MentalLiberty

Eradicating depression, anxiety, and mental health illiteracy among African youths.

Our evidence-based model tackles mental health illiteracy and treats depression and anxiety among youths in low-income countries facing shortages in mental health facilities and personnel such as Zambia and Sub–Saharan Africa. This solution consists of a mental health curriculum and Brief Interpersonal Psychotherapy (IPT–B). 

    We developed Zambia’s first-ever culturally-tailored mental health curriculum that educates youths about mental health by linking it to cultural beliefs, ensuring the de–westernization of mental illness. Collaborating with the Ministry of Education to deploy this curriculum in Zambian schools, we are equipping youths with the basic knowledge to recognize mental disorders in themselves and others, erasing mental illness stigma and making them more susceptible to seeking care. 

    By training youths in IPT–B to become mental health facilitators through an eight-session training program, we’ll morph front-liners who will create a strong, resilient, and reliable peer–to–peer support network to overcome youth depression and anxiety, improve functioning in Zambia and Africa.

    The trained facilitators emerge from different backgrounds and identities. We aim to especially train youths from underserved backgrounds (impoverished, LGBTQI+, and incarcerated) who will create self–sustaining communities that can pass on to others IPT–B skills, making our solution scalable and efficient.

    With a prevalence of 20%, Mental disorders constitute a significant proportion of the disease burden in Zambia, escalating suicide rates among youths: WHO (2016) estimates the rate increase by 6.1% (8.8% males and 3.5% females) per 100 000 people.

The 4.8 million Zambian youths (comprising the majority of the population) are especially impacted by gender-based violence, bullying, toxic relationships, and peer pressure resulting in alcohol and substance abuse, increasing their likelihood to experience depression, anxiety, and suicidal ideation.

Unfortunately, there is an absence of adequate mental health education, care, and personnel. For instance, there are only 0.06 psychiatrists per 100 000 population (WHO, 2016). On the other hand, existing mental health care alternatives are expensive (an average therapy session costs more than $100 ), foreign, and culturally incompatible, making them less effective.

Additionally, marginalized populations such as the LGBTQI+, impoverished, disabled, and incarcerated youths face some of the country’s harshest discrimination and neglect, making them more prone to experiencing depression, anxiety, and suicide. Like most Zambian youths, these individuals have no access to mental health care.

The status quo calls for an intervention that utilizes the already existing infrastructure such as human labor and talent to deliver culturally–tailored mental health care and knowledge that transcends personal backgrounds, identities, and socio-economic status to erase the existing mental health care disparities.

Our model serves traditionally underserved populations: LGBTQI+, incarcerated youths, women, the impoverished, and the disabled.

    This solution fosters an inclusive and stigma-free environment, allowing individuals to share their life experiences and seek mental health care. This environment is especially ideal for those identifying as LGBTQI+ who continue to face some of the harshest discrimination in the country and experience elevated levels of depression and anxiety.

    On the other hand, Incarcerated youths have no access to therapy critical for their rehabilitation and reintegration into society. This lack of proper correctional education essential for complete transformation contributes to recidivism and an increase in crime rates. Our IPT–B training will morph incarcerated youths into mental health front-liners who will, in turn, pass on the skills to fellow inmates, creating a robust mental health support system that contributes to correctional education and transformation.

    The widespread patriarchal system in Zambia and Africa at large renders women prone to gender-based violence in both the home and society, resulting in depression and other mental illnesses. Our model affords women a scalable and culturally compatible treatment for depression.

The disabled are socially excluded, poor, especially in low–and middle–income countries such as Zambia. These people are heavily stigmatized, exposing them to depression and anxiety. The impoverished also can’t afford costly mental health care, which costs an average of over $100 per session. Our solution creates an inclusive environment and an effective alternative to traditional mental illness treatments that are expensive and hardly accessible.

1. Through our outreach in schools and communities, we constantly research to understand the needs of our target populations. For instance, in 2021, we surveyed The Copperbelt University School of Medicine– one of the most populous schools in Zambia. Our findings revealed that of the 114 participants in our study, 57% experienced issues with studying, and 89.5% of those issues were mental health-related,  resulting in poor academic performance (90.7%) and relationship difficulties (83.1%). We also found out that only 56.1% of the participants had someone to talk to, and 98.5% had never sought mental health therapy due to cost and its scarcity in addition to stigma. 21.9% also considered suicide (MLF, 2021). Our outreach activities and research transcend beyond urban areas. For instance, we conducted a child mental health outreach in rural Mucini compound in the Eastern Province of Zambia. Post–outreach, the children’s parents reported that their children had increased mental health knowledge. 

2. We’re also collaborating with local organizations. For instance, we’re working with the Education Hope Foundation (focused on correctional education for incarcerated youths) to understand the mental health needs of inmates. Our collaborating with the Latu Human Rights Foundation helps us understand the unique needs of the marginalized and LGBTQIA+. Finally, we’ve collaborated with the Ministry of Education to deploy in Zambian schools. Counselors working for the Ministry of Education assist us with identifying the unique mental health needs of youths in different Zambian schools. 

3. Engaged local experts to craft our model.

The mental health literacy component: we carried a pilot outreach on youths at Muchini, Eastern Province, with over 100 attendants. We aimed to spread awareness of mental health using our mental health curriculum. Post–outreach, children’s parents reported that their children’s knowledge about mental health increased, and they could pass on the knowledge to peers.

To quantify the improvements in mental health literacy, we’ve collected data from our outreach events and are conducting 1) knowledge measures, 2) stigma measures, and 3) help-seeking-related measures as key indicators of increased mental health knowledge. Knowledge measures investigate the ability of illness identification and factual knowledge of mental disorders such as terminology, etiology, diagnosis, prognosis, and consequences. Stigma measures focus on stigma against mental illness or the mentally ill; self-stigma; experienced stigma; and stigma against mental health treatment and help-seeking. Help-seeking measures focus on help-seeking attitudes, intentions to seek help, and actual help-seeking behaviors.

Our IPT–B model is supported by an Addis Ababa University/ Wolaita Sodo University study in 2021 and evaluated IPT’s feasibility and ability to treat youths with mental distress in low-income country settings. Results supported the viability of IPT-B in low-income country settings for youths with symptoms of anxiety and depression.

Psychological interventions effectively treat anxiety and depression in low–middle–income countries (LMICs) and are recommended by the World Health Organization intervention guide. These interventions result in reduced relapses and premature treatment termination compared to pharmacotherapy, which is expensive and hardly accessible to most underserved populations. Of the potential psychological interventions, Interpersonal Psychotherapy (IPT) effectively resolves symptoms of depression and anxiety and improves interpersonal relationships, and has been used in primary health centers in LMICs, including Kenya, South Africa, Egypt, and Ethiopia. 

Brief Interpersonal Psychotherapy (IPT-B) is an eight-session adaption of Interpersonal Psychotherapy (IPT), evidence-based psychotherapy for depression and anxiety. IPT-B allows individuals such as those from underserved backgrounds (impoverished, LGBTQI+, and incarcerated) who are unlikely to attend 16 sessions of psychotherapy—because of external or internal constraints—to receive the full benefits of IPT in fewer sessions. A complete IPT–B program consists of three phases: the initial phase (2 sessions), the middle phase (5 sessions), and the termination phase (1 session). Each session lasts between 45–60 minutes administered weekly. 

IPT–B targets participants struggling with depression and anxiety associated with current interpersonal dispute/conflict, role transitions/life changes, grief/loss, and social isolation/loneliness, common in youths, especially the marginalized. 

Our solution combines the IPT–B with mental health literacy to tackle depression, anxiety, and mental health illiteracy among youths in Zambia and Africa. Our solution's mental health literacy component relies on a locally crafted mental health curriculum created by The MentalLiberty Foundation.

We plan to deploy our pilot model in ten schools countrywide, so we expect to impact between 20 000 to 50 000 youths in rural and urban populations. For incarcerated youths, we plan to impact approximately 20 000. We’re not sure about the population size of the LGBTQIA population since many of them don’t disclose their identities due to fear of discrimination.

1. Deploy our model in all correctional facilities across the country: we’re collaborating with Education Hope Foundation to achieve this. Education Hope Foundation is focused on correctional education for incarcerated youths.

1. Deploy our model in the LGBTQIA and the marginalized population: we’re collaborating with Latu Human Rights Foundation to achieve this. Latu Human Rights Foundation is focused on promoting human rights for the marginalized and the LGBTQIA populations.

1. Create school chapters across the country: We’re working with the Ministry of Education and we plan to train counselors from different Zambian schools in the first three months of 2022.

1. Establish ourselves as a hub for mental health in Zambia and Africa: we have established a research and evaluation department in our organization. This department will conduct research and evaluate our model to fine-tune it and make it more effective. We plan to publish the results in peer-reviewed journals.

1. Plan to scale our model.

1. Measuring mental health literacy changes: we plan to measure changes in mental health literacy before, during, and after deploying the mental health literacy component of our model. Key indicators of mental health literacy include knowledge measures, stigma measures, and help-seeking–related measures. Knowledge measures investigate the ability to identify mental illness factual knowledge of mental disorders such as terminology, etiology, diagnosis, prognosis, and consequences. Stigma measures focus on stigma against mental illness or the mentally ill; self-stigma; experienced stigma; and stigma against mental health treatment and help-seeking. Finally, help-seeking measures focus on help-seeking attitudes, intentions to seek help, and actual help-seeking behaviors. We expect to observe positive changes after deploying our model.

1. Measuring the feasibility of our IPT–B model: the indicators of the feasibility of our IPT-B model are consent, treatment completion, and attrition. We will use the Client Satisfaction Questionnaire and semi-structured interviews to measure the acceptability of the IPT–B model, self-reporting IPT-B checklist to assess treatment adherence, and World Health Organization Disability Assessment and Self-Reporting Questionnaire-20 tools to assess functional impairment and mental distress, respectively. We will use percentage, frequency, mean and standard deviation to summarize the demographic variables, feasibility, and acceptability of IPT-B. We will also analyze changes from pre- to post-tests of mental distress and functioning results using paired t-test and Wilcoxon signed-rank tests. Independent sample t-test and one way-ANOVA will be used to assess the difference in the mean score of demographic variables at baseline and eight weeks (the duration of our intervention).

The most significant barriers we have are financial and technical challenges. To scale, we’ll need more human resources and talent, which demands financial investments. Additionally, we need technical support to 1) efficiently evaluate our model using statistical analysis or machine learning and artificial intelligence. All of this demands more financial input. We are, however, optimistic that support from MIT Solv[ED] will open up more opportunities for us to grow and obtain resources.

Our team is made up of skilled technical experts ready to augment their expertise to effectively evaluate the effectiveness of our solution– whether adapting the model online in the case of Covid or performing statistical analysis on collected data. 

The team also includes entrepreneurs willing to utilize their expertise to transform the organization into a sustainable entity financially while prioritizing resources. We also have research-focused and applied psychology scholars and cultural experts leading our research and evaluation department in creating and evaluating our culturally–tailored model. 

    The majority of people in our team have experienced mental illness, stigma, and the adverse effects of lack of access to basic mental health care. Thus, they possess invaluable first–hand experiences that are critical in not only crafting but also deploying our solution. 

    Finally, we have a wide network of volunteers representing diverse backgrounds (from LGBTQIA and women to the marginalized and disabled). Their personal life experiences with mental illness have been crucial to the existence and success of The MentalLiberty Foundation.

As a team, we actively conduct in-person and online outreach in schools, radio stations, TV stations, and conferences nationwide and have impacted over 65 000 youths. In 2021, we worked with Project Hope, Repssi, and The Ministry of Health to raise awareness of children’s mental health, especially in rural populations where we offered free counseling and mental health resources.

Given our stellar record in project management and success in scaling The MentalLibery Foundation to the national level, we’re in the best position to execute this solution and scale it in Zambia and Africa.

We currently have three partnerships that will assist us in deploying our model in three different target populations:

1. Collaboration with The Ministry of Education to disseminate our model into different school settings.

2. The Education Hope Foundation (focused on inmates’ correctional education) will assist us in deploying our model in different correctional facilities.

3. The Latu Human Rights Foundation (focused on marginalized communities and the LGBTQIA) will assist us in deploying our model in our target marginalized populations and the LGBTQIA population.

We're supported by Dartmouth College and The Davis Project for Peace.

Not qualified

We plan to use The Pozen Social Innovation Prize to advance our solution and tailor a specific intervention to treat women with depression in Zambia and Africa.

A plethora of studies supports the feasibility of using IPT–B to treat depression in women. We're, thus, confident that we would scale our model to end women's depression.