StrongMinds is the subject of Inciting Altruism's first-ever Charity Spotlight, and we couldn't be more proud of the work they are doing to combat mental illness in Africa. If you haven't already, you should really read up on StrongMinds, the amazing work they do, and why Inciting Altruism recommends donating, which you can do by clicking here. Last week, our co-founder Gregory Light was fortunate enough to sit down with the founder and CEO of StrongMinds, Sean Mayberry. They cover topics ranging from working with women, to how StrongMinds is adapting their activities to address safety during the pandemic, to why donating even $1 to effective charities is a meaningful action.
Thank you to Sean and your team for making this possible, and we are looking forward to supporting your work long into the future.
Alright, let’s jump in. Sean do you want to introduce yourself a little bit?
Yeah! My name is Sean Mayberry, I am the founder and CEO of StrongMinds. StrongMinds works to improve the mental health of women of all ages in Africa.
Most iA readers will know by now that StrongMinds is our Spotlighted Charity for the month and that this is the first-ever charity we’ve done this for. So, we wrote up a little overview of StrongMinds’s activities, but can you give a little bit more of a detailed overview from your perspective?
Yeah, yeah! And thanks, so much Greg, and to your team, for supporting us. StrongMinds works to improve the mental health of women of all ages in Africa. We’re based in Uganda and Zambia. We focus on helping women to overcome depression, which is the number one mental illness in the world, and certainly in Africa. In Africa depression is also the leading cause of disability for women – greater than HIV or malaria for example. In Africa, depression affects over 66 million women, and, according to the World Health Organization, 85% of those women have no access to care. So, the sad story is: if we don’t help women to overcome depression, nobody will.
Clearly there is a depression epidemic. StrongMinds has been working to improve mental health and help women overcome depression since 2014, and we have treated over 70,000 women since then. We know and work under the mantra, that when an African mom is no longer depressed her entire family thrives. So, not only have we been fortunate enough to help 70,000 women, but we have also been able to help their 350,000 dependents to live better lives. That’s really what StrongMinds is about.
That kind of speaks to another one of my questions regarding the fact that StrongMinds works exclusively with African women and does group therapy for them. What inspires the focus specifically on women? Can you talk a little bit about the benefit of working with women and providing therapy to women?
Sure. You know globally depression affects women at twice the rate of men. And again, that is true globally. It is much more of a mental illness that affects females, so there is that reason why we focus on women. We also know the reality in many African nations is that women are the backbone of the family. When they are strong the family can be strong. When they are weak, suffering from depression for example, the family suffers.
And there is also another reason: sheer pragmatism. Funding for global mental health – funding for mental health in Africa – is severely limited. When you look at the last 10 years of health funding externally going into Africa, less than 1% -- in fact .3% -- of that was for mental health. So we’re really charged with maximizing every dollar we can find. In a perfect world we would love to be able to treat depression among males and females – men and women – equally; but, with limited resources, we’re forced to make a choice on, really, where is the greatest impact; where is the greatest return on investment, and in this case it is women.
In terms of depression as a cause overall: you spoke to it a little bit: the fact that the focus when it comes to development – and the development context in Africa – tends to be on working to combat communicable disease; tends to be on water, sanitation, and hygiene; and on food security. So, in the face of these issues that are in some sense life or death, what makes mental health and depression treatment a cause that is really worthy of support?
You know the sheer reality and sad part of the story is that everyone thinks mental health is last – or should be last – on the list of priorities when it comes to development. I’m here to tell you that it should be first. And that is not a bias of StrongMinds. It is the experience of StrongMinds. It’s my own experience of having lived and worked in Africa for over 12 years. You know, when you have a depressed mom, she is suffering a cognitive impairment. Some of those symptoms of depression: inability to sleep, fatigue, anxiety. She simply can’t function as well as someone who is not depressed. So that mom with that cognitive impairment, you literally cannot change her behavior.
Picture for example another NGO or the government coming to that mom. Helping her to understand how to take good care of her newborn child; how to feed the family; how to learn a new livelihood. When she is depressed, she can’t respond. She can’t hear that behavior change, so she can’t change her own behavior and help herself or her family.
I talk to a lot of NGOs and ask them, “if you are helping women overcome malaria in the community or to teach new livelihoods, is there some percentage of the population who just doesn’t respond, and you don’t know why?”
The overwhelming response is “Yes. And we don’t know why.”
What it comes down to is these NGOs are trying to change the behavior of women who are depressed. Now we see rates of depression in Africa up to 25%. So, if you have, say, 100 women in a room and you are teaching them a new livelihood, instantly 25 of those women cannot respond to that behavior change. They cannot learn that livelihood because of the symptoms of depression. So you, NGO, you’re starting with a best possible success rate of 75%.
We are trying to help governments and NGOs to understand why treating depression first – and putting it first on the list – is a good investment. The short answer here is that our model makes other models better and more efficient. That’s really what we’re trying to do: help the community understand why mental health should be first. Why it is a good and wise investment.
Wow. I’ve been doing all this research on the cause area – partially in preparation for this – and I had no idea it was up to 25%. That is crazy.
Yeah, you know, just on that. It is really a silent epidemic Greg. In the US, rates of depression are around 8-10%. You are talking 2.5 times that in Africa. The WHO does not report it accurately. They’ll tell you it’s 5%. So there is a lot of misinformation out there. We have consistently seen rates of up to 25% everywhere we work. Now when we go into brand new communities, we are doing prevalence research to understand what is the rate of depression here before we even start, and consistently it is between 20 and 25%.
1 out of 4 women are suffering. It is truly an epidemic the world doesn’t know about.
What makes the WHO’s numbers so off?
That’s the million-dollar question. I’ve been asking that for 7 years. I honestly just think many African governments simply aren’t doing research in their district health surveys to understand the rates of depression. They are not screening in clinics. So, they aren’t really asking the information; they can’t report it correctly.
I think what’s happening at the WHO is they are finding small pieces of research that are not comprehensive. This isn’t a criticism of the WHO. We would love to be able to work with them and help them to understand the scope of the problem. I think another answer to why the WHO reporting is so far off, is mental health just hasn’t been a priority anywhere. It’s not being researched and understood as well as other physical health issues like HIV or malaria.
In the US there is still an issue of stigmatization when it comes to mental health issues in general. Is that something you see in Africa as well, as a problem that’s persistent? Does StrongMinds do any work to combat that stigma?
Yeah, we do. The stigma in Africa against those who suffer from depression – I think of it more as a quiet stigma, because most people don’t understand depression. What happens is, for example, if you have a depressed African mom in the slums, given some of the symptoms of depression – the fatigue, anxiety, etc. – that African mom can’t take care of her family.
In most of these communities, these moms are working together to share the burden of cooking and watching children for example. Now this African mom who’s depressed, let’s say her neighbor comes up to her and says, “hey can you cook the community meal tonight? I’ve got to run and help my husband with his job.” Now me, as the depressed individual, my answer is no because I am exhausted. I can barely get out of bed. I can barely watch my own kids. There is no way I am going to cook a community meal for 10 people. So I say, “no.”
The next day, a different neighbor asks me, “hey can you watch my kids right now because I have to go. I have to work?” My answer is “no” because I am exhausted. After you say “no” and reject those outreaches from your friends for weeks and months, the community will ultimately exorcise you and throw you out of that community.
They don’t realize you have depression. They think that you’re just too good to help them. In Uganda, the English term is “backbiting”. Those friends will start to criticize you because they don’t understand that you’re suffering a cognitive impairment –suffering a mental illness. And that strife that will result from that backbiting – that criticism – will actually add to your triggers of depression, making your depression worse. So it is not a stigma of depression, it is really a stigma about lack of knowledge – of understanding – why this depressed individual is acting as such.
So, how do we combat that? When we’re in communities finding/screening women with depression, we’re talking to everybody in the community to help them understand – what is depression? What is it not? It is a mental illness, not a curse, for example. – and how they can see it in their neighbors; how those neighbors can come to StrongMinds; and, how ultimately by helping people and being supportive of people with depression as they journey out of that difficult mental illness, that they are doing a great thing for their friends and the community.
So our approach to breaking that stigma is really about education at the community level.
What are you most proud of when it comes to the work that StrongMinds has done?
That is a great question thank you for asking. I am proud of our team of 150 people who are all incredibly passionate and share my passion for good mental health. The hours they put in. We are out there working in the slums of Uganda and Zambia in incredibly difficult working conditions. We’re not maintaining clinics. We’re out there on the ground, conducting groups in the sun, next to the garbage dumps – difficult circumstances – but doing it day in and day out.
That we’ve reached over 70,000 women. Helping 80% of them to become depression-free. I am proud to work every day with 150 people who share my passion and who are slowly but surely improving mental health on the African subcontinent.
I was reading that the women you train to conduct these sessions are conducting, what, 14-15 sessions a week?
Yeah. Anywhere from 10 to 15 depending on who they are working with. For us, it is about throughput time. Our Mental Health Facilitators, our group leaders, can treat anywhere from 300 to 450 people per year depending on their group size and productivity. For us, it is about treating women. That is why we exist.
That is why we are not out there doing research for journals. It is about treating women because if we don’t do it, nobody will. Every woman we miss, in terms of a missed opportunity to return her to good mental health – depression-free status – that is a serious miss. So for us, we exist to treat women; we exist to implement our program; we don’t exist for any other reason.
That’s wonderful. I also imagine that is a bit of a challenge when it comes to that lack of awareness we were talking about before. On that same vein, what are some of the big challenges, or what was one of the larger mistakes that have been made along this journey that you’ve been on?
I saw that question; it’s a great one. You know, you make a million mistakes as you start something new. We manage ourselves really aggressively, and strongly. I come from Intel – the tech sector – it can be a little bit cutthroat. I think in retrospect we were overly aggressive in setting some of our targets. We used to work under a mantra of, “reach 2 million women by 2025.” Just in the last few months we’ve said, “that’s not going to happen.” That was too aggressive.
Our team was super stressed because they were just like, “Oh my god… we’re not going to reach it.” It became an impossibility. We were too ambitious in that end, but you live and learn. You realize the constraining factors in reaching 2 million women. Mostly it is just about inputs. It is about finding the financial support. We misread – or mis-planned – what we could do in the early years.
So, our big mistake is being too ambitious. But that won’t slow us down.
That’s good. I am sure recent events as well and global pandemics make it a little bit difficult to make accurate predictions of revenue…
Throw another fastball at your head yeah.
In what ways is StrongMinds adapting to the current pandemic? How has the pandemic been affecting StrongMinds?
At the end of the day, this is a huge opportunity for us to rise to the challenge. We know globally mental health is struggling – is reducing – for everybody. There are many more triggers of depression. There are much higher levels of stress and anxiety globally, including of course Uganda and Zambia where we work.
We stopped all of our face-to-face groups in March as our operating countries went into lockdown, as we have here in the US. It was the first time in 7 years at StrongMinds that there were not talk therapy groups for depression happening somewhere in Africa via StrongMinds. It was really one of many wakeup calls that we’ve all experienced in the last few months.
We’ve risen to the challenge. If we don’t help Zambians and Ugandans to respond to these challenges of depression, stress, and anxiety, nobody else will. It is our responsibility.
So yeah, in the three months our team has responded incredibly well. We’ve moved our face-to-face therapy onto the phone. It’s teletherapy. It was a three-month deep dive: how do we do this? How do we create a new curriculum? How do we change our psychotherapy to address not just depression, but also stress and anxiety?
Our teams are launching our teletherapy groups next week! As part of that, we reached out to as many of the 70,000 patients we did, just to do the research. To understand: how is your mental health? We spoke to over 12,000 of those respondents and confirmed what we feared: that their mental health is struggling.
As part of that, we also launched a mass psychoeducation campaign. Think of it as a publicity campaign. We’ll reach millions of Ugandans and Zambians with just good mental health messaging in terms of, “if you’re feeling this… this is something that you can do.” “If you are feeling really poorly or badly, you can contact StrongMinds and we will screen you and invite you into our depression groups if we find that you’re really suffering.”
We’re using tons of technology to do that, basing a lot of this on WhatsApp, Turn.io, and Viamo. These are all kinds of different phone menus that work both for literate – where you can read the phone menu/the phone options – or illiterate – where you are just listening to voice prompts. How do we make it easy for someone struggling in Uganda or Zambia to reach out to us, to screen themselves, for us to screen them more deeply, and then support them?
So huge shift. Huge pivot. But again, this is an opportunity and a responsibility for us to improve mental health. Cause again sadly, if we don’t do it. No one’s going to.
Yeah, and I imagine with increased isolation comes even more severe symptoms of depression. So, it sounds like the work that StrongMinds is doing is even more important than ever right now.
Yeah, that’s a great point. We use group-interpersonal psychotherapy, as the basis of our foundation. One of the triggers in that modality is social isolation – that that leads to depression. So, you are absolutely right. That is one of the big things we are worried about: that as people become more isolated that triggers for depression – which for us include social isolation, disagreements, death, loss of a loved one …. All of those – increasing, sadly because of the pandemic.
Yeah. Well myself and Inciting Altruism have made it very clear that we are impressed with the work that you guys are doing…
Yeah, we are super thankful! That’s awesome. Fantastic.
And we are very thankful for all the work that you’ve been doing. One thing that is important to us here at Inciting Altruism is changing the way that people think about charity and promoting the value of transparency. StrongMinds has been recognized for its commitment to transparency by a number of organizations, but I’d like to test that in a way. Can you tell our audience honestly about some of the risks that come with donating to StrongMinds, and perhaps why they should give anyways?
We pride ourselves on our transparency. Everything is wide open. There is nothing that goes unanswered. So, what is the downside or potential risk of giving to us?
Yeah.
That’s a great question. At the end of the day, our success rate is incredibly high. 80% of the women we treat are improved. Even the 20% that aren’t officially depression-free, their lives have improved because their symptoms have reduced, not to depression-free level, but certainly, they can live more fully and live more satisfying, happy lives.
So I would tell you the risk isn’t very high. Let’s be honest though. When you are working in countries like Zambia or Uganda there is a certain amount of political instability. Sometimes we have to stop groups because of what’s going on. Is it safe in terms of civil society conditions?
There are always unforeseen things going on. There is a three-day rainstorm: the groups stop. But it is not as if that donation would be lost; It is just a delay. If it takes 12 weeks to conduct a group, okay…. it’s going to take us 16 now because we some lee-time there. But we pride ourselves on checking our cost-per-patient. How effective we are. We pride ourselves on letting people know that when you donate this amount, we will treat these many people.
I like to think, there is certainly risk everywhere, but for StrongMinds that risk level is pretty low.
That’s good. That actually reminds me of another thing I wanted to ask. When I was doing an analysis of StrongMinds and I was looking at some of your quarterly reports, I think you said the cost per patient runs roughly $110 per patient…
Yeah, $109.
for the whole range of treatment, right? Yeah, $109. So, one thing we are trying to do with this Charity Spotlight program is to encourage all of our readers to get involved and get their toes wet – with giving – with philanthropy… even if that means just giving a dollar. I was wondering if you could explain – or rather the question I have for you is – does giving a dollar make a difference? Does giving these small amounts really make a difference when it comes to the work that you guys do?
Absolutely. If you are an individual who can only afford a dollar, we welcome it and we’re thankful for it. We’ll put it to good use. Again, with mental health being presently at the bottom of the list with such paltry support, every little bit helps. Those dollars add up to $109. Those dollars add up to helping a woman become depression-free, and to take better care of her children, and to go back to work. So that dollar is a very important step on that journey of helping that woman to achieve mental health.
So anything any of us can do – if you can only give a dollar… if you can actually start a non-profit that makes the impact – we all, I believe, have the responsibility to help to whatever extent one can.
Yeah, I used to tell people, in my door-to-door fundraising days, that even the small amounts really matter because even outside of the financials, by donating you are giving your voice to an issue and are saying, “Hey, this cause is important to me.”…
Entirely.
And then charities, like you all, can say, “we have this many supporters out there donating to us,” and use that to help influence government programming and all sorts of other things. It also encourages other donors to take up the mantle.
Very true. I would further that to say: thank you. Give us the dollar. Mention us to your friends and neighbors and tell them what you’ve done. Because they can give a dollar. Maybe they can give more – 5, 10, or 109 dollars. So it doesn’t just have to be about writing a check or opening your wallet. Just share that information. Help people understand that there is a silent epidemic in Africa. That there is an organization making a difference.
For us, support comes not just from the monetary support, but by creating awareness. Everyone talks about poverty, malaria, HIV, in Africa. They are not talking about depression. The higher we can get that up on the radar, the better.
I had a few more questions, but also, I think we’re running short on time here. Is there anything else you would like to share with readers of Inciting Altruism before we sign off?
No. You know, you did a great job with the questions. I think we hit the big points that are important to share. So yeah, I feel good about this if you do.
Yeah, I’m feeling good. Thank you again for your time!
Further Links
- Click here to read Inciting Altruism's full report on StrongMinds's activities.
- There are only two weeks left in iA's fundraiser for StrongMinds, and we still have a long way to go to reach our goal. Click here to donate starting at $1. Any and all help is meaningful. If you can't donate (or even if you are donating) you can still help by sharing our fundraiser!
- To learn more about the depression and the impact it has on African families, you should check out Sean's TedX talk, "Solving the Depression Epidemic in Africa".
About the Author
Gregory Light is a bartender, a traveler, a cook, a guitar player, a blackbelt, a French speaker, a cliff diver, a part-time theoretical physicist, a philosopher, a dog owner, a Star Wars lover, and probably some other things too. No one has ever seen Gregory and Batman in the same room…
He loves to rock climb, hike, and explore new trails. Most of all, he loves learning more about the world by getting to know strangers as friends.
Click out his writer's page to explore his work, or follow Gregory on Instagram at @greggo_my_leggo.