A team of UK, Ghanaian, and Zimbabwean researchers is adapting a proven psychological therapy—the Friendship Bench—for depressed and anxious 15-to-24-year-olds in Ghana and Zimbabwe, testing whether non-specialists can deliver it in schools and clinics. This matters because depression and anxiety affect roughly one in five young people in these countries, yet an estimated 95% receive no treatment. Cost-effective therapies exist but are rarely available in low-income settings. The original Friendship Bench, designed for working adults, has shown it works in Zimbabwe; this project tailors it for youth and tests it in two different health systems. If successful, the research will give governments and NGOs a ready-to-use, low-cost intervention that can be scaled through existing school and community health services—without requiring psychiatrists or psychologists. In Zimbabwe, it aligns with a planned government pilot called “Catch Them Young”; in Ghana, it targets students in the free senior high school system. The robust pilot trial evidence could support adoption across other low- and middle-income countries facing similar unmet needs.
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Our multidisciplinary group of African and UK researchers will work with youth in Ghana and Zimbabwe to adapt and evaluate an intervention for youth aged 15 to 24 with depression or anxiety, which is suitable to be delivered through task-shifting to non-specialists. We will build research capacity by involving early and mid-career African researchers in this project, training them, and strengthening their institutions. Malawi is added for capacity building but not primary research. Depression and anxiety are common in youth, often beginning at age 15-24. They cause functional impairment and are key risk factors for self-harm. Cost-effective treatments exist but are rarely available in low and middle income countries (LMIC). We have shown the acceptability and effectiveness of an intervention called the Friendship Bench for working age adults in Zimbabwe. This comprises brief psychological therapy. We now wish to adapt this for youth. In Zimbabwe and Ghana there have been calls to develop youth mental health treatments, especially since the COVID-19 pandemic but also before. Our planned research responds to, and will align with, stated priorities and planned pilot activities being led by Ministries of Health and/or well-established non-governmental organisations (NGO) in each country. For instance, in Zimbabwe, this includes Ministry of Health policy to integrate mental health care into existing health and community services, to scale up the Friendship Bench at least for working age adults, and to a planned government pilot, called “Catch Them Young”, of screening and psychological first aid in schools. The Ghana Mental Health Authority is scaling up basic WHO mental health care training, and the NGO, BasicNeeds, is piloting mental health literacy training in nine schools. A Ghana government policy report has assigned “top priority” to training youth sector practitioners in mental health. Context-specific research in African countries is needed to inform practice and policy to address an estimated 95% unmet need for youth mental health treatment. In the Formative Phase we will apply a theory-informed participatory approach to adapt the intervention, and develop implementation strategies in Zimbabwe and Ghana. Based on country priorities and context, we will tailor the intervention in Ghana for those aged 15-18 enrolled in Ghana’s free senior high school system and in Zimbabwe for youth aged 15-24 in schools, colleges and community health settings including sexual health services. In the Implementation Phase, in Zimbabwe, we will run a single-arm study to test feasibility of implementing through community, health and education systems, and assess preliminary outcomes. In Ghana, we will conduct a two-arm cluster pilot trial in senior high schools in Navrongo to test the effectiveness, cost-effectiveness and implementation of our intervention compared to control. Within 4 years, our pioneering ambitious new group will have adapted a intervention, tailored to the needs of communities in Ghana and Zimbabwe, suitable for delivery by non-specialists, for government and NGOs to use. We will disseminate through our Community Engagement and Involvement, program providing youth and family-friendly materials, and through webinars and publications. Our robust pilot trial evidence will support generalisation to other LMIC.
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