Equitable Health Systems
Same Same: A lifeline for LGBTQI+ youth
SameSame provides mental health support to LGBTQI+ youth living in countries where fear and stigma prevent equitable access to identity-affirming care.
What is the name of your solution?
Same Same: A lifeline for LGBTQI+ youth
Provide a one-line summary of your solution.
SameSame provides mental health support to LGBTQI+ youth living in countries where fear and stigma prevent equitable access to identity-affirming care
Film your elevator pitch.
What specific problem are you solving?
Navigating adolescence is challenging for everyone, but it’s especially difficult for young people questioning their sexual orientation and gender identity. At a time in their lives when they most need support and advice, many lesbian, gay, bisexual, transgender and queer (LGBTQ+) youth around the world have nowhere to turn.
ILGA World’s December 2020 report on State-Sponsored Homophobia reveals that 67 UN Member States criminalise consensual same-sex relations. 42 UN Member States have also put up legal barriers for freedom of expression on issues related to sexual and gender diversity, preventing the dissemination of information and guidance to young people grappling with their identity in hostile environments.
Beyond the threats of discrimination and violence, the stress of being LGBTQ+ in these countries can be profoundly harmful to the mental health and resilience of teenagers and young adults. Queer youth suffer from depression and anxiety disorders at far greater rates than their peers. Unfortunately, existing health systems and services don't cater to their needs. When queer or questioning youth do find the courage to seek care, they’re often confronted with discrimination and may even be subjected to forced conversion therapies.
Even in South Africa, the only country in Africa where discrimination against the LGBTQ+ community is constitutionally forbidden, Lesbian, gay and bisexual teens report suffer from depression, anxiety and stress at far higher rates than their peers. The South African Depression and Anxiety Group (SADAG) reports that while stress, anxiety, and depression affect about 10% of the total population, this is 3 to 4 times higher amongst members of the LGBTQ+ community. A 2015-2016 survey of health sector and education sector professionals found as many as half of surveyed respondents who work in the health and education sectors hold the LGBTQ+ community in negative regard, finding gay men and lesbians “disgusting”.
The situation is even more dire in places like Nigeria, Indonesia, Uganda, Pakistan and the Middle East, where the fear of stigma and persecution makes accurate data collection challenging and, as a result, the true scale of the problem is difficult to grasp.
Decisions made during adolescence can shape a young person’s entire future. To exert agency over their lives—and fight stress, anxiety and depression—queer teens and young adults in low- and middle-income countries (LMICs) need unbiased information, connections to trustworthy services and access to non-judgemental, identity-affirming psychosocial support that does not exclude them based on their sexual orientation or gender identity.
What is your solution?
Our solution is a psychosocial support service delivered entirely through WhatsApp.
Our WhatsApp chatbot provides users with the ability to complete mental health questionnaires, based on industry-standard screening tools, but designed to be engaging and entertaining, rather than clinical. These screeners will help us direct users to the content and resources they need the most.
Users are able to read and share stories of adversity and triumph that are relevant to their lives, rather than the Western-centric content that dominates the internet.
Working with content from AFFIRM (see below for more detail), we provide users with the tools to fight depression, anxiety, and stress through a series of self-guided activities that integrate identity affirmation with Cognitive Behavioural Therapy.
We also will connect users to queer-affirming and non-judgemental doctors, lawyers, and therapists in regularly scheduled live chats to get answers to their urgent questions.
Our confidence in this solution is based on two relatively recent developments.
First, the rapid expansion of mobile technology and increasing affordability of data in low- and middle-income countries (LMICs) have created an opportunity to offer LGBTQ+ youth access to essential information and a sense of belonging. In a survey of young people conducted in the UK, 96% of LGBT young people say the internet has helped them understand their sexual orientation and gender identity and 95% say the internet has helped them find positive role models.
Unfortunately, much of the LGBTQ+ content that is available online has been designed for users in high income countries that are more accepting of diverse sexual and gender identities. If we can produce, adapt and curate contextually relevant content in local languages—ensuring it’s accessible via entry-level smartphones in low-bandwidth environments—then we can open this same gateway to belonging and community for LGBTQ+ youth in LMICs, where they face the toughest challenges. The popularity of chat applications and WhatsApp in particular create an opportunity to reach millions in an affordable, scalable and contextually appropriate way.
The second cause for optimism comes from research that proves the effectiveness of cognitive behavioural therapy (CBT) in improving LGBTQ+ wellbeing. Studies suggest that CBT interventions can also be adapted for successful delivery via digital channels. One such example is AFFIRM Online, an eight session intervention focused on reducing depression and improving coping for LGBTQ+ youth in Canada and the USA.
AFFIRM Online combines identity affirmation and CBT, supporting LGBTQ+ youth to: develop identity cognition (self-awareness, identifying risk); manage their emotions (recognizing the link between thoughts and feelings); and change their behaviour (identifying strengths and ways of coping).
A study of the preliminary efficacy of AFFIRM Online, showed that participants experienced significantly reduced depression, improved their ability to identify and appraise sources of stress and helped them develop the sense they have the resources to meet challenges.
There are also studies that suggest even single-session interventions (SSIs) have helped reduce youth psychopathology across multiple trials, promising to broaden access to effective, low-intensity supports. Online, self-guided SSIs may be uniquely scalable, particularly if they are freely available for as-needed use.
LGBTQ+ young people in low-income communities have been suffering in silence for generations. Now, we believe it is possible to provide personalised information and support by combining the privacy of mobile phones, the widespread use of WhatsApp, and the scalability of online, self-guided CBT sessions designed specifically for queer youth.
Who does your solution serve, and in what ways will the solution impact their lives?
Our solution is designed to serve all LGBTQI+ youth, but our focus is on adolescents and young adults (15 to 24), with access to their own mobile phones, living in countries with restrictive and discriminatory laws and norms. We are targeting two countries for the launch of our service, South Africa and Indonesia, but have aspirations to serve youth across the globe.
Using population data and mobile penetration rates, we estimate that there are between 517,500 and 607,500 LGBTQI+ youth, between 15 and 24, who have sufficient mobile access to engage with our bot in South Africa. The figure for Indonesia is over 2 million.
Their needs are currently underserved because mental health care is difficult to access for all youth, but especially difficult for sexual and gender minorities who face discrimination and the threat of being outed or forced to undergo conversion therapy if they share their hopes and fears with others. In these contexts, LGBTQI+ youth are denied equitable access to care.
Our solution will address their needs by providing them with connections to vetted services and equipping them with tools they can use to manage their own mental health even in situations where care may be difficult or impossible to access. We expect that by engaging with our WhatsApp service, users will be able to decrease the severity of symptoms of depression, anxiety and stress, reduce self-stigma and hopelessness and boost their overall mental wellbeing. Over the long-term, these changes will enable LGBTQI+ youth to more fully embrace the opportunities that are open to them in ways that will improve their physical health, educational achievement and earning potential.
How are you and your team well-positioned to deliver this solution?
We believe our team has four essential attributes: we have experience developing and launching national-scale mobile health interventions across multiple countries; we have experience designing and running effective, community-driven mental health services in underserved communities in the Global South; we have award-winning content creators that know how to make a digital experience engaging as well as impactful; and we all have lived experience of the challenges faced by our target audience (more than 80% of the team are members of the LGBTQI+ community with experience accessing mental health services).
Our Tech Lead, Codie Roelf, has worked on national-scale mobile applications that have served millions, including the WHO’s Covid WhatsApp service and the South African National Department of Health’s mobile maternal health service, MomConnect.
Our Clinical Lead, Dena Batrice, is a global mental health clinician. In her former role as StrongMinds Uganda Executive Director, she improved the quality of clinical care, expanded services to all of Uganda and two additional countries and, during COVID, created a remote therapy model delivered via non-smart phones. She was also responsible for designing and launching a successful pilot focused on the unique mental health needs of the Ugandan LGBTQI+ community.
Our Design Lead and Co-founder, Jonathan McKay, has been working in media and communications since 2001, specializing in youth programs that combine entertaining content with social behavior change theory.
Our global Content Lead and Co-founder is the founder of a creative studio in Indonesia that has worked with Netflix, GIPHY, Marvel and MTV, amongst others, and has had work showcased at prestigious festivals across the world, including SXSW and The Sundance Film Festival.
Our Partnerships Lead, Keith Mundangepfupfu, is establishing and strengthening our ties to service providers, activist networks and community-based organisations to integrate our work into existing ecosystems of care.
Which dimension of the Challenge does your solution most closely address?
Build fundamental, resilient, and people-centered health infrastructure that makes essential services, equipment, and medicines more accessible and affordable for communities that are currently underserved;
Where our solution team is headquartered or located:
Johannesburg, South AfricaOur solution's stage of development:
PrototypeHow many people does your solution currently serve?
Less than 100 (we are in prototype stage) but our aim is to reach 100,000 in our first year
Why are you applying to Solve?
SameSame is a young organization still looking to establish the organizational infrastructure we need for our solution to achieve its potential. We need connections to partners that can augment or amplify our technologies and advise us on emerging data security and privacy practices. We are looking for guidance from organizations that have rapidly scaled across multiple countries to understand how they manage diverse teams operating in different languages. We need support establishing a board and a fundraising team to further develop and fund our plans. Finally, we're looking for the credibility that comes with being a Solver to help us establish connections with partners across the globe.
In which of the following areas do you most need partners or support?
Human Capital (e.g. sourcing talent, board development, etc.)
Who is the Team Lead for your solution?
Jonathan McKay
What makes your solution innovative?
There have been enormous advances in the delivery of mental healthcare through digital channels over the last few years, accelerated by the Covid-19 pandemic. These new innovations have not been adapted for delivery in low-resource, low-bandwidth contexts, however, where offline services are difficult to access and where they could make a real difference. Our solution is innovative in recognising that increased mobile access across low- and middle-income countries has created an opportunity to reach people with digital health services that are personalised and tailored to their needs, specifically the needs of LGBTQI+ adolescents and young adults.
What are your impact goals for the next year and the next five years, and how will you achieve them?
Over the next year we will engage over 100,000 young LGBTQI+ people in Indonesia and South Africa and provide them with access to a cognitive behavioural therapy (CBT) course that has been proven to reduce depression, anxiety and stress in other contexts. For users who finish the CBT course, we expect to see significant reductions in self-stigma, hopelessness and the symptoms of depression, anxiety and stress, alongside improvements in overall mental wellbeing. Poor mental health is both a cause and a consequence of poverty, compromised education, and ill-health. It impedes an individual’s capacity to realize their potential and make a full contribution to their community. By providing LGBTQI+ youth with coping mechanisms and tools to improve their mental health we have the chance to have a transformational impact on their lives.
Over the next 5 years, we want to reach 1 million youth, expanding to countries in Africa and Asia where LGBTQI+ youth are most in need of understanding and support.
How are you measuring your progress toward your impact goals?
- Decreases in self-stigma
- Decreases in hopelessness
- Decreases in the severity of symptoms of depression
- Decreases in the severity of symptoms of anxiety disorders
- Increases in mental wellbeing
What is your theory of change?
Our long-term outcomes are improvements in mental health as measured by increases in mental wellbeing (Cantril ladder surveys) and decreases in the severity of depression (PHQ-9) and anxiety (GAD-7).
To track our progress towards these outcomes, we will focus on decreases in self-stigma and hopelessness as intermediate outcomes. Societal contexts that support discriminatory norms create a hostile climate for sexual and gender minorities (SGMs), exposing them to messages that are detrimental to the development of a healthy identity (Meyer, 2013). Social institutions and interpersonal interactions promote the belief that being heterosexual and cisgender is the only way to be normal, right, or good (Harkness & Israel, 2018). Individuals grow up exposed to these beliefs and are likely to apply these judgments toward their own identities. This application of negative social messages toward the self is referred to as self-stigma and has been identified as an important construct in understanding how societal prejudice contributes to behavioral risks and psychosocial health problems among LGBTQI+ people.
The outputs that will contribute to the attainment of these intermediate and long-term outcomes include the number of users who complete the 8-sessions of the AFFIRM cognitive behavioural therapy course that we are adapting for this solution. By completing these sessions, users will develop coping skills to improve their mental wellbeing. Compared to demographically similar control groups, across multiple randomized control trials (see reference below), AFFIRM has recorded significant impacts on participants’ overall wellbeing, with 63% reporting reduced depression, 57% showing an improvement in reflective coping skills and 70% reporting increased ‘hope pathway thinking’ (the ability to see multiple pathways of success leading into a desired future).
To achieve these outcomes, we will use social media, influencers, community-led outreach and other marketing tactics to reach LGBTQI+ youth, encouraging them to engage with our WhatsApp chatbot. Using the bot, we will provide the CBT course described above alongside a host of other content (including stories from other users) designed to engage and retain users.
Describe the core technology that powers your solution.
The technological infrastructure has already been built to deliver, manage and monitor our service—a WhatsApp chatbot—across multiple countries and a number of different interactive channels, from WhatsApp to Facebook Messenger and even Interactive Voice Response (IVR) systems. Using a combination of Turn.io and TextIt—two solutions that allow us to design, manage and monitor complex automated two-way conversations—we have a system set up that allows us to run multiple versions of our chatbot in multiple languages, personalizing it for different segments of our target audience. This same set-up has already been used to develop and deploy the WHO’s global Covid chatbot and the South Africa’s National Department of Health’s mobile maternal health platform (MomConnect) and will lay the foundations for work in this project and in the future as we start to introduce Artificial Intelligence (AI) to improve the accuracy of our bot's assessments and interactions.
Which of the following categories best describes your solution?
A new application of an existing technology
Please select the technologies currently used in your solution:
Which of the UN Sustainable Development Goals does your solution address?
What type of organization is your solution team?
Nonprofit
How many people work on your solution team?
8 part-time collaborators (a combination of volunteers and contractors)
How long have you been working on your solution?
10 months
What is your approach to incorporating diversity, equity, and inclusivity into your work?
All project team members are members of the LGBTQI+ community and 75% of the team have lived experiences with mental illness, like depression, and have experienced both the challenge of finding affirming mental healthcare and the life changing benefits that occur when good MH interventions exist. 80% of the project team are from the Global South and the majority (over 80%) of our team are people of colour. As an organization founded to promote the health and wellbeing of sexual and gender minorities we are fully committed to all aspects of diversity and inclusion.
What is your business model?
Through our WhatsApp chatbot, we will provide LGBTQI+ youth with access to engaging content that not only inspires them, but provides them with the tools to manage their own mental health and connect to offline services.
Do you primarily provide products or services directly to individuals, to other organizations, or to the government?
Individual consumers or stakeholders (B2C)What is your plan for becoming financially sustainable?
Our plan is to achieve sustainability through sustained donations and grants. We are identifying and developing relationships with donors who are interested in mental health as well as donors who are interested in advancing LGBTQI+ equality. We believe there is growing international interest in these two areas that we will be able to leverage to secure funding.
Solution Team
-
Jono McKay Co-founder, SameSame
to Top
Our Organization
SameSame Inc