Mental health conditions are among the leading causes of lost wellbeing worldwide, yet access to care remains out of reach for most people in low- and middle-income countries. Friendship Bench Zimbabwe has spent 20 years working on this problem in one of the most extreme cases: a country with only a handful of psychiatrists serving a population of millions.
One of our Top Charities, Friendship Bench is reimagining the delivery of evidence-based mental healthcare. We have interviewed them to give you a better sense of who they are and how they work.
Their answers reflect practitioner experience rather than formal research findings. These do not necessarily represent HLI’s views.
In your own words, what does Friendship Bench do?
“Friendship Bench is a community-driven mental health initiative that provides accessible, evidence-based talk therapy to people experiencing depression and anxiety. Instead of relying on hospitals or specialists, it brings care directly into communities by training local lay health workers (our grandmothers) to offer structured talk therapy on simple wooden benches outside clinics or in safe spaces within the community.
At its core, the Friendship Bench creates safe spaces where people can talk openly about their problems and begin to find practical solutions, making mental health care both approachable and culturally grounded.”
Zimbabwe has one of the lowest ratios of mental health professionals to population in the world. How has this context influenced how you work?
“Zimbabwe’s severe shortage of mental health professionals has been a key driver of innovation behind the Friendship Bench. With very few psychiatrists and psychologists available for a large population, traditional models of care simply could not meet demand.
In response, the model adopted a task-shifting approach which is training lay community members to deliver basic psychological support. This has allowed mental health services to reach far more people than would otherwise be possible. It has also encouraged the use of simple, structured therapies that are scalable, low-cost, and adaptable to resource-limited settings.”
You deliver therapy in communities, through people who aren't clinicians. What does that make possible? And what, on the other hand, does it make harder?
“Delivering therapy through trained community members opens up important possibilities. It expands access, especially for people who might never seek help in formal clinical settings. It also reduces stigma, as individuals are more likely to speak openly with someone they see as a peer or trusted elder rather than a distant professional. Additionally, it ensures the care provided is culturally relevant and rooted in local understanding.
However, this approach also comes with challenges. Lay health workers may not have the expertise to manage complex or severe mental health conditions, which makes strong supervision and referral systems essential. In addition, some individuals may initially question the credibility of non-professional therapists, even when the outcomes are strong.”
Problem-solving therapy is built around the central idea that the first session is itself a complete therapeutic act. What actually happens in that first conversation?
“The first session on the Friendship Bench is designed to be immediately impactful. Our grandmothers begin by listening deeply and empathetically, allowing individuals to share their stories in a safe and supportive space.
The session consists of three core elements:
Opening of the mind: The counsellor helps the individual feel safe to share their thoughts and identify the main problem affecting them.
Uplifting: The counsellor provides emotional support and encouragement to help the individual feel hopeful and less overwhelmed.
Strengthening: The counsellor works with the individual to develop simple, practical steps they can take to address their problems.
The key active ingredients include psychoeducation and problem-solving therapy, which involves active listening, expressed empathy, reflection, and summarising, as well as activity scheduling. By the end of the session, individuals typically leave with a clearer understanding of their situation and a sense of agency. A key part of the model is the option to join a support group (Circle Kubatana Tose) for continued support. These groups promote mental wellbeing through peer support, self-care practices, behaviour activation, and income-generating activities.”
Friendship Bench started 20 years ago. What is the biggest lesson you’ve learnt over the years?
“The most powerful lesson from the Friendship Bench is that effective mental health care does not always require highly specialized professionals or expensive systems. With the right training, supervision, and structure, ordinary people within a community can deliver meaningful psychological support.
Another key insight is the importance of empathy, cultural relevance, and human connection. When care is accessible, relatable, and rooted in local realities, people are far more likely to engage with it and benefit from it.
Ultimately, the Friendship Bench demonstrates that simple, scalable interventions can have profound impacts, offering a model of mental health care that is both pragmatic and deeply human.”
We thank Friendship Bench for their time and their thoughtful answers. To learn more about their work, you can read our evaluation. You can donate to Friendship Bench here.