Zimbabwe Friendship Bench

The Zimbabwe Friendship Bench is a grassroots mental health initiative that reimagines care delivery by training elders—“grandmothers”—to provide culturally resonant, evidence-based therapy in safe, public spaces. Born out of national trauma and a lack of mental health infrastructure, the initiative addresses depression, anxiety, and social isolation through talk therapy and peer-led support groups.

Grounded in the principles of Justice, Compassion, Multiple Ways of Knowing, Complexity, and Transformation, the program tackles systemic mental health issues linked to poverty, conflict, and HIV. With over 3,000 trained health workers across 70 communities, it has served 700,000+ people, reducing depression and suicidal ideation by 78%. It mainstreams community-led healing, blending local wisdom with cognitive behavioral therapy, and scales via a DIY toolkit, “Friendship Bench in a Box.”

Now active in the USA, El Salvador, UK, Malawi, Kenya, Zanzibar, and Vietnam, and expanding to other countries, it demonstrates how compassionate, culturally embedded responses can bridge treatment gaps and reshape global mental health care sustainably. This case study is part of ASRA’s Systemic Risk Response (SRR) Case Studies series—find out more in From Benches to Boardrooms: Responding to Systemic Risks.

Case Study: The Zimbabwe Friendship Bench

Overview: In 2005, Robert Mugabe’s government in Zimbabwe launched a cleanup operation called Murambatsvina, or “removing the filth”. Buildings deemed to be illegal were flattened. Over 700,000 people were left homeless, and more than two million were seriously psychologically affected, according to the United Nations. That was only one trauma in Zimbabwe’s long history of poverty, genocide, and disease, which has inflicted a vast psychological toll on its people (Effective Altruism, n.d.).

Dixon Chibanda started searching for interventions to address that epidemic in the wake of Operation Murambatsvina (Effective Altruism, n.d.). Public resources were scarce and many of Zimbabwe’s professionals had emigrated, so he began working with a group of 14 elders, known as “grandmothers”, delivering cognitive behavioral therapy (CBT) to traumatized community members. They found that offering psychological therapy on benches, in discreet outdoor spaces, yielded results. Hence, the Friendship Bench was born.

The NGO’s mission is to get people out of “kufungisisa”—depression and anxiety—by creating safe spaces and a sense of belonging. Anchored in over a decade of research, Friendship Bench has reimagined the delivery of evidence-based mental healthcare. It trains elders as community health workers and, after one-on-one talk therapy, introduces clients to a peer-led support group known as Circle Kubatana Tose (“holding hands together”), allowing them to form connections and talk openly. Importantly, Friendship Bench also creates revenue-generating opportunities, teaching clients to crochet sellable items out of plastic bags and old VHS tape ribbon (The Friendship Bench, n.d.).

Friendship Bench is an exemplary systemic risk response. Rooted in compassion and with a focus on vulnerable groups, its approach addresses systemic mental health issues which is both a consequence and a cause of systemic risk, while delivering multiple co-benefits such as increased income generation, improved mental health, as well as improvements in the health outcomes of those with diabetes and hypertension. Critically, it also shows a capacity to scale internationally, with the model now being applied in several other countries. 

Highlights in Systemic Risk Response

A systemic risk response encompasses any action that deliberately seeks to mitigate, prepare for, adapt to, and/or transform away from the harms of systemic risks. This case study demonstrates how compassionate, culturally embedded responses can reshape global mental health care sustainably.

Complexity

The Friendship Bench aims to tackle mental health problems arising from systemic risks in Zimbabwe, including poverty, genocide, and the HIV epidemic. Its grassroots approach, backed by peer-reviewed research, provides an effective, affordable, and sustainable solution to bridge the mental health treatment gap within a strained healthcare system. Tackling mental health brings a range of benefits from physical health (for example, those living with HIV who received the Friendship Bench were three times more likely to maintain HIV viral suppression compared to people who did not receive Friendship Bench services) to income generation (for example, a 2021 study found that 67% of women clients in Zimbabwe had maintained or expanded their income-generating projects) (PLOS Global Health, 2024; The Friendship Bench, n.d.).

Mainstreaming and Multiple Ways of Knowing

The Friendship Bench seeks out elders who are trusted in their communities, training them to provide basic CBT. The elders translate medical terms into words that resonate culturally. Using problem-solving therapy, they help clients identify stresses and social issues, and to find their own solutions. If the patient needs more intensive therapy, they are referred.

The approach is proven: a cluster randomized controlled trial, published in the Journal of the American Medical Association, showed that grandmothers were more effective at alleviating symptoms of depression and averting suicides than usual care delivered by nurses, psychologists, and medication.  

Featured Tool: 

Friendship Bench in a Box

Source: (The Friendship Bench, 2023, p. 9)

Friendship Bench in a Box is a do-it-yourself toolkit that brings together lessons from over ten years of the NGO’s experience, providing a step-by-step guide on how to introduce the methodology in a new setting. The toolkit allows for easy replication of the Friendship Bench anywhere in the world. In 2023, Friendship Bench in a Box was used to train the organization HelpingAge USA in Washington, D.C. The D.C. Grandparents for Mental Health program will provide mental health support to people in their communities.

Justice and Compassion

The Friendship Bench approach focuses on the rights of anyone regardless of age, gender, ethnicity, etc., providing access to mental health treatment, free at point of care, in underserved communities. After observing that not all young people were comfortable talking in a public space, the group developed a digital platform to deliver its services (Effective Altruism, n.d.). During the COVID-19 pandemic, it also offered remote-based services via WhatsApp.

Transformation

Friendship Bench’s services are now delivered in 70 communities in Zimbabwe, via 3,000 trained community health workers. Results show a significant impact on mental health. Since 2016, Friendship Bench has reached more than 700,000 clients, with a 78% reduction in depression and suicidal ideation, and a 60% improvement in quality of life.

Beginning as a grassroots movement, Friendship Bench has worked in partnership with Zimbabwe’s government since 2019 and is now in the process of handing over implementation to the government. Importantly, it has shown capacity to scale its methodology internationally, with projects now running in Malawi, Kenya, Zanzibar, Vietnam, the USA, and El Salvador.

Key Insights and Lessons Learned

Friendship Bench’s integration of Complex Thinking, Justice, Compassion, Multiple Ways of Knowing, and Transformation make it an exemplar of systemic risk response. Grounded in multiple ways of knowing, it not only redefines mental health by replacing stigmatized, specialized language with culturally resonant narratives but also transforms care through a community-based system that emerged in response to Zimbabwe’s lack of formal mental health infrastructure—an approach now recognized and supported by the government

For systemic risk response efforts, some key insights of note: 

1. Combine effective responses with other existing activities to scale up: Professor Chibanda stresses the importance of working with the government to support service delivery. “If you can get governments to integrate the model in the work that they are already doing in countries, it's more likely to be sustainable,” he explained (ASRA interview, November 2024). 
2. Building community goodwill is critical: Chibanda says: “Bringing the community onboard makes it easier for governments to jump onto the bandwagon, because governments don’t run countries; communities run countries. When you bring those communities together, they have such an influence.” 
3. Situate the response at the heart of the communities in need: Friendship Bench has made mental health services available in locations where historical traumas have left serious psychological scars. The initiative’s just and compassionate approach connects elders with patients in safe spaces within their communities. Its transformative potential is huge because it takes an affordable, sustainable approach to bridging the mental health treatment gap in primary care.
4. Make stakeholders aware of the systemic risks targeted by the response: Friendship Bench invests in raising awareness on mental health issues, boosting mental health literacy among healthcare workers dealing with divergent government systems (The Friendship Bench Annual Report 2023).