I agree that based on all of the barriers and life challenges that it seems like it would be harder to treat depression in Kampala. As mentioned in some of the other answers, I think the model itself, being culturally appropriate and community-centered, as well as the interpersonal bonds, play a significant role in the program's success. Also, the fact that we work where the women are, in refugee camps, slums, or schools, to deliver our services.
Thanks for these questions! I appreciate the time you took to really look at our data, and I think some of the questions will help us ponder what we need to be looking at next within StrongMinds. Please note, as the Founder, I'm not a researcher or clinician by trade, so my answers may not be as granular as you would hope, but I'll do my best to respond. I'm going to tackle the first four tonight.
Hi, harriet! Thanks for the questions! Yes, there are advantages and disadvantages to both individual and group therapy, and as you mentioned, cost certainly favors the group model. We can offer a woman an entire course of treatment for $105. In terms of patient outcomes, StrongMinds doesn't utilize individual therapy, but some studies have shown that effectiveness overall is pretty similar, and it really comes down to individual (and sometimes cultural) preferences to determine what type of therapy is best. I hope that helps!
In terms of SSRIs, yes, they can certainly be effective. In some cases where we think the client is a risk to themselves or others during therapy pre-screening, we refer them to where they have access to other methods, including SSRIs or other prescription options. That said, there are some significant challenges with the availability of SSRIs, given the treatment gap and the fact that everyone may not have the access needed to get to a trained psychiatrist/psychologist or nurse to prescribe them. This is one of the reasons the WHO recently cited and recommended community-based models and methods using lay community workers rather than trained mental health professionals as a key way to meet the growing need for services.
In terms of cost-effectiveness, prescribed medication is reasonably affordable, but the cost can add up over a lifetime of use. For $105 USD on our end (and entirely free for the women we treat), we can provide long-term depression-free rates. Our results show that for every woman who restores her mental health, four additional members of her family feel the benefits. The HLI cost analysis looks at the benefits for the whole family as well as some of the long-term impacts as well, which is what makes our model so cost-effective.
Currently, StrongMinds is actively looking to hire for a few positions listed here. We are growing and are always looking for smart, ambitious, and creative people to join our team. We encourage everyone to follow us on LinkedIn for our most up-to-date job openings. At this time, we currently do not use volunteers.
StrongMinds seeks to treat 300,000 women and adolescents between 2022 through 2024. To do that, we need to raise $30M U.S. dollars. To date, we've raised about $13M, which leaves us at a shortfall of $17M. So there is lots of room for more funding!
In 2022 we expect the cost to treat one patient will be $105 USD. By the end of 2024, we anticipate the cost per patient will have decreased to just $85. We will continue to reduce the cost of treating one woman even while our numbers increase. This is through effective scaling and continuing to evaluate where we can gain more cost savings. A donation to StrongMinds will be used as effectively and efficiently as possible. And when you think about what it costs for therapy in the United States, to spend just $105 and treat a woman for depression is a pretty incredible feat.
Thanks so much for your kind words and for following our work! I appreciate your comment about the incredible impact mental health can have. We've certainly seen it change women's lives far beyond what we could have predicted, such as helping a woman's children eat more meals a day or even helping individuals with HIV adhere to their antiretroviral treatments more regularly.
Thanks for the question! We decided to start the StrongMinds programming in Uganda because the initial RCT had such positive results there. We wanted to see if we could replicate those findings and reach even more women. I also had some experience there in my prior work as a diplomat and through my work with other NGOs. My family and I lived just across the border in the Democratic Republic of Congo for over four years, so I have many friends and connections in sub-Saharan Africa and have seen the dire need for treatment options and the consequences of untreated depression there firsthand.
I suggest doing your research (the information we received from the researchers who conducted the initial John Hopkins/Columbia University RCT was instrumental to our success.) Also, know your audience. We try to consider each woman in our therapy program's perspective. How did she hear about us? How is she accessing information about the program? The more demographic information you have about your audience, the better you can target your outreach/messaging and achieve results. Other considerations are what staffing is needed to make the product or tech run? And what frameworks need to be in place? We had to do a lot of this evaluation ourselves when switching our model to teletherapy during the pandemic. The model, resources, and modes of communication available will all have a huge impact on the specific strategy.
Both are true! Numerous studies have shown that when you help an African Mom, the downstream effects are significantly more substantial. Globally, women have a depression rate of 1.5 times higher than that of men. An African woman with depression, compared with her healthy peers, suffers greatly: she is less productive, has a lower income, and has poorer physical health. If she is a Mother, the negative impact extends to her entire family. Research shows that children of depressed Mothers are more likely to have poor health, struggle in or miss school, and suffer from depression themselves.
Furthermore, because depression impairs the ability to focus and concentrate, depression sufferers do not respond to health initiatives or livelihood trainings, rendering these programs less effective.
This impaired ability to function in day-to-day life creates profound hardship in Uganda and Zambia, where life is community-centered and reliant on each person fulfilling her role and where depression carries a great stigma. When a woman cannot perform her social responsibilities, she can become a target of criticism and social exclusion. Women in these communities also often have far less access to resources.
Thanks for your kind words and for the great questions!