StrongMinds has now treated over 160,000 women with depression to date in Uganda and Zambia. On average, 80% of the women we treat remain depression-free six months after the conclusion of therapy.
This sounds like you.. solved depression? And you did it in the extra challenging setting of working in Uganda and Zambia (!)
Can we import your methods to other countries, like even the U.S?
Is everyone doing therapy wrong and should instead learn from your programs?
(What am I missing? Are these questions wrong somehow?)
Hi Yonatan. Thanks for the questions. I wouldn’t quite say we solved it, but we have found a solution that has had tremendous results in Uganda and Zambia. There are probably a few reasons for this. Most of the communities we work in are very close-knit and interpersonal, so the group talk therapy model of IPT-G works well. Additionally, around 85% of women in sub-Saharan Africa don’t have access to quality mental health care. There is a huge treatment gap, for instance, Uganda has approximately 30 trained psychiatrists serving a population of 45M, so we are also filling a dire need by providing these free services using lay community health workers. The symptoms of depression are still not commonly known in Uganda and Zambia, and many people think they are just fatigued, sick, or just unmotivated/lazy, so discovering that there is a way to treat their symptoms and that there are other people experiencing this too is life-changing. Many women in therapy groups form a bond and continue to meet long after therapy ends. They now have a new support system and are no longer isolated. All of these factors play a role in our success.
The program model can be replicated in other geographical locations, and IPT has been shown to work well cross-culturally. We are currently exploring an American pilot where the need is also extreme in underserved BIPOC communities. Our pilot is happening in the Newark, NJ area just outside of NYC. That said, we have to do quite a bit of work to determine how western preferences fit into this, and we are collecting data from some initial groups now.
StrongMinds therapy model is based on an RCT from 2002 in Uganda. It has shown to be a highly effective way to reach women in underserved and remote areas that would otherwise not have access to mental health treatment options.
I’m glad this is (currently) the top-voted comment. I’ve reviewed the evidence StrongMinds offers up and find it relatively persuasive. But every page yells “offer this in wealthy countries and you’ll do good and do well at the same time.” A quick google suggests that the global ‘market’ for mental health is in the order of $400b. And this intervention seems significantly better than anything else currently in the market. Shouldn’t this be a multi-billion-dollar company being snapped up by pharma giants?
I guess that outcome seems so wild that it generates doubt about the original claim. I’d like to know the additional detail that contextualises that.
Greg S- I wish we had 400B at our fingertips because I can only imagine what impact we could have. In all honesty, our model is very low-tech. There are no apps or fancy gadgets. We also don’t use prescription medicine (which may be why a pharma company has yet to snap us up!) Finally, the women we treat mostly live on less than $2 a day, so they aren’t in an income bracket that many investors might want as consumers. While apps, tech, and pharmaceutical partnerships receive considerable funds, mental health in low and middle-income countries trying to help with poverty reduction is not heavily funded. Yearly global costs from mental, neurological, and substance use disorders are estimated at between $2.5 and $8.5 trillion dollars a year. That figure is projected to nearly double by 2030. Mental health is still frequently overlooked in health budgets. Most African governments devote less than 1% of their budgets to mental health services.
You raise a good point, though, to which we have given a little thought. Is there space to look at our model and make it self-sustainable and profitable? We would never consider this with our current clients, but is there room to have a for-profit arm that funds the non-profit, or should we consider a franchise model? We constantly push ourselves beyond what is comfortable, and we’ve had some early discussions. While I have no answers, I wanted to flag that we had considered new and different ways to fund our work.
I guess if I was in your position I’d consider running a pilot of the service (using as-similar-a-method-as-possible) in a demographic that is seen as desirable to the health industrial complex (New York or California or something). Perhaps I’d also talk to an intellectual property lawyer and see if there are any elements of your method that can be subject to protections (patents, copyright material or whatever).
If it’s so impactful and cost-effective it might be immediately profitable if offered to other demographics (including because market-provided mental health services seem hugely expensive in many western countries—it’s possible that this model could undercut the market dramatically).
I think it would be useful to know the percentage of women with depression who we would expect to be depression-free after a six month period without any intervention.
Sam Glover- We looked at this with a control study and found that a statistically significant number of women were depression-free after completing StrongMinds therapy versus those that received no treatment. Additionally, using the PHQ-9 (an international standardized tool to assess depression), we saw an average difference of 12 pts after the conclusion of therapy. To contextualize that, in western countries, a change of 4 pts is considered significant in terms of depression recovery.
You wrote:
This sounds like you.. solved depression? And you did it in the extra challenging setting of working in Uganda and Zambia (!)
Can we import your methods to other countries, like even the U.S?
Is everyone doing therapy wrong and should instead learn from your programs?
(What am I missing? Are these questions wrong somehow?)
Hi Yonatan. Thanks for the questions. I wouldn’t quite say we solved it, but we have found a solution that has had tremendous results in Uganda and Zambia. There are probably a few reasons for this. Most of the communities we work in are very close-knit and interpersonal, so the group talk therapy model of IPT-G works well. Additionally, around 85% of women in sub-Saharan Africa don’t have access to quality mental health care. There is a huge treatment gap, for instance, Uganda has approximately 30 trained psychiatrists serving a population of 45M, so we are also filling a dire need by providing these free services using lay community health workers. The symptoms of depression are still not commonly known in Uganda and Zambia, and many people think they are just fatigued, sick, or just unmotivated/lazy, so discovering that there is a way to treat their symptoms and that there are other people experiencing this too is life-changing. Many women in therapy groups form a bond and continue to meet long after therapy ends. They now have a new support system and are no longer isolated. All of these factors play a role in our success.
The program model can be replicated in other geographical locations, and IPT has been shown to work well cross-culturally. We are currently exploring an American pilot where the need is also extreme in underserved BIPOC communities. Our pilot is happening in the Newark, NJ area just outside of NYC. That said, we have to do quite a bit of work to determine how western preferences fit into this, and we are collecting data from some initial groups now.
StrongMinds therapy model is based on an RCT from 2002 in Uganda. It has shown to be a highly effective way to reach women in underserved and remote areas that would otherwise not have access to mental health treatment options.
I’m glad this is (currently) the top-voted comment. I’ve reviewed the evidence StrongMinds offers up and find it relatively persuasive. But every page yells “offer this in wealthy countries and you’ll do good and do well at the same time.” A quick google suggests that the global ‘market’ for mental health is in the order of $400b. And this intervention seems significantly better than anything else currently in the market. Shouldn’t this be a multi-billion-dollar company being snapped up by pharma giants?
I guess that outcome seems so wild that it generates doubt about the original claim. I’d like to know the additional detail that contextualises that.
Greg S- I wish we had 400B at our fingertips because I can only imagine what impact we could have. In all honesty, our model is very low-tech. There are no apps or fancy gadgets. We also don’t use prescription medicine (which may be why a pharma company has yet to snap us up!) Finally, the women we treat mostly live on less than $2 a day, so they aren’t in an income bracket that many investors might want as consumers. While apps, tech, and pharmaceutical partnerships receive considerable funds, mental health in low and middle-income countries trying to help with poverty reduction is not heavily funded. Yearly global costs from mental, neurological, and substance use disorders are estimated at between $2.5 and $8.5 trillion dollars a year. That figure is projected to nearly double by 2030. Mental health is still frequently overlooked in health budgets. Most African governments devote less than 1% of their budgets to mental health services.
You raise a good point, though, to which we have given a little thought. Is there space to look at our model and make it self-sustainable and profitable? We would never consider this with our current clients, but is there room to have a for-profit arm that funds the non-profit, or should we consider a franchise model? We constantly push ourselves beyond what is comfortable, and we’ve had some early discussions. While I have no answers, I wanted to flag that we had considered new and different ways to fund our work.
Thanks for the reply Sean.
I guess if I was in your position I’d consider running a pilot of the service (using as-similar-a-method-as-possible) in a demographic that is seen as desirable to the health industrial complex (New York or California or something). Perhaps I’d also talk to an intellectual property lawyer and see if there are any elements of your method that can be subject to protections (patents, copyright material or whatever).
If it’s so impactful and cost-effective it might be immediately profitable if offered to other demographics (including because market-provided mental health services seem hugely expensive in many western countries—it’s possible that this model could undercut the market dramatically).
I think it would be useful to know the percentage of women with depression who we would expect to be depression-free after a six month period without any intervention.
Sam Glover- We looked at this with a control study and found that a statistically significant number of women were depression-free after completing StrongMinds therapy versus those that received no treatment. Additionally, using the PHQ-9 (an international standardized tool to assess depression), we saw an average difference of 12 pts after the conclusion of therapy. To contextualize that, in western countries, a change of 4 pts is considered significant in terms of depression recovery.
There’s a sister org working on it About Depression—StrongMinds America