Mental Health Fund Deep Dive 2026

Depression is one of the most widespread and disabling conditions on earth, yet in sub-Saharan Africa it remains almost entirely untreated. StrongMinds estimates that hundreds of millions of people are affected by depression globally, and that women and adolescents bear a disproportionate share of that burden. In low-resource settings, the barriers are not just clinical: they are structural. There is roughly one mental health professional for every 1.5 million people across much of the continent, making conventional psychiatric care an impossibility for most.

StrongMinds was founded to close that gap. Their mission is to democratise access to mental health care for people with depression globally, starting with the communities least served by existing systems. They provide free, community-based therapy in low-resource settings across sub-Saharan Africa, using a model that removes the need for expensive clinicians and puts the power of recovery directly in the hands of communities.

The scale of unmet need is staggering. According to the Happier Lives Institute (HLI), only 13.7% of people with mental illness in low and middle-income countries receive any treatment at all. For depression specifically, just 8% receive any treatment, and only 3% receive care that could be considered adequate. For anxiety the picture is similarly bleak, with just 10.8% receiving treatment, of which 2.3% is potentially adequate. Mental health is, by any measure, one of the most severely neglected problems in global development.

More than 2 million people have been treated for depression since StrongMinds’ founding in 2014, with the second million reached in just over a year. For every woman treated, four members of her family feel the benefits, meaning over 5.2 million people have experienced indirect improvements through household and community spillover effects.

StrongMinds treats depression using Group Interpersonal Therapy (IPT-G): a manualized, time-bound talk therapy model recommended by the World Health Organisation as a first-line depression intervention in low-resource settings. IPT-G treats depression by focusing on interpersonal relationships as both the root cause of, and the source of recovery from, depressive episodes.

Therapy takes place in small groups over six structured sessions led by lay counsellors, not doctors or psychiatrists. Group members build trust, identify the interpersonal triggers underlying their depression, and work together to develop coping mechanisms and practical solutions. The four key trigger areas explored are grief over loss, major life changes, unresolved conflict, and social isolation. Because depression is episodic, the skills participants acquire have both immediate therapeutic value and long-term preventive impact.

StrongMinds monitors outcomes using the internationally validated PHQ-9 tool, administered before, during, and after each therapy cycle. This data-centred approach allows the organisation to track whether symptoms are improving and continuously refine its model. Sustainability is built in: former clients and local health workers are trained to facilitate future groups, spreading capacity without proportionally increasing cost. StrongMinds also integrates its model into existing government and NGO programmes across health, education, food security, and livelihoods.

HLI has conducted the most in-depth independent evaluation of StrongMinds available, drawing on a systematic review and meta-analysis of 84 randomised controlled trials (RCTs) of psychotherapy in low and middle-income countries, combined with direct evidence from StrongMinds' own programmes. HLI rates StrongMinds as one of the most cost-effective and well-evidenced life-improving charities they have evaluated.

HLI's central estimate is that StrongMinds produces 40 WELLBYs per $1,000 donated: that is 40 wellbeing-adjusted life years, each representing a one-point increase in a person's self-reported life satisfaction for an entire year. This makes StrongMinds five to six times more cost-effective than unconditional cash transfers at improving subjective wellbeing. The cost to provide a full course of group therapy to one person is estimated at $45, based on StrongMinds' 2023 expenditure data.

Mental health treatment in sub-Saharan Africa is one of the most underfunded areas in global development. HLI is explicit that the funding need for StrongMinds is real: the organisation has demonstrated the capacity to absorb and deploy additional capital, and additional donations are expected to translate directly into additional people treated.

StrongMinds has treated over 2 million people for depression since 2014, delivered through StrongMinds staff, government health workers, NGO partners, and trained peer facilitators across Uganda, Zambia, and a growing presence in Kenya, Malawi, and Nigeria. Clients report meaningful reductions in depression. The programme likely generates spillover benefits across households, with clients' children more consistently attending school, clients having greater access to social support, and families experiencing improved food security.

Friendship Bench began with a simple observation: in Zimbabwe, as across most of sub-Saharan Africa, there are almost no trained mental health professionals available to ordinary people. With one mental health professional to every 1.5 million people across much of the continent, conventional clinical care is simply not accessible at scale. Friendship Bench was built to reimagine that reality entirely.

Founded in Zimbabwe and now expanding globally, Friendship Bench trains community health workers, many of them grandmothers and lay health workers with no prior clinical background, to deliver evidence-based talk therapy at the primary care level. Their mission is direct: to get people out of depression, locally known as "kufungisisa" (thinking too much), by creating safe spaces and a sense of belonging in communities. The intervention is affordable, sustainable, and built specifically for settings where formal mental health infrastructure does not exist.

The Happier Lives Institute (HLI) rates Friendship Bench as one of the most cost-effective charities they have evaluated to date, based on an in-depth analysis that includes a systematic review and meta-analysis of 84 randomised controlled trials (RCTs) of psychotherapy in low and middle-income countries, four RCTs specifically related to Friendship Bench's own programme, and direct monitoring and evaluation data.

When someone visits a Friendship Bench, they are first screened using a locally validated tool called the Shona Symptom Questionnaire (SSQ-14), as well as the PHQ-9 and GAD-7. Those who score above the threshold are invited to receive one-on-one problem solving therapy delivered by a trained lay health worker. Friendship Bench describes its approach as basic Cognitive Behavioural Therapy with an emphasis on Problem Solving Therapy, activity scheduling, and peer-led group support. The structure follows three levels: opening the mind (Kuvhura Pfungwa), uplifting (Kusimudzira), and strengthening (Kusimbisa).

After completing individual sessions, participants are introduced to Circle Kubatana Tose (CKT), meaning "holding hands together": a peer-led support group for those who have finished Friendship Bench counselling. Friendship Bench operates through a task-shifting model, training organisations and individuals via their Friendship Bench In A Box system, which provides a standardised blueprint for implementation in any setting in the world. Training is delivered face-to-face and online, and participants receive ongoing supervision to build clinical confidence.

HLI's director conducted an in-person site visit to Friendship Bench in Zimbabwe in 2024, observing sessions directly and speaking with grandmothers and clients at a local health centre. The visit reinforced HLI's assessment of the programme's real-world impact and informed their in-depth evaluation.

Friendship Bench's evidence base is among the strongest in the mental health sector. Friendship Bench notes that its approach is anchored in over a decade of rigorous research, including a RCT published in the Journal of the American Medical Association (JAMA). Four RCTs of programmes directly related to Friendship Bench have been conducted, giving evaluators a richer direct evidence base than is available for most comparable interventions.

HLI's most recent comprehensive analysis estimates that Friendship Bench achieves 49 WELLBYs per $1,000 donated: the highest figure HLI has recorded for any well-evidenced charity they have evaluated. The cost to provide a full course of one-to-one therapy to one person is estimated at $16.50, based on 2023 expenditure data. Friendship Bench is five to six times more cost-effective than unconditional cash transfers at improving wellbeing, according to HLI.

The mental health treatment gap in Zimbabwe is severe, and Friendship Bench is filling it in a way no government or conventional clinical system has managed. According to HLI, Friendship Bench has a genuine and unmet funding need: the programme is scalable and has demonstrated that additional resources translate reliably into additional people treated and recovered.

Friendship Bench has trained 3,000 community health workers and seen 859,000 clients to date, with 919 active peer-led support groups operating across 12 countries. Clients report meaningful reductions in depression and suicidal ideation, along with improvements in quality of life. The model has been replicated across Africa, Europe, the Americas, and Asia, with active programmes in countries including Malawi, Kenya, Zanzibar, Germany, the UK, the USA, Colombia, and El Salvador.

Mental health challenges are not confined to low-income countries. Depression and anxiety affect hundreds of millions of people in high-income countries too, where treatment rates, though higher than in sub-Saharan Africa, still leave a vast majority of sufferers without adequate support. Action for Happiness was founded in 2010 on the belief that individual behaviour change, grounded in evidence, can make a measurable difference to people's lives, and that communities built around that shared commitment multiply the effect.

Action for Happiness is a registered UK charity and a global movement of people taking action to create a happier and kinder world. With over 800,000 members from 193 countries, it brings people together through courses, groups, events, and digital resources grounded in positive psychology, mindfulness, and behavioural science. The organisation has no religious, political, or commercial affiliations, and its patron is the Dalai Lama.

Founders Pledge recommends Action for Happiness as an evidence-based charity with a strong track record, noting that their interventions represent a highly cost-effective way of improving people's wellbeing. The organisation's model is distinctive: it combines behaviour change nudges with community-building, taking people from initial engagement through to deeper and more lasting forms of involvement.

The core programme is the Happiness Habits course: a six-week group course drawing on positive psychology, mindfulness, and behavioural science. Participants meet regularly, in person where possible, to learn evidence-based skills for happier living, build a sense of belonging, and commit to personal action. Action for Happiness notes the course has been run in over 250 locations and attended by thousands of people. A complementary 10-day online programme provides a shorter, digital entry point for those unable to attend in person.

Beyond its courses, Action for Happiness operates a daily action calendar used by millions, coordinates local groups where members meet to discuss happiness and commit to action, hosts live talks with leading thinkers that have attracted over 250,000 attendees, and supports networks of Happy Cafes across communities. The organisation also provides resources for children, young people, schools, and workplaces. The bulk of the movement's activity is driven by trained volunteers worldwide.

Participants are assessed using validated wellbeing measures before and after the course, allowing Action for Happiness to track outcomes rigorously. The same measures are applied across both the in-person and digital programmes.

The evidence base for Action for Happiness is rooted in a peer-reviewed randomised controlled trial (RCT) of its Exploring What Matters course, the predecessor to Happiness Habits. The RCT, conducted by researchers from Oxford University, the London School of Economics, and University College London, found that the course produced large and statistically significant improvements in general wellbeing, reductions in depression and anxiety, and increases in compassion and social trust. Action for Happiness notes the study found the course increases average life satisfaction by a full point on a 0-10 scale: greater than the increase associated with becoming partnered or finding employment in comparable research. These effects were sustained and even increased when measured two months after the course ended.

The estimate of roughly 14 lives improved per $100 spent comes from a preliminary calculation by the Happier Lives Institute. The figure should be read as an indicative order of magnitude rather than a reliable basis for comparison, and treated with caution. Founders Pledge evaluated Action for Happiness's cost-effectiveness in terms of WELLBYs and found their best-guess estimate of cost per WELLBY to be $137, with an optimistic estimate of $33 per WELLBY. Founders Pledge notes the organisation has strong institutional credibility with over 11 years of experience, a clearly defined theory of change, and a demonstrated commitment to measuring its own impact through both RCTs and ongoing participant data collection.

The model has particular relevance to donors seeking to reach populations underserved by clinical mental health systems in high-income countries. Founders Pledge highlights that beyond direct wellbeing gains, the programme also drives pro-social behaviour: participants report greater compassion, social trust, and commitment to positive action in their communities.

Action for Happiness has grown to over 800,000 members from 193 countries since its founding in 2010. The Happiness Habits course has been run in over 250 locations. Live talks have attracted over 250,000 attendees. The RCT of Exploring What Matters found a one-point increase in average life satisfaction on a 0-10 scale, with effects persisting two months after the course ended.