Strong Minds Interview

[00:00:00]

Hi and welcome to the Great Charities podcast. A podcast with a purpose of explaining what great organizations do in a way that is easy to understand. And today we are here with a special treat. And for me personally, I was so excited when this podcast got booked because today we’re here with organization Strong Minds that org a organization who provide group talk therapy to African women so they can alleviate their depression and lift themselves out of poverty. And I got to know about organization, strong minds months ago when I was speaking to a researcher at a foundation in the Netherlands. Her name is Vera. And she said, you have to check out this organization, strong mine. They might be the most effective organization out there when it comes to helping humans. It might be more effective than givewell. It might be more effective than giving out nets to prevent malaria. So I’m personally super curious to find out what is it exactly that is making strong-minded such a effective organization? And I’m here today with Sean Mabury, the founder of the organization. Yes, I’m the founder. And Gondar. And I got your name right. You did. Thank you. All right. So, Sean. What is making your organization so great?

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Well, let me tell you what it is that we do.

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I mean, we focus on depression in Africa, which many people don’t think is a problem. But it for depression in Africa is really the most debilitating and pervasive mental illness throughout all of Africa. It impacts and afflicts more than sixty six million women. And that’s really our focus. We use a community based model of group talk therapy to help women who are depressed, to overcome their current episode of depression and then to remain healthy for it for years to come, because we don’t use doctors or nurses who are in such short supply in Africa. We really think that our model is highly scalable, scalable in the sense that we can begin to reach the millions of women who are suffering with depression throughout Africa and who the world really forgets or never really knew existed. We’ve been in existence since 2014 and we treated over 70000 women and more than 80 percent of them have become depression free. And our work is incredibly gratifying and I’m excited to share it with you today.

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Well, so many questions already. So let me begin by how come you’re focusing on only women?

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So we focus on women because globally, not just in Africa. Depression affects women at twice the rate of men. So for us, you know, one of our many challenges is really trying to raise funds to support our work. And there are very, very limited funds for mental health in Africa. So we’re left with the choice of really maximizing every dollar that we spend. So for us, we choose to treat women because women are more commonly harmed by depression than a man. But then also there’s a big advantage in that in many African households, it’s really the woman who is the backbone of that household, which she is strong, that the family thrives when she is weak or suffering. In this case from depression, the entire family suffers. So by helping women, we’re helping not just the women to return to good mental health and to return to work, but we’re helping their children because that depressed mom, when she’s no longer depressed, can take better care of the entire family.

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You can imagine how much the most affect a society as a whole if a lot of mothers have this depression. So do you know why women are more affected by depression than men?

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That’s a great question. You know, if you were to Google that, there is no clear answer.

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There’s a lot of theories that it may be a biological or hormonal issue. There is no proven evidence to say why other than the fact that globally it is a recognized instance that women are affected twice as commonly as men.

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So. How does it work in your process? You said this is group therapy, therapy, therapy. So this is led by the women in the community and how how’s it working?

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Yeah. No. Let me let me explain to you. So we use group talk therapy, clinically speaking.

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It’s called group interpersonal psychotherapy. But that’s really what we’re doing is we’re running groups of women are groups can average in all sizes between 10 and 18, depending on how many leaders of the group. But we’re not using doctors or nurses. We’re able to train people in the community. So this these are African leaders of the groups helping their African female colleagues or neighbors to overcome depression. So we’re able to train these leaders to operate our groups. The groups come together generally about once a week for 12 weeks. And we’re really helping women to understand that they have a mental illness, in this case, depression. We’re helping them to kind of take it apart and understand what’s causing the depression, what we call the triggers, and what can they do to overcome those triggers and then to return to good mental health. I think an important thing to remember, Emile, is that we’re at least in Africa. There are the sixty six million women who suffer with depression, really have no access to care if they’re going to their local clinic or hospital. Most, if not all of those staff members are not trained in mental health, so they’re not able to address their depression. So we’re really providing that access in the community where the need exists.

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So someone that has looked into this problem more closely might think, OK, so people have depression, but there are also problems in Africa, like lack of water or lack of food or lack of medicine. How come depression can be such an effective way to improve people’s lives?

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Now, that’s a great question. You know, at the end of the day, most of the world today puts mental health in Africa at the bottom of the list.

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But I’m here today to tell you that it should be at the top of the list. And that’s not because I’m biased. It’s really just based on the information. So when an African woman, for example, is depressed and you want to teach her how to prevent malaria in our family or to help her to understand a new livelihood or when she should immunize her child. But if she’s depressed and in general, we’re seeing the instant or excuse me, the prevalence of depression up to 25 percent and African women, so roughly one in four that one in four of the women who is depressed, you can’t help her to understand malaria or how to take better care of her child, because depression is what we call a cognitive impairment. Right. It doesn’t allow that depressed person suffer to really think clearly. So for us, it’s about if you put mental health first on the list, you could help these sixty six million women to be stronger, take care of their family, and then respond to what we call it. All these other behavior changes help them to learn new skills, help them to take better care of their family. So that’s really the approach that we’re taking in terms of, you know, why mental health matters so much more than everything else when they’re when these women have strong mental health. Everything else becomes, in a sense, easier.

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And there’s going to be huge ripple effects as well. I guess I can only know from myself if someone in my family is feeling down. The whole family and everyone around them gets worried, takes up their energy, their mental capacities and vice versa. If someone in a family or community is really, really trying mentally, that would rub off and have ripple effects on everyone else surrounding that person.

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You’re absolutely right.

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And that’s really what you know, we work very hard to actually track those differences. You know, we’re not measuring just the change in the people who we treat, not just their depression status. But we’re really working to understand what is happening to their their their their family and the community. We know, for example, a meal that when a mom is no longer depressed, that the family improves in terms of better nutrition. We know the kids go back to school at a higher rate. Attendance improves. We also know that the moms are able to be more productive at work. So there is that ripple effect. And we really track that so that we can understand what’s the impact of our work.

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And also, just as part of our effort to really educate and help people in the community and our funders and stakeholders understand why treating depression is such a great investment.

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Soman advantages, and I can really see them in front of me, something I can’t really see in front of me, if someone who’s living in Sweden is what kind of challenges you are facing when you’re trying to provide these group theories. What is holding you back? What is in the culture or the environment or whatever is your biggest obstacle obstacles?

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Yeah, there are a lot of obstacles. You know, treating depression in Africa is not a walk in the park. As we say, one of the hardest things we have is really just finding these depressed women now. Now, we’re not maintaining infrastructure clinics. We’re out there running the groups in the community level where these women live. And we work with the most impoverished women, the poorest of the poor. So many of these women really are living in slums. So we’re out there in the slum communities running groups. The big challenge is how do we find these women? You know, typically depression in the countries where we’re working, Uganda and Zambia really manifests itself so that the depressive suffer is very reclusive. They’re withdrawn. It’s hard to find them. It’s hard to get the information to them that we’re there to treat depression. So that continues to be the hardest thing we’ve done since we started over seven years ago. How we’re solving that is by being in communities over the long term. Word of mouth. The awareness of our work gets out there. So while a depressive sufferer may not volunteer herself, hopefully she has a friend or a neighbor who can connect her to strong minds because they understand what depression is based on the information sharing that we’re doing in the community.

[00:10:11]

That’s the biggest challenge we have a male. I would tell you the other challenge is something I’ve already touched upon. It’s really just finding the funding, the resources for us so that we can treat more women. Now, we’ve treated over 70000 women since 2014 and we’re incredibly excited about that. But as you’ve heard, there’s 66 million women who are suffering. How do we treat more of them? Well, there’s several ways we’re doing it. But one of the big challenges there is simply the funding funding for mental health in Africa is incredibly restrained, if constrained, rather. If you look at all of the funding that went to the developing world over the last 10 years, including Africa, all of the health funding that is less than 1 percent of that has been for mental health. So that also holds us back, is just finding the resources to fuel our work, to power our work and to allow us to reach hundreds of thousands and eventually millions of women. Those are big challenges. A male.

[00:11:06]

Who can sense the frustration, but you see there’s this huge need for something to be done. And then there’s such restricted funds. And I will get back to what someone can do if they feel passionate about supporting your organization towards the end of this. But I have a question. What are the biggest causes for depression? Is there something that is bigger than something else? Because someone in SPDM, again, for example, is probably not really aware of the day to day life of these poorest people?

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Sure. No, that’s a great question.

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I think some background there’s a common belief or misconception that, you know, poverty causes depression, that if you’re poor, you’re going to be depressed. That’s not the case. Certainly poverty adds to depression. It’s, you know, exacerbates it makes depression a little more common, but it’s not causing it. You know, when when I’m here, right outside of New York City, if poverty cause depression, then you would say, well, rich people won’t be depressed. And when we’re in the slums of Uganda and Zambia, you know, we find twenty five percent of the women are depressed, but the entire slum community is poor. But then there’s seventy five percent of women

who aren’t depressed. So there is a there is not a direct cause and effect there. But what’s causing depression? You know, because we use group interpersonal psychotherapy, their whole approach is if you ask why enough times, we really understand why are you feeling this way? Why, why, why? It really comes down to some common causes or triggers of depression, which can be a change in life. You know, for example, maybe you’ve gotten divorced or you’ve moved from the rural area to the urban area disagreements. You’re disagreeing with your spouse over how to spend your 1 to 2 dollars that you make a day.

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It can also just be, you know, you’ve suffered a severe level of grief.

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Maybe there’s been a death in the family. So it really comes down to these common triggers that we talk about in the groups and then help them and to come up with strategies to really deal with those triggers that kind of reduce them. And by reducing them, the depression levels reduce themselves.

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Some similar to things people can go through in our Western society as well, in a way at least some of those factors know, yeah, it’s very similar, you know, when you think of our approach to psychotherapy.

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You know, we we could be using the same approach in Stockholm or in New York City in terms of coming down to what are the common triggers and helping the people to to negate or reduce those triggers. So it’s the exact same approach that we would use anywhere in the world. Now, of course, you you need to modify it sometimes for cultural awareness and sensitivity. But ultimately, you know, the causes of depression are the same around the globe.

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Got it. So Bovell could be something really great that could happen for your organization in the next year or years. What would make you really happy?

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Well, know, I’m really happy. We’ve treated 70000 women today, but I’d be happier if that was seven hundred thousand or seven million. So what we really want.

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What I would love to see to make me happier is a significant scaling up of the impact. Know we need to reach the hundreds of thousands and then millions of women. And the way we’re planning to do that is because we’re a small team. We’re about one hundred and forty people between Zambia and Uganda. You know, we we won’t find the resources to build the large army of group group talk therapy leaders, for example. So it’s about working with these large what we call international NGOs or NGOs, organizations like Care and Save the Children or Oxfam. It’s about working with those organizations who are already reaching hundreds of thousands and millions of women, helping them to begin to implement our model amongst the populations where they all already work. Now, that’s just a much more efficient approach. It’s using or reaching the women who are already being supported by the large NGOs. And those efforts to reach the hundreds of thousands and millions of women would take us years. And we probably really don’t have the financial resources for it. So I’m being long winded, but to make us really happy, it’s about really beginning to scale more with large NGO partners.

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That’s very interesting. She’s used some infrastructure that is already in place by this big organizations. And then you can go in and be super specialized at what you do.

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Exactly.

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It’s really identifying what is the lever in the system where you can get more leverage. And for us, it’s not strong minds employing more group leaders. And we also use volunteers. But it’s about finding others out there who can take the model forward for us quicker and faster so that the bottom line is more health impact. The bottom line is more women in Africa become depression free, which is what we’re all about.

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I’m starting to see now how Vera thought you were such a efficient organization. So imagine if someone is listening to this and they say, yes, Bonnie, for women affected by depression in Africa. This is unacceptable. I want to do something to aid in a system, be of service to your organization. What can someone do to get involved?

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There’s a lot of things I would tell you. We need to create more awareness. So if you’re any random person on the street in Stockholm or New York City and you’re hearing this podcast.

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Well, if you’re giving money to any NGO, please continue to do so. That’s fine. But challenge at NGO, ask them, are they addressing depression among their populations? If that NGO is out there doing HIV work or family planning, that’s great. But are they addressing depression as well? Because if they’re not, there’s a certain level of inefficiency in their system because one in four of the women they’re working with, if they’re in Africa, can’t be helped. So help us to create the awareness by anyone who’s listening to really ask these questions and simply to be aware and to talk about it with your friends. And you could simply say, did you know depression is a silent epidemic in Africa and that it really should be first on the list. It shouldn’t be behind HIV or malaria. It should be first so that HIV and malaria can be better managed. So help us to create awareness, help to challenge people who are already have maybe misconceptions about mental health and how depression is ranked or should be ranked in terms of treating it in Africa. And then, of course, if you really love our work, you know, we would welcome donations. But I’m not here to plug that necessarily.

[00:17:28]

That was a beautiful summary, Sean. I had a lot of fun speaking with you. You are a terrific communicator in all and I am engaged in and sharing on your organization. And I hope you will reach those million women’s women soon. Or thank you.

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Jamal, thank you for having us on great dot com. Today is great to speak to you. And thank you so much.

[00:17:51]

Thank you for being on, Sean. Bye bye.