Treating the Global Depression Epidemic.

May 21, 2024

An innovation in GIF’s portfolio which provides life-changing mental health services to low-income African women and adolescents suffering from depression has doubled its reach in 12 months.

StrongMinds treated a record-breaking 239,672 people in 2023, delivering facilitator and peer-led Group Interpersonal Therapy (IPT-G) courses over 10 to 12 weeks. With GIF’s grant of US$1.6m, StrongMinds is significantly increasing its reach through partnerships with civil society organisations and governments in Zambia and Uganda, as well as refining its IPT-G approach.

StrongMinds’ continued success in scaling its approach offers key lessons in providing mental health care in the developing world.

Why depression is a sustainable development issue

Depression is a common mood disorder that affects the mind and body. It can affect anyone, regardless of age, gender, religion or socio-economic status. Globally, 280 million people
experience depression disorders, with women are twice as likely to be affected than men. 

When individuals enjoy good mental health, they are better equipped to handle the daily stresses of life, realise their potential and contribute positively to their communities. Yet only .03% of global development aid for health goes towards mental health services.

Consider how depression directly impacts economic advancement. Symptoms of depression such as persistent sadness, fatigue, and cognitive impairments can lead to decreased work performance, increased absenteeism and a higher likelihood of disability leave. Depression can also lead to interrupted or restricted education, leading to limited employment opportunities, perpetuating poverty cycles.

Good mental health is also a protective factor that can lower the risk of HIV infection. 70% of global HIV cases are in sub-Saharan Africa, and three in four new HIV infections occur there, with adolescent girls particularly at risk. Providing mental health services to people living with HIV can increase adherence to antiretroviral therapy (ART)resulting in overall improved health and quality of life.

Innovating to provide a cheaper, effective treatment model

In Africa, there are only 1.3 qualified mental healthcare providers per 100,000 people, compared to 45.5 qualified mental healthcare providers per 100,000 people in Europe. Up to 85% of people in low-income countries have no access to treatment at all.  IPT-G is well-respected as a treatment method for depression: in fact, The World Health Organization has recommended IPT-G as a first-line treatment in resource-poor settings. 

Sean Mayberry, Founder and CEO of StrongMinds, came across the findings of a randomised controlled trial in Uganda from 2002 that had remarkable success in treating depression with group interpersonal psychotherapy (IPT-G). The study, by researchers from Johns Hopkins University and Columbia University, used lay community workers with a high school education. The results were overwhelmingly positive, with more than two-thirds of the women remaining depression-free well beyond the conclusion of formal therapy groups and reporting improvements in their economic and social lives.

Inspired by this initial study, in 2013 StrongMinds adapted the model to treat underserved women and adolescents with depression in Uganda, and later in Zambia. It has enhanced IPT-G with role-playing activities, interactive charts and visual aids, adapted to the cultures and literacy levels of their participants. 

StrongMinds approach shows that group-orientated community-led care can be just as successful, and far more cost efficient, when compared to expert-led individual therapy.

It also increased its efficiency in 2023, with cost-per-person hitting a historic low of US$40. This means it can operate even in very low resource areas. The programme delivers impressive healing rates of 71% to 95%.

When communities have greater impact than experts

Lack of access to expert-led therapy was once seen as one of the challenges of treating depression in the developing world. However, StrongMinds proves that not only can community-led care work, but it has other benefits above expert-led care.

The programme demonstrates that therapy can see high healing rates even when facilitators have very little, or no, formal education.

The benefits community led care can bring are significant. As well as cost, facilitators have local knowledge allowing them to adjust the therapy to suit the participants. Group therapy brings together people who have similar experiences, who understand what they are going through – which is particularly valuable in cases such as natural disasters.

One powerful case study involves Susan who became depressed after Eastern Uganda’s Mbale District was hit by a catastrophic flood, leaving a trail of ruin and destruction. Susan lost her home; her husband lost his work, and their children were forced to leave their private school due to a lack of income and shelter. Is it any surprise she felt overwhelmed and struggled to cope?

A volunteer recommended Susan for the StrongMinds programme, which would become her lifeline.

“I connected with other people who had experienced similar losses and who understood what I was going through. I learned how to manage my stress and take care of my mental health during such a difficult time,” she says. 

Beyond emotional support, the group offered practical advice on rebuilding her life after the floods, suggested that she start brickmaking, as she had land that could be used for it. Embracing the suggestion, Susan and her family embarked on this new journey, generating income and using the bricks they crafted to construct a new home.

StrongMinds has become embedded into the communities it serves, offering unexpected benefits and making care more effective.