tirsdag den 26. februar 2019

Everyone, everywhere should have someone to turn to in support of their mental health

In Zimbabwe, the term for depression is “kufungisisa”, which translates to “thinking too much.” Like many low-income countries, Zimbabwe is ill-equipped to care for its citizens suffering from mental illness. The country of roughly 16.5 million currently has about 12 trained psychiatrists.

One of those psychiatrists, Dr. Dixon Chibanda has been on a mission to narrow this treatment gap ever since one of his young patients, who didn´t have the $ 15 bus fare to travel to a scheduled evaluation, hanged herself from a tree.

Source: https://www.friendshipbenchzimbabwe.org/factsandfigures

In 2007, Chibanda seized on the idea of creating an informal system of therapists from the community. ”It suddenly dawned on me that one of the most reliable resources we have in Africa is grandmothers, “ he says.

Chibanda´s organization, Friendship Bench, now trains hundreds of Zimbabwean grandmothers in problem-solving therapy, role-playing and behaviour activation. Their therapy sessions take place outside, on wooden seats known as Friendship Benches.

Source: https://www.friendshipbenchzimbabwe.org/#!

Grandmothers, Chibanda says, are often best equipped to provide care because they listen and guide their charges toward a solution, unlike other members of the community who tend to direct their patients what to do.

Source: https://www.friendshipbenchzimbabwe.org/factsandfigures

A representative of The Friendship Benches has mailed me this very relevant correction to the description above:

"One thing that repeatedly gets misrepresented in the media is that this is of course not Dixon Chibanda’s work alone.

As much as we tell journalists the real story, they still choose to write whatever they want (and what they think their readers want to read).

We are a team and without the team, the Bench would not be anywhere near where it is now. Some of us have been working with Friendship Bench since its beginning.

And what is really important too is that there is a peer led group support that follows the problem solving therapy on the bench.

That is where Zeebags are being made as an income generation component which is really important in this very difficult economic situation.

If you want, you could just send us any question that you might have and we can answer them and then you would be one of the people whose website actually reflects what is really happening on the ground!

Thanks,

Ruth

Dr. Ruth Verhey PhD

Consultant Clinical Psychologist

Friendship Bench

www.friendshipbenchzimbabwe.org "

The Friendship Benches are now expanding to four countries in Southern Africa and even making their way to New York City. In January he brought a Friendship Bench to Davos, Switzerland as part of an effort to address depression, an escalating problem that destroys lives and costs the global economy trillions of dollars.

Source: https://www.devex.com/news/mental-health-in-the-spotlight-at-davos-94183

“My dream is to take this to scale” Chibanda says. “With something simple, we make a difference in the world”

Quote from an article by Eben Shapiro in Time, February 18, 2019: A humble solution to global depression.

Source: https://www.bbc.com/news/world-africa-35597558

Deepening based on Source: Table 1 in

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Description of the problem solving therapy intervention

Delivering agent

Lay health workers (Health promoters). Mean age 58, all female, mean years of education 8, …

Structure of intervention

Six weekly sessions of 30–45 min delivered through the Friendship Bench over 6 weeks, including home visits where deemed necessary. The first session lasting between 45 and 60 min

Structure of sessions and areas covered

Part 1.

Problem identification (Kuvhura pfungwa):

(A) Share Shona Symptom Questionnaire (SSQ) information with client, explain symptoms in relation to kufungisisa,

(B) Actively listen to clients story, identify and list problems raised, clearly define problem/s.

Problem exploration (kusimudzira):

(D) brainstorm practical/feasible solutions, outline the options available (these have to come from client), encourage client to think over solutions of each problem before having the client decide which one to focus on. Help client to come up with a specific, measurable, achievable and realistic solution (don’t tell client what to do). Agree what the client will do before you next meet and set appointment date

Part 2.

Reassure (Kusimbisa)

(E) Home visit if needed before second meeting, otherwise see again on the bench, how did it go? Went well, then reassure praise encourage. If no progress or new obstacles present then go back to Part 1 contents, redefine problem and goals, what were the obstacles? Problem solve around obstacles and give homework again and reassure, you can phone or send SMS to reassure client (up to 6 per client).

Part 3 (kusimbisisa).

(F) Summarise session 1, how did it go? Going well then reassure and encourage. Still having problems with agreed plan? Go back to Part 1 again or if you feel frustrated go to supervisor

Remember

Action plan:

(G) Zero in on a specific solution, focus on what client wants to do and not what you think should be done,

(H) How, when, what assistance is needed? Referral if necessary

(I). Identify activities the person used to find rewarding and which matter to them and encourage these

(J), Implementation:

(K) How will it be done? Motivate; homework, Refer after 4th session to support group.

Follow up:

(L) What has been achieved? What were/are the obstacles if any? Go back to Part 1 as often as needed during the 6 sessions

(M) Reinforce. What has been achieved, repeat SSQ score.

(N) No improvement refer to supervisor. Nurse counsellor

Supervision

Weekly group supervision by a clinician (Psychologist) or senior study team member trained in PST. Access to direct mobile voice call to support team

Is the answer a doughnut model when the issue is...

What does it take to create a sustainable future?

Here are the major issues: Global warming, environmental problems and poverty issues must be solved.

Climate Issues

The super-short version: Due to unprecedented greenhouse gas emission levels have soared (CO2 and others). The increased greenhouse gases in the atmosphere prevent infrared radiation from escaping to the same extent as before. This causes the temperature of the globe to rise and it will change the climate dramatically if the temperature rise does not come under control.

Solutions must be found in answer to the question: How do we get this man-made global warming slowed down by greatly reducing greenhouse gas emissions?

Environmental problems

The super-short version: There are limits to how much impacts of human activity that each global environmental process on Earth can withstand. By "limit" is meant a point on a scale that researchers have estimated that cannot be exceeded without damage. This means damage that cannot be rectified.

Source: https://www.stockholmresilience.org/research/planetary-boundaries/planetary-boundaries/about-the-research/the-nine-planetary-boundaries.html

Two planetary boundaries have already been exceeded: biosphere integrity (diversity in nature) and the field of biogeochemical flows (especially nitrogen cycle) (Source: Rockström J, et al. (2009): A Safe Operating Space for Humanity. Nature's Journal)

The other planetary boundaries are becoming increasingly threatened.

Solutions must be found in answer to the question: How do we rearrange production, consumption and living so we stay within these limits and restore the conditions where they are severely threatened or already exceeded?

Poverty Problems

The super-short version: The problems can be described by the numbers "1", "1.5", "2" and "2.5".

- Right now there are 1 billion people on this planet that belong to the middle class or higher.

- There are 1.5 billion people in the middle class. They came to towns around 15 years ago and are now taking part in economic development. They have established themselves with fairly stable income, but they feel threatened by globalization and technological change.

- There are 2 billion people who have recently moved to cities. They do not own anything.

- The last 2.5 billion people on this planet are the poor in the countrysides who live from hand to mouth of agriculture and other professions that are almost not part of the global economy. If climate change exacerbates their conditions, they must migrate or die. (T. Friedman (2016): Thank you for being late: An Optimist´s Guide to Thriving in the Age of Accelerations)

Solutions must be found in answer to the question: How can we create growth, stability and social inclusion for the billions of people who are in an uncertain economic situation or at the bottom of the economic pyramid?

In the book “Doughnut Economics”, Kate Raworth states that growth must serve specific purposes: production is a means, not a goal. Her doughnut model focuses on an inner circle and an outer circle where the inner circle is the social foundation of existence, which is the purpose of the economic activity: water, food, housing, education and the like. The outer circle is the physical limits of our economic activity: climate change, pollution, loss of biodiversity, etc.

The outer circle is the limits that must not be exceeded because they form a kind of organic ceiling. The green area in the model is the area where our human activities and economic development can take place safely.

The problems are very complex, but there are also worldwide efforts to do something. The climate agreement in Paris and United Nation's 2030 Goals, called the Sustainable Development Goals, are the international community's attempt to solve these problems by efforts from governments, businesses, and all of us in civil society.

As we find that ice glaciers melt without us being able to recover the loss, then it is a fact that we cannot avoid all the consequences. But we can - as global citizens - try to limit the damages and eradicate the worst poverty.

A doughnut solves nothing, but the doughnut model helps us to keep focus on the interconnected problems, and (consequently) the interconnected problem solving!

………………………………………………….

The solutions are in Focus in UN`s sustainable Development Goals.

No 1 is: No Poverty. No. 13 is: Climate Action. No 15 & 16 have focus on life below water & life on land … but all the other goals focus on interconnected problems and problem-solving.

Teach GLOBAL CITIZENSHIP 2

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tirsdag den 26. februar 2019

Everyone, everywhere should have someone to turn to in support of their mental health

tirsdag den 18. december 2018

Is the answer a doughnut model when the issue is...

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