Verified by 
The 10th of October was World Mental Health Day. The objective of World Mental Health Day is to raise awareness of mental health issues internationally and encourage support for mental health through awareness, advocacy and initiatives that challenge social stigma associated with mental illness. While I have been part of an initiative addressing mental illness in Sub-Saharan Africa (see Let's Unite for Mental Health) I wish to highlight the role of NGOs in addressing the mental health needs of people in low-income countries drawing upon a range of perspectives (or paradigms).
The aim of my blog is to showcase examples of good practice, demonstrate what can be achieved, and promote awareness of initiatives that have the capacity to influence and strengthen mental health in low-resource environments. These initiatives may be the result of work undertaken by individuals or organizations. The aim is to raise awareness of innovative, appropriate, affordable initiatives which promote mental health and/or address substance abuse irrespective of the socio-economic status of the population.
In this post, I wish to highlight an initiative by Sean Mayberry, who founded an NGO, StrongMinds, in 2013. Sean is a former diplomat and social marketer. His organisation focuses on women who are suffering from depression. The rationale for his approach is that improving the mental health of women in Africa will have a broader impact on the larger community. I will follow this post with further examples of NGOs addressing mental health within a global context.
Robert: Why did you found StrongMinds and take it in the direction you have?
Sean: In recent years, we have seen NGOs, governments, and the private sector conclude that good mental health is the foundation of thriving individuals, families, and communities. Ten years ago, when I founded StrongMinds with the mission of scaling access to depression treatment for women in sub-Saharan Africa, the situation was very different. Institutions, donors, and policymakers believed that—on the long list of global investment priorities—mental health was a nice-to-to-have, not a need-to-have.
In 2018, the Lancet Commission on Global Mental Health issued a call for collective action to align mental health with the Sustainable Development Goals (SDGs), recognizing that mental health and development are intrinsically linked. The report called for broader mental health investments, including preventative care (especially for children and adolescents) and improved quality of care.
And yet, despite this and other calls to action, global investment in mental health has lagged far behind other initiatives. Mental health still accounts for less than one percent of public health expenditures in low- and middle-income countries (LMICs).
In 2022, The World Health Organization’s Global Mental Health Report affirmed the connection between mental health and all 17 of the sustainable development goals (SDG) and called for innovative, cost-effective solutions to comprehensively address mental health as part of global development. StrongMinds arose from these precursors with the purpose of addressing depression in Uganda and Zambia, and representing an exemplar of innovation in this area.
Robert: I am curious about your motivation to build an NGO addressing mental health in Africa, as you live in the USA.
Sean: I had spent many years working on public health initiatives in sub-Saharan Africa, where I had seen firsthand the stigma and abuse experienced by people with mental health disorders. I wanted to find a scalable solution to treat depression among low-income women lacking access to quality mental health services.
In 2013 I came across a Johns Hopkins University (JSU) study that had successfully treated depression in Ugandan women using group interpersonal psychotherapy (IPT-G)—otherwise known as “group talk therapy”—delivered by lay community health workers. I suspected that IPT-G was the scalable, evidence-based depression intervention I had been seeking.
We decided early on to focus our depression treatment on women because 1) women experience depression at higher rates than men, 2) when depression interferes with a woman’s ability to participate in family and community life, everyone around her feels the impact, especially her children. We believed that treating depression in just one woman would also improve the lives of her family members and dependents.
Robert: From a practical point of view, please tell me a little more about the implementation of this project.
Sean: With support from some forward-thinking donors, we ran two pilot projects in Uganda to try to replicate the JSU study results. Our results were extraordinarily encouraging: An astonishing 85% of the women who completed our pilot talk therapy groups—led by lay community health workers trained in IPT-G—were seen to recover from depression, as measured by changes in a Patient Health Questionnaire (Phq-9). The women in our first groups subsequently reported that, months after completing therapy, they were able to work more and provide their families with more regular meals. This is a remarkable and laudable outcome.
Robert: What impact has the project had?
Sean: Ten years later, lay workers, who are part of the initiative have treated more than 150,000 women and adolescents for depression in Uganda and Zambia. We work in schools and communities, and our eight-week therapy groups are available in-person and by phone. Over 80% of the individuals we treat are reported to be depression-free after therapy, and the results are sustained six months later.
Robert: How have you scaled the project through partnerships with others?
Sean: We noted that increasingly, global policymakers and institutions are calling for mental health integration into poverty, education, and healthcare initiatives. In addition, we have seen an increasing number of organizations seeking to acquire mental health expertise internally. We applaud these initiatives and collaborate where possible to scale our initiative.
Through partnerships between NGOs and government agencies we have sought to ensure that mental health is addressed comprehensively at multiple levels, such as primary healthcare settings, schools, and communities. When institutions cooperate across sectors, we shift the conversation about mental health. Stigma and misconceptions start to fade, and people who need help can better access mental health resources.
Robert: Do you engage in any research or evaluation of your services?
Sean: Research on mental health in Africa has been thin to date. However, we believe that prevalence studies of mental health disorders significantly undercount depression rates in sub-Saharan Africa. While official figures suggest that depression rates for adults hover around 5% in Africa, door-to-door screening by our own mobilizers in Uganda and Zambia see depression rates as high as 20-30%.
Research shows that mental health has a bidirectional relationship with many of the significant challenges facing the African continent. For example, mental health disorders such as depression can put people—particularly adolescent girls—at greater risk of HIV infection while inhibiting the ability of those living with HIV to adhere to treatment. Poverty, poor nutrition, and lack of education can exacerbate depression, while depression can also interfere with an individual’s ability to earn an income, achieve food security, or finish school. But when you treat depression in a single individual, the world around them starts to change. Our clients report that they are able to work more, send their kids to school more regularly, and feed their families more regular meals. Family well-being improves.
Robert: Thank you. Do you have any final comments?
Sean: No one organization can do this alone. We need cross-sectoral collaboration to fully assess the impact of mental health disorders—and conversely, promote mental health and human well-being in sub-Saharan Africa.
Comment
The Lancet Commission on global mental health and sustainable development set out to consider future directions for promoting mental health, including the reduction of treatment gaps as well as improving the mental health of whole populations through initiatives that are aimed at addressing population-wide interventions, prevention, and quality care. Sean Mayberry provides an exemplar of an initiative, started by the vision of one person, and scaled up to address the needs of people with application across the continent.
