at the top of the list. Take the case of refugees, for example. Before you could think of other interventions like a training program, you need to get the refugee back to good mental health.

If you don’t follow this order, the illness will be a blockage, nullifying the effects of other aid measures.

In this regard, I know that you’ve recently started to develop a new program tailored to refugees’ needs. Why did you think it was important to do it?

Kari Frame: In Uganda, the refugee population is huge. Over one million people have been welcomed there in the past years.

The reason is that it’s one of the most liberal and receptive environments in Africa when it comes to allowing refugees to settle, to work, and in general to rebuild their lives.

So there’s this huge population that is migrating there carrying the typical mental health challenges that come with displacement and conflict. That’s why we’re interested in developing a therapy that caters to their distinctive needs.

We’ve been researching this topic for a while now. Interestingly, there are quite a number of scientific studies demonstrating that to address refugees mental health you don’t have necessarily to focus on the trauma or the PTSD.

Depression and the challenges of the “here and now” are sometimes even more important. And these are the problems our therapy is particularly well suited to address.

In fact, data reveal that a traumatic event like a war is more likely to trigger a depressive episode than to trigger PTSD.

In addition to refugees, you’ve also decided to dedicate a new program to adolescents. The question is the same: why did you think it was important to do so?

Kari Frame: Adolescence is the cradle of depression. That’s when most people who experience depression have the onset of their illness.

If you treat depression, the risk of relapse over time will be drastically reduced, so a focus on depressed adolescents, epidemiologically, makes sense.

However, adolescents are a difficult target group. They have a lot of different competing priorities, like boyfriends or girlfriends. It’s then important to be flexible with certain parameters like the length of the treatment.

We also know that the important people in an adolescent’s life - such as her friends or partner - can either support or put off her engagement in therapy, so we also need to find ways to engage with these other people and make sure they understand the treatment’s importance.

Interpersonal Group Therapy is usually considered very effective for adolescents, even though it has not been widely studied in the context of Sub-Saharan Africa. But that’s what we’re set out to do this year.

This really is our typical Strongminds approach. There’s a lot of experimentation involved, of figuring out what we don’t know yet, testing it, and ultimately being able to develop a state-of-the-art, replicable model.

For example, at the moment, we’re looking into how we can package our therapy in a way that is more appealing for adolescents.

We suspect that technology and specifically social media might play a role since they are the important currencies in an adolescent’s life.

You’re not just expanding your treatment’s reach to new target groups. You’re also expanding geographically. I’m referring to your decision to start up a new Strongminds chapter in Zambia. Why did you pick this country?

Sean Mayberry: Of course, geographical expansion is part of our plans to scale.

When we had to decide where to go next, we looked at everything, from demographics to safety, but the single most important factor that brought us to Zambia is that we have received the greatest proactive stance from its Minister of Health, who directly asked us to partner up and deliver our service as part of the existing national health infrastructure. And being involved in larger partnerships is one of the ways we want to scale our solution.

On last New Year’s Day, the president of Zambia visited the local mental health hospital and pretty much said that mental health will be a top priority for the government.

It’s gonna take a lot of work. When I was there in October, I was told that in the country there are just around eight psychiatrists. That’s for a population of over 16 million people. For us, it’s not a shock. This is pretty much the standard ratio of mental health professionals in Sub-Saharan Africa.

And so we go back to why our community-based model is designed to work without trained doctors and nurses.

I have one final consideration: I certainly don’t want to make a “ranking” of mental diseases but depression seems relatively less debilitating than schizophrenia. And I guess that people in the schizophrenia spectrum have an even stronger stigma attached to them.

I was just wondering what could be the fate of someone suffering from it in a country like Uganda or Zambia, also in light of the radical lack of mental health professionals you mentioned.

Sean Mayberry: We focus on depression because it’s the number one problem there at the moment. It’s also a matter of percentages: depression affects around 30 percent of the population while schizophrenia has an incidence of around one percent.

But, granted, someone with schizophrenia is living a horrible life, also because it outwardly presents the signs most associated with the mental illness stigma.

On top of that, access to medication here is a real issue.

So yes, it’s an extremely difficult situation. In Sub-Saharan Africa, mental illnesses are often not recognized as such, so people might think it’s a curse or their own personal weakness.

Then, there’s the social decay that happens with it. Many of the people that we have found to be depressed, they were thrown out of their social networks, and they were isolated for months or years.

The strength of the Strongminds group therapy approach is that it pulls depressed people out of isolation, encouraging them to share their feelings and experiences with other women so that they understand they are not alone. In doing so, it removes the stigma of mental illness, which is a source of shame for sufferers and confusion for their loved ones.

© header image: Strongminds

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  • How could citizens’ assemblies be used to tackle climate change?

    Solutions

    In one mad sunny week over the Easter weekend, Extinction Rebellion brought public attention to the problem of climate change in a way that had rarely been achieved before. The group’s most ambitious demand - to cut greenhouse gas emissions completely by 2025 - is unlikely to be met. But another - for governments to be led by the decisions of citizens’ assemblies on climate and ecological justice - has a successful history in many parts of the world.

    Not to be confused with people’s assemblies (a more informal gathering, often of existing activists) citizens’ assemblies are a way of exploring public views on a particular topic and coming up with concrete solutions. They sit under the umbrella term ‘mini-publics’ as an example of deliberative democracy, alongside citizens’ juries, planning cells and consensus conferences.

    Sarah Allen, engagement lead at public participation charity Involve, is a big advocate of citizens’ assemblies as a tool for resolving complicated policy problems. She recently designed and ran assemblies on adult social care for a couple of House of Commons committees and on Brexit for a research project, and is now working on one for the National Assembly for Wales which will consider the main challenges facing the principality over the next 20 years.

    Citizens’ assemblies are a bit like focus groups, but usually larger and longer; they can take up a single weekend or up to a year in some cases. Allen explains on the phone that participants are chosen at random to represent the broader population and are paid for their time so that everyone can afford to take part.

    All citizens’ assemblies have three stages. The first involves learning about the problem, when everyone is given a primer in the subject and hears from people advocating different solutions. Then there is a period of consideration and discussion, often in small groups. The assembly as a whole then has to decide about what it would do to solve the problem at hand.

    Allen says the learning phase is particularly important. “The discussions are designed to give participants a better understanding of why people might hold a different view of the subject and encourage people to critically reflect on their own opinions.”

    Oliver Escobar, senior lecturer in public policy at the University of Edinburgh, says in an interview that research into mini-publics shows that they are good at taking a balanced view. “When citizens are given the right opportunity, space and support, they can consider an impressive range of evidence, perspectives and testimonies and then on balance make an informed recommendation.”

    The idea of citizens’ assemblies has been around for well over a decade. It was pioneered in British Columbia, Canada, in 2004 to consider the thorny issue of electoral reform, and later played a key part in assessing public feeling about abortion and same-sex marriage in Ireland, which paved the way for a successful referendum in favour of repealing the eighth amendment to the Irish constitution.

    Linda Doyle, coordinator of the citizens’ assembly working group for Extinction Rebellion, became interested in the idea of citizens’ assemblies when a friend took part in one in her native Ireland. “Citizens’ assemblies are well known there now,” she tells me in an interview, “They’ve played a big role on the political scene.”

    Although they’re not yet well known in the UK, the idea of using a citizen’s assembly to unravel environmental problems isn’t new.

    In the early 1990s, Texas installed a huge amount of renewable energy after deliberative polls conducted by utility companies found that the public were in support of the idea.

    Ireland also held a citizens’ assembly on climate change in 2017, which concluded that the state must take a lead role on mitigation. It recommended that government prioritise public transport spending over new roads, tax greenhouse gas emissions from agriculture and stop subsidising peat extraction. Strikingly, 80% of participants said they would be willing to pay higher taxes on carbon-intensive activities.

    “When people hear it from their peers who say ‘we’re fucked’, that will be really powerful.”

    In 2009, the World Wide Views on Global Warming project gave thousands of people from across the world the chance to discuss climate change. The project, led by the Danish Board of Technology, is one of the largest experiments in deliberative democracy to date.

    Escobar says it was a problematic process (”they all are”), but the results eventually fed into the Paris Agreement on climate change in 2015. “Climate change is a global problem and what we have is a very nationalistic world setup,” he said. “Mini publics have been one of the few participatory models that have been thought of as adaptable to deal with global threats.”

    Escobar says citizens’ assemblies reorganise how voices in a debate are given space and heard. They would not exclude the views of climate change activists or conservationists or people who contest aspects of climate policy, he says, but they can help to filter out full-on climate denial. “With most issues in public policy you have a spectrum of debate, but in climate change naturally there is a scientific consensus and if you are to try and represent sceptical views it will be problematic because it cannot be proportional to the other side.”

    Those arguments still have to make their way into the assembly so they can be scrutinised and refuted, but “it could be one of the mechanisms that helps to displace the current state of affairs in terms of current actors and policy priorities and power plays, and create a space where people need to justify their positions more clearly.”

    Allen is also optimistic: “I think it’s possibly the one thing that can happen now that would make the most difference in pushing forward the climate agenda.”

    She says a citizens’ assembly would give politicians much better information about what people’s actual preferences are and what tradeoffs they’d make. “One of the reasons that politicians aren’t moving forward is because they’re worried about public backlash on, for example, wind farms. But if you can get people in the room and ask how you think targets should be met and here are your realistic options, they have got to choose one. Participants can’t say ‘we’d like more, higher quality services but we’re not prepared to pay for them.’”

    They are invaluable for getting the public on board too and securing more consensus. “With climate change, we have to sacrifice some aspects of our current lifestyles,” Doyle says, “and nobody wants to hear politicians telling them because we’ve had it before; it’s not as if austerity was applied across all echelons of society equally. We really believe that to get the public on board with this it would be useful to have a citizens’ assembly, because when people hear it from their peers, from someone like a single mother, a farmer, who says ‘we’re fucked, we’re really afraid’, that will be really powerful.”

    Participants also benefit. Escobar says that people who have taken part nearly always find it satisfying and come out of the process both exhausted and delighted. “They have a strong sense of having done a civic duty on behalf of others and they’re exhausted because very rarely people get to get exposed so systematically to evidence and arguments - it’s very intense.”

    But there is a flip side: some people, particularly those who haven’t taken part in public processes before, suddenly discover how simplistic public and media discourse actually is. “There is a long debate about whether this means people are more likely to participate and become more active citizens,” says Escobar. “The theory is that the more people participate the more we develop our civic muscle and democracy enters this virtuous cycle. But that assumes that these opportunities are readily available when these are still instances of extraordinary rather than ordinary democracy. So when these citizens’ go back to their realities…expecting some carefully crafted engagement they are disappointed.”

    He warns that mini-publics have to be seen as part of the wider democratic system, “otherwise they’re quite problematic because they’re exclusive to those that have been selected.” “We shouldn’t think of them as isolated bodies, we should think of them as a stage in a broader process which might also include referendums, more standard policymaking, [and] further committee action.”

    “This is democracy: people come out of it feeling invigorated, feeling great and quite empowered by the process and the fact that they’re really having a say."

    Allen describes citizen’s assemblies as plugging a democratic gap. “When an issue is complicated like climate change and has become politically stuck, the best way to unblock it and make a decision on the future of the country is a citizens’ assembly because it’s a representative sample of the population; people get to learn about the issue first and discuss it with one another and get to a detailed and nuanced position. You can’t do that with the other democratic tools we have,” so they.

    They can also be used to kick-start wider participation. In Canada for example, citizens’ assemblies supported participants to go back to their communities and run town hall meetings to engage more people about the issues. “They are not party-political events,” says Escobar, “not dominated by power or money or partisan logic. It is about reason, evidence, arguments, perspectives and different forms of knowledge - local, technical, scientific, even emotional.” He notes that the results of the Irish abortion referendum showed that the citizens’ assembly was more reflective of actual public views than parliament itself.

    The idea is gaining traction in the UK. In April, Oxford City Council became the first local authority to promise a citizens’ assembly on climate change, three months after formally declaring a climate emergency. More recently Extinction Rebellion representatives met with Mayor of London Sadiq Khan and environmental secretary Michael Gove, who promised to follow up on the idea.

    Doyle is cautiously optimistic and stresses how citizens’ assemblies can shift power back to the public. “This is democracy: people come out of it feeling invigorated, feeling great and quite empowered by the process and the fact that they’re really having a say. This really brings the human element to political discussion.”

    This article was originally published on Open Democracy and was written by Isabella Kaminski. You can read the original article here.

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  • India’s cyclone Fani recovery offers the world lessons in disaster preparedness

    Solutions

    Fani, a rare summer cyclone in the Bay of Bengal, hit eastern India on May 3. It is one of the strongest cyclones to have hit India in the last 20 years, according to the Indian government’s meteorological department. Storm surges and powerful winds reaching 125mph blew off roofs, damaged power lines and uprooted countless trees.

    But the worst-affected state, Odisha, has been successful in keeping the loss of life and numbers of affected people to a minimum. This is the result of a very effective strategy of disaster preparation and quick responding.

    The United Nations office for Disaster Risk Deduction (UNISDR) and other organisations have hailed government and volunteer efforts that have ensured the levels of destruction have been kept to a minimum. According to official estimates, 64 people lost their lives due to the devastating cyclone Fani. But considering the power of the cyclone, it is remarkable that more lives have not been lost.

    To put the death toll in perspective, the 1999 Odisha cyclone (which had 155mph winds) killed 9,658 people and caused US$2.5 billion in damages in the state. It was this super cyclone in 1999 that led the state to become better prepared for future cyclones.

    The government’s “zero casualty” policy for natural disasters and the near accuracy of the India meteorological department’s early warning system have helped reduce the possibility of deaths from cyclone Fani. A record 1.2m people (equal to the population of Mauritius) were evacuated in less than 48 hours, and almost 7,000 kitchens, catering to 9,000 shelters, were made functional overnight. This mammoth exercise involved more than 45,000 volunteers.

    The statistics are striking when compared to the impact of recent big weather events around the world. When Hurricane Maria hit Puerto Rico in 2017 with wind speeds of 175mph, it caused a death toll of 2,975. The same year, Hurricane Harvey struck Texas with winds of 130mph and caused devastating flooding. There was US$125 billion in damage and at least 68 direct storm-related deaths reported in Texas. Most recently, cyclone Idai hit Mozambique on March 14 and ripped through Madagascar, Malawi and Zimbabwe, with more than 1,000 people feared dead.

    So the Indian state of Odisha’s ability to put such an effective disaster management plan in place and save thousands of lives is a template that the world can learn from. This, after all, is a state where the average income is less than US$5 a day. We identify four key takeaways from Odisha.

    1. Build a relief infrastructure

    Until 1999, Odisha didn’t have a well laid out plan for disaster management. Two months after the cyclone hit, the Odisha State Disaster Management Authority was set up and plans put in place. Around 900 cyclone shelters have been built in vulnerable pockets of the state, with systems in place for the evacuation of hundreds of thousands of people. By 2001, Odisha Disaster Rapid Action Force was also set up to conduct rescue operations and distribute relief.

    There is a clear command and control structure for disaster relief and there are clear protocols in place for carrying out relief operations. These were successfully used in managing cyclone Phailin in 2013 (a storm five times the size of hurricane Katrina), cyclone Hudhud in 2014 and cyclone Fani.

    2. Accuracy of early warning systems

    The India Meteorological Department has built an effective service to predict accurate timings of cyclone formation in the Bay of Bengal and when it will make landfall along India’s coastline. This early warning system enables the state to be disaster ready and minimise loss of lives. It’s then crucial that people follow the protocols in place when the warnings come in.

    3. Clear communication plan

    Roughly 2.6m text messages were sent to locals in clear language before cyclone Fani hit, keeping those potentially affected alert. Regular press briefings were made by officials to update people of the approaching cyclone. People were repeatedly advised over all forms of media not to panic and given clear “do and don’ts”. This helped in the record evacuation of 1.2m people to safe buildings.

    4. Effective co-ordination of groups

    Preparations to fight the onslaught of Fani involved a number of government agencies, as well as local community groups and volunteers working together. The government’s disaster response forces were pre-positioned in vulnerable locations, food packets for air-dropping were made ready for air force helicopters to drop to people. Senior state officials and police officers were sent to the affected districts to co-ordinate efforts of various agencies.

    Cyclone Fani has, however, left a fury of damage to properties and public infrastructure. The post-cyclone recovery will be a daunting challenge to the administration in Odisha, demanding a lot of resources. In the aftermath of the 1999 super cyclone, the state relied on a number of community-based groups and volunteers to help rebuild communities. The same goes for today, but they are in a much better position thanks to the disaster preparedness and risk mitigation followed before the storm hit.

    This article is republished from The Conversation under a Creative Commons license. It's written by Manoj Dora, Reader in Operations & Supply Chain Management at Brunel University London and Arabinda Kumar Padhee, Director of Country Relations and Business Affairs at New Delhi, ICRISAT, CGIAR System Organization. You can read the original article here.

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  • Young activists assemble to discuss the state of the world and how to save it

    Solutions

    When policy consultant Vandita Morarka co-founded a social reform initiative to work around marginalized communities including slum-dwellers and street children in India six years ago, she was stunned at the lack of youth leadership to address crucial developmental issues in Asia's third-largest economy, India.

    Now, six-years-later, Morarka runs a feminist youth leadership organization 'One Future Collective' from India's financial capital, Mumbai and mentors other youth leaders to run programs around South Asian feminist literature, a queer resource center and a mental health awareness initiative.

    "OFC is based on the idea that there is transformative power in each person that can lead to larger societal transformation. We zeroed in on a couple of thematic areas which was gender, mental health, legal reform, and policy and we felt that many issues were not addressed by other organisations," 24-year-old Morarka, a policy consultant and lawyer said.

    Morarka is not alone. Around 80 youth leaders from across 45 countries and working in civil society spaces including gender-based violence, mental health, inclusivity, and LGBTQ issues joined hands for a two-day 'Youth Assembly' in Serbia's Novi Sad. The sessions involved sharing lived experiences and fighting against abuses in oppressed regimes, and creating a thematic framework to address crucial human rights issues in the global south.

    "[T]here is transformative power in each person that can lead to larger societal transformation."

    The event that preceded the 'International Civil Society Week' held in Belgrade, Serbia in April held engaging discussions on the state of civil society globally. Issues pertaining to human rights violations in India-administered Kashmir, Palestine, and censorship and threats in various parts of the world to activism and journalistic work were highlighted.

    For Renata Thakurdyal from Madagascar, conducting workshops around sexual health for school children and dismantling the country's 'taboo' outlook on sexual health and reproductive rights is crucial.

    Thakurdyal is a program development officer at Madagascar's 'Projet Jenue Leader' that runs sexual health and leadership classes in schools across Madagascar who believes that creating conversations among youngsters is the only way to sensitise them.

    "Educators work in pairs of a male and a female teacher. Male educators talk about the menstrual cycle, showing the entire class how to put on a pad and the importance of menstrual hygiene. The female educator could also do it but the role reversal takes away the stigma and there's a transformation in students," Thakurdyal adds.

    In Madagascar's Malagasy language, menstruation is referred to as 'taboo part of the month’, highlighting how little awareness on menstrual hygiene, access to healthcare or generally on the topic there is.

    "Both boys and girls need to know about sexual health and a culture of open information is very transformative. Talking about sexual health is taboo in Madagascar and teachers often end up inserting their own opinions or ideas," Thakurdyal adds.

    The youth assembly was hosted by Johannesburg-based civil society alliance CIVICUS and brought together more than 850 delegates from around the world including Morarka and Thakurdyal to join the discussions on how to build movements for change.

    Armed with posters and drawing broads, Amanda Segnini, a Brazilian climate justice activist and founder of non-governmental organization Engajamundo holds discussions on how political situations have resulted in the killing of a record number of human rights defenders worldwide.

    "In the Amazon rainforest, we run a project with Brazilian youth and build leadership around climate justice to enable community leaders to protect their local eco-systems. We have around 100 young people as part of the pilot project from different traditional communities," Segnini, co-founder of Engajamundo said.

    Regarding threats faced by activists due to the dangerous political situation in Brazil and elsewhere in Latin America, she adds Brazil has killed the biggest number of human rights defenders and most of the vulnerable communities in the country are under threat due to climate change.

    According to Soledat Kenzhebulatova and other ICSW organizers, Segnini, Morarka, and Thakurdyal represent a growing movement of youth activists fighting for the defense of civil and gender liberties and seeking government action on important issues including climate justice, sustainable development, and gender equality.

    "I can see the transformative power of bringing youths together at this summit as decision-makers. This is no longer lip-service. This is about giving youngsters the power to enable change."

    "We work with young lesbian, gay, intersex, bisexual, queer, gender non-conforming and othered individuals who have shared experiences of systematic discrimination, hate, and violence. Our work focuses on vulnerabilities. It is clear that in the context of citizenship some freedoms are exclusive to certain demographics only," Gatsha, one of CIVICUS 26 accelerator program goalkeepers said.

    Meanwhile, for 39-year-old Nyaradzo Mashayamombe, Zimbabwe's record on women’s rights and gender-based violence against young girls and children led her to establish Tag a Life International Trust (TaLI) after facing persecution growing up in a marginalized community.

    "We engage with leaders locally, nationally and through regional and international platforms to advocate and advance the rights of girls. We have a flagship young women's Leadership Programme designed to raise young women as young leaders in their communities where they are trained about their own self-awareness," Mashayamombe said.

    Speaking about the recent internet shutdowns due to fuel price hikes and reports of sexual assault allegedly carried out by government officials, Mashayamombe said human rights defenders had to play it low-key and as women human rights defenders were forced to protect themselves amid government crackdowns, advocacy spaces shrunk completely.

    "We need to ensure that women have an access to platforms where they can easily report cases of rape without fearing for their lives and that women human rights defenders themselves are able to assist victims without feeling vulnerable and constrained to help," she added.

    Most of the youth leaders, including Gatsha and Morarka, echoed similar sentiments on the need for more spaces for youngsters where they can engage besides the ‘tokenism and symbolism that is not meaningful’ in terms of grassroots impact.

    "I can see the transformative power of bringing youths together at this summit as decision-makers. This is no longer lip-service. This is about giving youngsters the power to enable change," Morarka concludes.

    This article was originally published on Open Democracy and was written by Vishal Manve. You can read the original article here.

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