Calling for Vision

Paul Bolton made one call after another, methodically working his way down the list of NGOs. A researcher with the School's Center for Refugee and Disaster Response, Bolton was in search of a funding partner for a project in Africa to improve mental health care. He hesitated before making the last call to World Vision after being turned down by every agency on the list.

"I shared an office with a guy, and I said, 'Well, if this call fails, then I'm just going to have to do something else for a living,'" Bolton recalls of the nervewracking moment eight years ago.

World Vision's answer? It was the only one that expressed any interest, says Bolton. The NGO agreed to back Bolton's proposal, giving AMHR its first opportunity to introduce a mental health intervention and follow up with a clinical trial to assess the impact.

World Vision was working with a community in southwest Uganda to strengthen agricultural production, but found that the population, which had lost many residents to AIDS, seemed lethargic, and had little interest in the project. Onsite NGO staff suspected that depression might be a problem in the community.

In Uganda, Bolton and Bass interviewed residents to understand the reasons behind the lethargic behaviors. They used the information to develop a questionnaire to aid in diagnosing depression among residents and to identify participants for the trial. The researchers chose a group-based model of an interpersonal psychotherapy intervention, with weekly meetings for 16 weeks. Non-professionals could lead the sessions—a critical piece given the scarcity of mental health professionals in Uganda.

The results were dramatic: a 75 percent reduction of diagnosable depression in the treatment group. The trial was one of the first to demonstrate that simple, cheap interventions for common mental disorders can be effective. World Vision adopted the psychotherapy intervention as a permanent part of its assistance programs in Uganda, and it has served approximately 3,000 people to date.

The inclusion of mental health treatment as part of World Vision’s services reflects a central tenet of AMHR’s work: People have to be able to function to make full use of assistance programs in agriculture, finance, nutrition and other areas. Says Bass, “Mental health intersects with everything—physical health, the economy—it’s intrinsically linked with functioning.”