Peers Helping Peers With Mental Health

In Zimbabwe, teens and young adults have an unusual place to go for help coping with depression and anxiety. Called the Friendship Bench, it’s a spot where they can meet a peer who is trained to offer support. 

“The bench is available in different primary care clinics where youth can speak to someone trained on this intervention or to other young people called ‘Bench Buddies,’” said Primrose Nyamayaro, Ph.D., the program manager for African Youth in Mind, which created the project. “The intervention is provided over a period of six weeks.” 

The benches are an example of a promising approach to provide adolescents across Africa with wider access to mental health services. To compensate for shortages of trained specialists, several pilot projects are training non-specialist peers to provide guided interventions for mental health issues like depression and substance use. 

Nyamayaro and other experts working in African countries described the projects in a Think Global event on Feb. 20 at the Duke Global Health Institute. The event was organized and co-sponsored by the Duke Center for Global Mental Health, which was launched this month to advance global mental health research and training. 

Fifteen percent of adolescents across the globe have a mental health disorder, according to a 2021 report from the World Health Organization. But the number of providers with specialized training in mental health falls well short of that demand. In some African countries, there is not even one trained specialist for every million residents, noted Eve Puffer, Ph.D., director of the new center.  

“We have an enormous unmet need and disparities between those that have access to care and those who don’t,” said Puffer, a DGHI associate professor who served as the event moderator. “Closing this treatment gap is an enormous job. One of the essential pieces to this is creative solutions to deliver and sustain programs at scale.” 

During the discussion, the panelists noted the link between mental health and other health issues, such as the stigma faced by adolescents living with HIV. Dorothy Dow, M.D., an associate professor of pediatric infectious diseases with Duke and DGHI, saw this when she went to Tanzania in 2011 to lead research on the health of adolescents with HIV.   Dow shared the story of one young woman she met who felt her HIV status denied her the chance to marry, have a family and be happy.

Dow said patients felt that “if things aren’t possible, why would you take your medicine? We set out to address this depression and loss of hope. If we can improve mental health, we can improve adherence and [other] outcomes.” 

Dow co-developed Sauti ya Vijna (The Voice of Youth), a program where peer mentors living with HIV lead sessions to improve life and coping skills. Participants learned how to live with their diagnosis and accept it. As a result, they adhered more to antiretroviral treatment. The interest from peer leaders has been so strong, Dow noted, that many want to keep serving even when they age out of the program. 

Florence Jaguga, MBChB, has seen similar interest at Moi Teaching and Referral Hospital in Eldoret, Kenya, where she leads the Alcohol and Drug Abuse Rehabilitation Services Department. Adolescent peer leaders in the program aid young patients in counseling, helping them navigate substance abuse harms and relationship problems. 

“Peers like talking to their peers because they understand them better,” said Jaguga, noting that 44 percent of youth in the country experience mental health problems. “Overtime, we hope to develop a curriculum with detailed training that can make this more structured.”

Near the end of the discussion, Puffer asked the panel to identify the top priorities in adolescent mental health, noting the high rates of suicide among adolescents. Dow suggested partnering with schools as a way to find more students who need care. Jaguga said healthcare systems need to provide resources specifically for teenagers because “their needs are unique.”

All agreed that promising peer-led programs need more resources and cooperation from all levels of government to grow in scale and impact.  

“For scale up, you have to work with people,” Jaguga said. “It’s a slow process, but it’s needed. You have to bring everyone to the table. I found overtime, you can’t work as an island. You have to think about collaboration from the beginning.”